Incident reports: Who uses, completes and where do they go???

[NRSKarenRN, BSN, RN]

Doctors and nurses are responsbile for improving quality and promoting patient saftety. Use of incident reports has increased since starting proactice....but do people really really use them to help improve safety and document unusual occurance?

[Tweety, BSN, RN]

Nurses and doctors think they are "writing someone up" and don't use them to document occurence to improve things, but more out of anger at someone else.

[ZASHAGALKA, RN]

In 13 yrs, I've only filed an incident report against one nurse, and only because I thought the case would turn into a lawsuit and I felt I needed to justify my position for future reference.

I see doctors write "fill out an incident report" as an order, but they are SUPPOSED to be taught that doing so is 'incorporating by reference' the report into any legal case.

But, in fact, I have never filled out an incident report in response to a doctor's order. I'm not their toady, if they want one, pens work in their hands, as well, as evidenced by their ability to write an order to write one up.

In my 13 yrs of ignoring probably 200 'orders' to write up an incident report, I've only been called on it once. My response: 'you didn't get that? I put it under your door. I'll write it up, again.' There was no follow-up on the fact that I didn't write it up, "again".

Mostly, I see incident reports as wastes of time and blackmail devices. They tend to only be used to 'get' someone, and that is a waste of my time.

Oh, I know their 'intent'. But, intent and actual practice are two different things.

~faith,

Timothy.

[Tweety, BSN, RN]

Good grief Timothy? 200 times?

This may sound terrible, but I wrote an Incident Report, and copied the order an MD wrote in anger "write an incident report over nurses not doing.........", just so management would educate this MD.

The MDs might ask for incident reports to be written, but the rarely write it in the charts. They know better.

[Ruby Vee, BSN]

i've written many an incident report, even writing up myself sometimes when i've made a serious error. (like when i hung the lidocaine drip instead of the heparin i thought i was hanging. and vice versa.) it helps to explain the situation, how it happened and what was done about it. now they're calling them "patient safety reports," and yes, i've filled out a few of those.

i filled out an incident report when the confused old man in the wheelchair wheeled himself out of the nursing unit to the head of the stairs, and the nice young medical student, at the patient's request, opened and held the door to the stairwell for him. the results were predictable. while ortho was putting my patient into the body cast, i wrote up the incident.

i wrote it up when the surgeon threw contaminated sharps and the rn i was working with. (although not when the rn, a former college football player, "encountered" the surgeon in the parking lot later on that night.) i wrote it up when the new grad in the icu have 5 mg. of digoxin iv push rather than the 5 mg. of diltiazem that was ordered. also with predictable results. (not the exact two drugs that were given -- details changed to protect everyone involved.) and i wrote it up when my orientee marched into room 12 and gave 60 units of nph insulin intended for room 14. (wrote up who we notified, what was done, the patient's blood sugars, etc. etc. etc.)

i wrote it up when i did the narcotic count and found a box of morphine 10 mg. syringes missing. and again when a co-worker found them -- in our manager's desk drawer where he was looking for the on-call list. i wrote it up when the cardiologist (who was aiming for the pulmonologist) smacked my co-worker in the face with a metal-edged chart and she went to the er for sutures. (er required an incident report before they'd suture her.) i wrote it up when i accidentally stuck that same pulmonologist with a blood gas needle, although why he'd sneak up behind a nurse trying to draw a blood gas is beyond me! i wrote it up when the visitor attempted to solve all the patient's problems with a 9mm and a mugful of whiskey, and i encouraged my friend bob to write it up when the same visitor shot him in the a$$ while he was trying to get away from said visitor. (again, details changed to protect the guilty.)

i'm sure i could entertain for hours with the incident reports i've written up. my point is that i don't understand how anyone can get through a career without writing one. am i just a magnet for bizarre situations? or are people letting these kinds of thing go?

[ZASHAGALKA, RN]

Or are people letting these kinds of thing go?

I don't let everything go, but I bring them up verbally with the person, my manager, or whoever needs to know.

It's not my job or desire to create a 'paper' trail. That just leads to games people play.

Why blow forgetting to open a roller clamp on an antibiotic out of proportion? I fix it and bring it up to the person - in passing - and then, let it go. Most of the stuff people use incident reports for I consider 'fluff', or crossing the white (cap) line to 'write up' a peer. There are better levels and ways to handle minor issues.

~faith,

Timothy.

[pickledpepperRN]

I fill out many incident reports. For every for every med error I also write factual possible system problems. It may be short staffing, the med came late from pharmacy or the wrong med was delivered.

Never do I write the name of anyone, just the MR#, date, time, room number, and unit,

If equipment doesn't work, we have insufficient supplies, or short staffing I will write one.

Recently I was charge, there was no break relief nurse, and no secretary. I wrote that fatigue and the need for RNs to answer the phone and enter all orders MAY have caused an error or incomplete documentation.

The supervisor got an "assignment despite objection" (ADO) form too. That has no patients names but is signed by all staff who agree that the situation could pose a risk to patient care.

Befor we got ratios a med-surg unit had only one RN and a registry LVN plus extra certified nursing assistants. Patients could not be assessed in anything approaching a timely manner. PRNs could not be given. CNAs were literally in tears because their patients were suffering because there were only 2 licensed people who could give pain medication.

In addition to the ADO each staff member, the RN and the CNAs wrote incident reports after the next shift arrived. They sent them to the hospital attorney because they didn't trust their manager to forward them to risk management.

The hospital attorney met with the staff in person. In the five years since then that unit has had a licensed nurse for every four patients and they kept their CNAs. Since the ratios each RN has five patients with LVNs and CNAs assisting. I don't know what went on "behind the scene" but that attorney clearly knew of the potential liability.

[mekrn]

Nurses and doctors think they are "writing someone up" and don't use them to document occurence to improve things, but more out of anger at someone else.

I have to agree with Tweety on this, most incident reports in my facility (or threat of them) are more for the satisfaction of "writing someone up". This is usually physicians. Sometimes the mere "threat" to write someone up gives them the satisfaction the seek. I guess they think that scares us! Usually when I hear one ranting about writing one, I open the drawer and hand it over!

The only incident reports I have written are related to patient falls, not writing up staff. In fact, this week was the first time I wrote up staff, a first year resident who is a pompous you-know-what and needed a small dose of being put in his place.

Usually if it is a staff issue, I will just speak directly to the person. I find this to be more effective since they may never know I wrote an incident report in the first place, as usually the buck stops with handing the report to the supervisor!

[pickledpepperRN]

It is truly sad that incident reports are used to punish nurses.

The purpose is to discover system problems leading to errors before a patient is harmed.

[brendamyheart]

Doctors and nurses are responsbile for improving quality and promoting patient saftety. Use of incident reports has increased since starting proactice....but do people really really use them to help improve safety and document unusual occurance?

Not were I work. Just paper compliance!!

[brendamyheart]

I fill out many incident reports. For every for every med error I also write factual possible system problems. It may be short staffing, the med came late from pharmacy or the wrong med was delivered.

Never do I write the name of anyone, just the MR#, date, time, room number, and unit,

If equipment doesn't work, we have insufficient supplies, or short staffing I will write one.

Recently I was charge, there was no break relief nurse, and no secretary. I wrote that fatigue and the need for RNs to answer the phone and enter all orders MAY have caused an error or incomplete documentation.

The supervisor got an "assignment despite objection" (ADO) form too. That has no patients names but is signed by all staff who agree that the situation could pose a risk to patient care.

Befor we got ratios a med-surg unit had only one RN and a registry LVN plus extra certified nursing assistants. Patients could not be assessed in anything approaching a timely manner. PRNs could not be given. CNAs were literally in tears because their patients were suffering because there were only 2 licensed people who could give pain medication.

In addition to the ADO each staff member, the RN and the CNAs wrote incident reports after the next shift arrived. They sent them to the hospital attorney because they didn't trust their manager to forward them to risk management.

The hospital attorney met with the staff in person. In the five years since then that unit has had a licensed nurse for every four patients and they kept their CNAs. Since the ratios each RN has five patients with LVNs and CNAs assisting. I don't know what went on "behind the scene" but that attorney clearly knew of the potential liability.

Good for you!! That is the way to do it, however in a lot of companies, this does not matter!!

[ns lpn]

Our incident reports at the facility I work in cover just about anything from equipment failure, to occupational health and safety, to client abuse, staff abuse ect.. I fill out a lot of them but fail to ever see any difference in how things really run. On very few instances have any of my reports ever been reviewed by more than just the DON and most times there is no change made.