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

[NRSKarenRN]

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?

[shellek]

While I was obtaining my BSN my nursing supervisor was too busy to attend incident reports reveiw hospital wide, she asked me to fill in for her. I was the only staff RN in the committee, we only reviewed nursing I.R.'s Dr.'s and pharmacist had their own committees. I was very blessed to had been able to be apart of this especially since I was the only actual hands on RN in the committee and not just a superviser pushing papers and attending meetings. Mostly over time you would recognize names cautiousing us on their skills and amazing enough most reports were on insulin and heparin delivery. Reveiwing charts definately taught and reinforced my skills in charting and I am still having a problem with this "charting by exception" I was trained if its not charted it wasn't done, then after graduating this concept of exception charting came about. So I do tend to over chart but in the long run I am responsible for my actions so I stand firm but do cooperate with the institutions policies. As far as where they go they are locked away within the institution unless it is considered a level 3-4 which is referred onto the state board of nursing. 4 is diversion of meds(such as nurses stealing, meds or items) 3 has to realy affect patient outcomes as could be detrimental to their life. Lawyer are to have no access to the incident reports-unless you chart a incident report was filed-so do not chart that! It is only a back up safety paper trail for the hospital and does identify nurses that may need education updates or possible other actions.

[Morning-glory]

I work in a psych facility so the incident reports are mostly about the wierd things our residents do. Occassionally we have med errors and that needs to be brought up the chain of command. Staff issues are brought up to the DOC and she deals with the issue, not the personal crap. Teaching, inservices and counselling are the norm at my place. I have worked in other places that used them as punitive tools, but where I am now, they are really great with getting to the base problem.

[Sweden]

Incident reports are a important part of improving the quality of care and I have written more than I can remember....

At my hospital a group of nurses, lvn and doctors at each unit have undergone special training and meet once a month to discuss the incident reports written. They examine each case and try to figure out why it happend and what we can do to try and prevent it from happening again.

We are encouraged to write reports on everything we think might be a risk (for patients or staff) even the small stuff. The incident report group than decides if they need to investigate moore (sometimes several people report the same things).

My unit is the absolutely biggest contribitor of reports in the hospital and this is something we are proud of. It doesn´t mean we make more mistakes, it means we have an open climate and that we are not afraid to talk about the mistakes we do or might be in danger of doing!

This has led to a lot of changes at my unit, from small to other more important changes.

The person writing the incident report get feedback within a month (or two). And I don´t write a report for anyone elses mistakes, I simply inform the person what has happend and that person needs to fill out a report. I will be in the report as the one discovering the problem and that i can give more information if the group needs it (I also get a copy of the report so that I can see what the other person has written).

BUT, the big difference here in Sweden is that I really don´t have to be afraid of being sued by my patient if something goes wrong. If something go on to be investigated (if it´t seriously enough) by the National Board of Health and Welfare I might get a day in court, but not sued for money or risking jail. The only thing I can think of that would cause me to loose my lisence, is if I did something seriously with intent to harm/murder a patient.

Here in Sweden it´s under discussion that if a nurse (or doctor) reports a mistake within a certain amount of time (1-2 weeks), they should not be reported to the national Board of Health and Welfare.

Incident reports should be a way to improve care, not a way to find a person to punish.

Anna

[nyapa, RN]

Nothing seems to be done at my facility. Most are written for falls, and the main reason for them being written is as a legal record of what occurred. Oh and they are mainly used for statistics, both local hospital, and national. If it is an aggressive/abusive incident report, then you have to fill out the normal form plus the latter report. And as for trying to fill out biohazard injury paper work, there is so much incident reporting for different depts its confusing! Oh and did I mention that all of these are written in the patient's notes as well?

[sharona97, BSN, RN]

I'm confused. The "incident" reports (2) that I have written up was due to the fact harm or potential harm happened and I was involved. 1) The nurse I was training had LATEX allergy & mngmt knew about it upon hiring and she went ito a fast reactive airway situation just opening cupboards that had the "will be gone" gloves in it. We had to tx her so I felt it appropriate.2) A doc was REAL funny when he went to squirt me with the flexsig, and it was a dirty scope. I wrote a report for myself, in case of injury at a later date. I've never written up a co-worker. I've been written up by an insane DON but it wasn't called an incident report. I refused to sign the nonsence she wrote on this report. Took a copy and went to her boss and c/o harrassment. I suppose every facility has it's own rules.

[nursejane236]

Incident reports in my facility are about anything out of the ordinary. Consequently, there are several incidents from everything such as skin tears to medication errors. Every incident that happens to a patient is investigated, careplanned and all appropriate personnel notified. Do they help? the jury is still out on that. Sometimes I see changes that are beneficial and other times I see them as a way to document compliance, non-compliance and create a paper trail for the powers that be!

[ebear, BSN, RN]

RubyVee,

I didn't know whether to laugh or cry when I read your post! Good Grief!!!!!!! :uhoh21:

ebear

[2longasn]

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.

I guess it depends on the type of facility you are in. In LTC incident reports are taken seriously. State surveyors request them and you better have a darn good reason for an in house aquired fracture with no documentation of a fall or a diagnosis that could link fracture to idiopathic causes. Incident reports are iniated and investigated to determine changes that need to be made to improve care for the patients. This includes medication errors. Sometimes a change in practice of Pharmacy is needed to improve care or an inservicing for nursing staff is identified. Incidents reports are more than a paper trail. They help to identify a need for change. What happens if the same staff members keep making the same mistakes and out of fear or apathy we decide to ignore them and someone get's seriously harmed? We missed an opportunity to correct this repeatedly. Incident reports are necessary and legal requirement.

[Daytonite, BSN, RN]

As a nurse manager I was a member of our facility's Safety Committee. All incident reports ultimately came to the Safety Committee for final review and disposition. When an incident report was first filled out it was the responsibility of the manager of the employee making out the incident report to carry out an initial investigation of the incident and write their findings on the back of the report. Any employee education, training or discipline was then carried out. The report then went on to the Safety Committee where the results were trended and any decisions were made to make changes in equipment or policies that would affect the employees job performance. A report of the incidents was generated and went to the Executive Committee of the Hospital. People who think these things are silly and ignored are wrong, wrong, wrong. We had policy in place that clearly listed the things that were to be written up as incidents in case there was any doubt. The tracking of safety is a JCAHO requirement.

[MQ Edna]

Where I work, EVERYONE fills out incident reports. If they witnessed it, or even if they were in the vicinity, they have to do an incident report. Because our clients rights are so sensitive because they can not self advocate and the often have behaviors (like SIB [self Injurious Behavior] and Pica [They will eat ANYTHING]), absolutely everything must reported immediately and logged in about 3 different places.

I remember once an individual was scratching at his skin, which caused redness... 3 pages each for 5 different reports. They are a bit of a joke at my facility, but I have seen some positive things come from them.

[laurelmae]

it's supposedly confidential but at one hospital i worked at, our floor managers kept track of individuals' reported incidents and when one nurse had made a mistake worthy of discipline, they brought out 3 reports that were implicating her (2 med errors, one pts IV infusion of floor stock (like LR) didn't have his name and account on it, which is mandatory even if it doesn't have added meds). my friend was shocked when they pulled out these reports and she could even see WHO had written her up! this all resulted in her being on probation for 3 weeks, but the point of the reports was supposed to be to FIX THE PROCESSES not punish the nurses!!! :down:Appalling.