Incident report filing....How do you do it?

mother/babyRN, RN · Jul 4, 2003

Supposed to be that the person who discovers the incident, files the incident report. There is great misconception that if you discover something related to another nurse or shift, you wait for them to do it. The purpose of an incident report, ideally, is not to blame someone for the incident, but rather, to report that it occured...Thus, if you discover a med error or patient fall, for example, it isn't up to you to wait until you see the nurse or shift involved in the actual incident, but to fill out the paperwork indicating that the incident has occurred...

mother/babyRN, RN · Jul 4, 2003

If I discover something like a bedsore ( in my former nursing life), or someone slipped in the bathroom and actually fell, impacting any part of their anatomy with the floor, if a medication is inadvertantly omitted, or the wrong one given, I do of course file an incident report because if something like that happens more than usual, perhaps it is something as simple as poor staffing or mistakes due to fatigue because of that poor staffing ( as with mandatory overtime)..I have floated to other floors where the wrong ivs are hanging etc and they don't file incident reports ( they still see them as acusatory paperwork), but they do themselves a disfavor in that regard....Wrong ivs ( coming from someone who had an anaphylactic reaction when the wrong antibiotic was hung), is a big deal in my book. Committees meet monthly in most facilities to review these reports and assess them. Nursing names need never be indicated on the form and the term "RN" or "LPN" can be...As brief a description of the event as possible is usually given. No mention that an incident report was filed, should go into the patient chart, not only because it is supposed to be an internal vehicle of assessment, but also because if the particular incident did eventually result in a lawsuit, the documentation that such a report exists stands out as a red flag...One can describe the actual incident, if warrented, as, with example, a pt fall and resultant description of the injuries, or lack there of and the notification that a doctor was notified and whatever treatment ensued, if it did...Hope this helps...Probably you already were aware of all of that...Scarily, most people, I have found, are not, and many of them are either missed or disregarded, inappropriately...

atownsendrn · Jul 4, 2003

There are many reasons to file and not to file. I have filed more in the last two weeks than my entire nursing career. Right now we have some really bad:( (and I mean really bad) docs (from an agency)coming through our ED. And risk management has told us the only way to get them out is to file incident reports. I have always been against filing them unless the patient has fallen or hurt themself in some way. Or if a really bad medication error has occurred. Let me give you some for instances - would you have file reports on these things.

#1 - Drunk patient comes in around midnight after falling off a ladder (approximately 8 feet) and landed on his ribs on a cement wall. Complaining, of course, of rib and side pain. MD goes in to talk to patient - never touches patient. Comes out says "do a xray, but he's okay - just drunk" VS are stable at triage. Pt goes to xray. The RN taking care of the patient just feels something isn't right. In xray - pt has a syncopal episode. BP 94/62 HR 124.

1 1/2 hours later - MD returns to re-eval patient. MD aware of BP and syncopal episode. Discharges pt with diagnose of rib contusion. Nurse asked MD to at least check a H&H. MD says "he's drunk. Let him go home and sleep it off" Nurse does orthostatic VS on discharge. Pt's BP when supine is 96/54 and when standing 74/42. Pt is pale diaphoretic and nauseated. Heart rate is 146. MD still wants to send pt home. Nurse is very, very reluctant to discharge pt. "Luckily," pt becomes unresponsive when transferring to wheelchair. Abd is now rigid - injury is now 3 1/3 hours old. RN initiated IVF wide opened to try to increase blood pressure. MD finally orders H&H - RN asked MD about maybe doing a CT scan of his abd. MD says "no need." RN points out that pt's abd in rigid - and since the MD never touched the patient he didn't know this. So finally orders CT scan. And guess what????? Ruptured spleen - surgery called and pt prepped for OR.

So would you have filed an incident report on this MD?? Failure to diagnose and delay in treatment. Luckily no bad outcome - thanks to a great ER nurse.

Tell me what you would have done on this. I'll give you another example next time.

live4today, RN · Jul 4, 2003

When I believe in my gut that something is not kosher with a patient, I act on my gut feelings by drawing in the Nurse Manager and anyone else with some pull to evaluate the patient a second time and put our heads together to make the docs take notice and do something, especially if they are "green" in the medical field.

Twice, I have had to go over the docs heads and take action to save two patients lives. The docs only say "That's not my organ system, I'm a so and so doctor". :rolleyes: Or, they have the gall to ask "Why do you think the patient is getting worse?", or "Why do you think the patient needs to go to ICU?", or.............. You get my drift?

Nurses are with patients more than the docs are, and we are usually the patients first line of protection against incidents as you shared.

I say act on what you know or sense or just have a gut instinct about and get others involved to make the docs take notice. Insurance has a lot to do with docs taking that "hands off approach" with certain patients, too. :nurse:

Pete495 · Jul 4, 2003

I couldn't imagine filing a report because of doctor's mishaps. How much weight would be held under those reports?

I think some nurses believe there is a difference between an omission and a med error (wrong med). Therefore they don't file any reports on omissions. What do you do if Milk of Magnesia is ordered QD, and you accidentally give it twice in one day? This happened on my unit not too long ago. Obviously it wasn't a big deal at the time, but it did happen. I don't think a report was ever filed, but not sure.

IV meds are serious and need to be looked after. It's hard to know where to draw the line when it comes to filing an incident report. Most people probably chalk up abnormals as normal every day stuff, and some people don't file for fear of persecution and prosecution toward individuals involved and the hospital itself.

Tweety, BSN, RN · Jul 4, 2003

Remember and Incident Report is just reporting that an incident occurred. It's not necessarily covering your butt, that's done in the nurses notes. It's not "writing someone up". It's simply reporting occurrences. (It does help your case when it's documented that you reported it upward.)

I probably write more reports since I do charge a lot. We report primarily falls, delays in treatment, family problems when it's plain they are trying to sue, horrible IV infiltrates, med errors etc.

The management needs to look for trends, be aware of occurrences so if we're sued they are somewhat prepared.

But do we write reports on every little IV infiltrate? Every little med error (like the MOM example), to be honest no. But every little fall, yes.

gwenith, BSN, RN · Jul 4, 2003

Incident reposts have generted new ways of assessing risks such as the risk assessment froms that are currently being trialled at my hospital. The idea is that if you can identify the high risk patients then you can better monitor them.

They are first and foremost a research tool to improve quality of care.

angelbear · Jul 4, 2003

I dont think alot of nurses in my facility would write an incident report on most meds and if they could avoid it not on minor scrapes and such. The reason is because they view the reprecutions as punitive. In the case of med errors it is punitive med error means you have to go through a med class. Scrapes and red areas probably not either as that to seems punitive first you have to assess it then call the oncall to report it immediately then chart it in the nurses notes and then fill out an incident report and initiate a care plan. It is sad but true unless it is thought of as life threatening or at leaste very harmful I doubt it would get written up. Because it is so punitive we are generally hesitant to write it up when it was someone else as you then become the target of the week. If I am totally to blame and would be the only one to suffer the consecuinces(sp) sure I would write it up.

Scotty · Jul 5, 2003

It depends on where I'm working and what the "incident" is. In some institutions I was certain that senior staff would use incident reports to threaten and bully the nurses. Once, against my better judgement, I filled one in over several med errors during a busy time. Clearly the normally competent RNs had too much to do to pay attention to any one task. Did we get extra staff? No. Did my friends and colleagues get disciplined? Yes, and in a very unpleasant and humiliating way. Were any patients harmed? No. So I certainly regret that incident report. In places like that I generally tried to sort things out by other means, i.e. sorting it with the doc, then having a quiet word with the staff member involved.

I currently work in a supportive environment with good management so am more likely to write incident reports. I have less of a problem writing them if it's me who's made an error than if it is another member of staff. I do still worry that at some point they may be used to punish staff. I think that some issues are better resolved with diplomacy or education. And for some I would go for the heavy ammo, i.e. unions, statutory government health and safety bodies.

The most bizarre incident I ever had was when an apparently immobile patient, who had been admitted with a CVA, got downstairs and outside from the 4th floor of the hospital, into the security officer's car, which had been left unlocked, with the window down and keys in the ignition. Due to his CVA he couldn't drive properly, so he drove in a circle and collided with the hospital neon sign. The patient was unhurt. I tried to report the incident - honestly I did - but the doctor and the nurse manager wouldn't believe me and when they came to see the now placid patient he told them: "she's making up stories about me."

I don't think the somewhat embarassed security man put in an incident report about the damage to his car.

night owl · Jul 6, 2003

At my place of employment, our IR's go to the Chief of Staff and he decides whether or not an investigation needs to be warranted. If so, and the blame is put on someone, action is taken against that person and it gets filed into their personel folder which is what happened to me...Once I gave two 15mg Restorils to a pt because we were out of the 30mgs. The pt was waiting for the medication at the med room door. After closing and locking the narc box I gave the pt his meds. At the same time another pt asked me to help him button his pj bottoms and then the call bell rang and I answered that...one thing after another. I forgot to write on the narc sheet that I took out the two 15mg restorils, an honest mistake. It was 15 min before the end of shift so the other nurse said go home and that she'll give the night nurse report. So I did. We had a float relief that night due to a call out. When they counted the narcs and found two missing restorils that weren't signed for, the relief made a big deal out of it. The supervisor was informed and the police were involved even though in my report I wrote that Mr so n so received restoril for insomnia. Didn't bother to call me and ask, didn't bother to look on the pt's PRN sheet to see that it was written that I gave it and didn't ask the pt who was A&O. The IR was made out, an investigation was made. I had to write a memo stating why the mistake was made and what was I going to do about it. If it was the regular night nurse, she would have left a sticky memo on the narc sheet reminding me to enter the restorils I had taken out and no big deal would have been made. Sometimes it all depends on the person initiating the report. The relief didn't know the floor, the pts and was just covering her butt and did what she had to do. I wasn't fired or anything, just told to be more careful the next times and it was filed in my personel folder. That's what I regret the most.

P_RN, ADN, RN · Jul 6, 2003

It's just a "heads up" to the risk manager to be aware in case something does come of it. That way they're not caught with their drawers down. It's not punishment, tattletaling, it's just reporting an occurrence.