Incident Reports...aarrggghhh!!!

[MessyMomma]

I am so frustrated by some coworkers' attitudes about incident reports. Why can't they understand that I am NOT being "mean" and "writing people up"?

To me, it is writing up an incident or problem in hopes that it can be fixed and avoided in the future.

I don't "write everything up"---if someone missed giving a med, or timed something wrong on the MAR, or forgot to unclamp the IVPB tubing or change a dressing, I just fix it and go on.

But if it is the same person doing the same thing wrong, it needs to be addressed. If an IV is grossly infiltrated or has purulent drainage around the catheter, I will complete a report. Those can possibly cause harm, so I do it.

If a nurse physically signs an order off but then does not carry it out, it's "written up".

I don't just go around specifically looking for things or people to write up, but as charge nurse lots of stuff gets brought to my attention (by nurses who refuse to fill out the reports) or I catch stuff as I look over charts.

My boss is good in that she wants them filled out---for the same reasons. She also doesn't review them with the person in an accusing or punitive way.

I want to do a good job and make sure our patients are taken care of in a darn good way. But errors do happen and must be addressed.

If my coworkers could just keep remembering that we are not "writing each other up" and not "being mean" by filling out these incident reports.

Guess I'm just ranting...thanks for listening! :-)

[iluvivt, BSN, RN]

It sounds like you are very prudent in selecting what you are going to use the system for. I agree you are using the system properly. I would tell my co-workers that they need to change how they view the process and they need to look upon it as a chance to learn and grow professionaly. Part of that process is to correct errors and initiate a process to correct them.

I would also tell them that how they handle or deal with it is an indication of their level of maturity. That will give them something to think about! I can understand their annoyance if the system was being used unfairly or as a tattle system for interpersonal conflict but that does not sound like that is the case here. In addition. it sounds as if the management is also using the information to improve the nursing care.

Our department gets written up fairly frequently because others have expectations that are not realistic. They think we should be able to get PICCs in at the drop of a hat no matter what time they are ordered or how many orders we have or what our priorities are based upon all the calls we have out. Slowly it has improved as the word gets around that we have only have 3 nurses spread out over 16 hours and how we work the system we have in place.

[amoLucia]

To Op - you have a realistic understanding of incidents with a management team that seems to be in accordance with you. However for many, many, it is NOT like that. Any incident that couldn be traced back to a specific single employee or multiple ones is like putting nails into their coffins. It's fuel for the fire for mgt looking to light a conflagration at the expense of an employee. I guess it makes the mgt person feel self-important to his/her higher-uppers.

As a result, many floor staff band together with the intention to cover one anothers' backs by just 'fixing' the problem and alerting their peer. So sad that incident reports were administrative punitive instruments, and not something to learn from and prevent future problems.

Hence, I try to be VERY selective and cautious when I absolutely must write an incident report because of this reality. And this comes after years and years of experience. I acknowledge that too many incident reports send up 'red flags' to Corporate and regulatory agencies. But there's little chance to correct things at the root if the right approach isn't there. So sad!

[beeker]

We work as a team and if there is a repeat issue we talk to each other about it. If you are at the point where you are known for "writing people up" then it sounds like you might be doing it a bit more than the average bear. How many write up s does it take to get a reputation for it? And for the record, we are writing each other up. There are consequences. I think in the last year I have written up 2 reports, both were for gross negligence on transfers, one from er and one from pacu. ANd these were written to cover our floor from taking the hit that certain policies and care standards had been neglected.

I guess I am wondering how many times you have written people up. Have you spoken to the offenders? Is it the same person you are writing up?

[MessyMomma]

We work as a team and if there is a repeat issue we talk to each other about it. If you are at the point where you are known for "writing people up" then it sounds like you might be doing it a bit more than the average bear. How many write up s does it take to get a reputation for it? And for the record, we are writing each other up. There are consequences. I think in the last year I have written up 2 reports, both were for gross negligence on transfers, one from er and one from pacu. ANd these were written to cover our floor from taking the hit that certain policies and care standards had been neglected.

I guess I am wondering how many times you have written people up. Have you spoken to the offenders? Is it the same person you are writing up?

Yes, I definitely mention incidents the first few times. Usually just to say "The Fole for Mr. Jones was ordered to be dc'd, but we got it" or "that Vanc order you signed off didn't get put on the MAR so we started it tonight". But after the fourth, fifth, ninetieth time, I guess it gets old. I really try to help the new nurses especially, whether a new grad or new to facility. Lots of those mistakes are due to not knowing.

I guess on average, I fill out 3 or 4 a month, unless we have a bad "fall spell".

I would love to be able to ignore the "error/incident" part, but usually feel I can't. Either the doctor brings it to my attention as charge, or it gets discovered during chart checks or audits. So then my boss wants to know why the report wasn't filled out. It's something she expects of us.

I know everybody makes mistakes. I absolutely loved "writing myself up" for errors. But, we gotta do what we gotta do.

[Altra, BSN, RN]

So your manager wants reports completed for med errors made for the fourth/fifth/ninetieth time. But is there follow-up to fix the system problem that created the error, or discipline for lack of diligence, if such is the case?

[K+MgSO4, BSN]

OP you have a fantastic understanding of incident reporting. As a NUM this is what I want to see in reports. We know these things happen. Healthcare is one of the most dangerous things that can happen to a person.

I have one petty staff member who fills out incident reports for all kinds of irrelevant c@#p. She reported on me for drinking tea while writing notes on a patient! And who does she report to? ME! My divisional director who has a insulated cup of tea with her all the time rang me up when she seen the report and asked if I wanted a cup:.......that was as far as that got.

Anyhow, incident reporting is needed to show where there are errors in the systems and processes that we use and what we can do to correct them. Is it an increase in falls because interventions that should happen are not. That may simply require education or investigation to see if the required equipment is available such as ultra low beds fall mats high visability room opposite the nurses station.

It's not a blame game where with me. If some is sub par in their nursing I want to see it or have definate reporting of it so that it can be managed by me to start and escalate as required.

[MessyMomma]

Altra---I think you nailed it. It's like we just keep 'writing things up', but what good does it do, except going into your file eventually.

So honestly, what can I do to help? Just keep kinda reminding people of things we found and skip any reporting? That's where I feel like heading towards.

[MessyMomma]

But then this makes me feel better.

There's been a couple of reports/incidents/whatever that lead to a positive outcome/resolution.

But I have seen too where it's just petty B.S. getting thrown back and forth. Like "if you write me up for neglecting to give this new med", then "I'll write you up for not doing that dressing change".

[BrandonLPN, LPN]

Too often incident reports function as an "ace in the hole" for management to horde away for use at a latter time. They pull them out to use as bogus evidence in the form of a "paper trail" when they want to fire someone, but have no good reason.

This is especially true in unionized facilities. Incident reports are one of the few ways management can bypass union rules. I've seen many CNAs have old fall related incident reports dragged out when someone decides they don't like them. In the vast majority of these falls, the CNA was completely blameless. Sometimes this is done to get rid of lazy employees who would otherwise be protected by the union. But too often it's done as a part of some petty personal vendetta. I've even seen petty IR's dragged out to fire employees just before they are about to retire. These things happen.

And the worst part is, a majority of these IR's are either ridiculously insignificant (a LPN held colace, but forgot to circle her initials) or nobody's fault (like most falls). We work in a facility that houses hundreds of frail, confused elderly people. There *are* going to be falls.

It would be nice if IR's were used as tools to improve performance. But just as often their use is just capricious and vindictive.

[nurseprnRN, BSN, RN]

It's been my experience that a visit and inservice from the risk manager is very useful to get everyone on the same page as to what variance reports (the proper term, since they document variance from usual or expected events) really mean, how they are compiled and used, and what the statistics are for comparable facilities. I"ll bet your RM would looove to come and share. Really.

[BSNbeauty, BSN, RN]

OP,never get tired of doing the right thing. I know that you are not, but just in case you think about it. It seems as though you really are trying to make things better and not trying to throw people under the bus.