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*** RNs critical in intercepting medical errors ***

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NRSKarenRN is a BSN, RN and specializes in Vents, Telemetry, Home Care, Home infusion.

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from today's ana smart brief:

rns critical in intercepting medical errors

a recent study indicates nurses recover more than 7,300 errors a year in a 10-bed critical care unit. the lead researcher said nurses can really affect patient outcomes, especially when they are "more up-to-date, more knowledgeable, more attentive, and more forthright and communicative with others when they suspect problems."

nurse.com (gannett healthcare group)

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979 Posts; 8,155 Profile Views

Would like to see the study. It would mean something if they tallied all errors, classified them according to gravity, and identified who made the error and who caught it. The simple statement that it's nurses catching doctors' errors and not vv. doesn't cut it without data. Why gather data only on errors nurses catch? With full data, that would be something else. With only part of the data one would expect, and with the profession's collection of axes to grind, well...

We see bad nursing research all the time. Remember that study that purported to prove hospitals with a higher proportion of nurses with BSNs had lower mortality? Someone had a real axe to grind there. Did they study how many of those BSNs were previously diploma nurses? If they'd counted up the proportion of diploma nurses regardless of added degrees, that would have said something different. Did they check the nature of the hospitals, whether teaching hospitals? The majority of nurses at a university hospital could be expected to be BSNs, and that would have meant something altogether different. How about rural versus urban and the proportions of degrees there? One region against another? VA vs. Catholic vs. you name it?

If the profession wants credibility, it needs to produce credible research.

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643 Posts; 8,119 Profile Views

We see bad nursing research all the time. Remember that study that purported to prove hospitals with a higher proportion of nurses with BSNs had lower mortality? Someone had a real axe to grind there. Did they study how many of those BSNs were previously diploma nurses? If they'd counted up the proportion of diploma nurses regardless of added degrees, that would have said something different. Did they check the nature of the hospitals, whether teaching hospitals? The majority of nurses at a university hospital could be expected to be BSNs, and that would have meant something altogether different. How about rural versus urban and the proportions of degrees there? One region against another? VA vs. Catholic vs. you name it?

If the profession wants credibility, it needs to produce credible research.

I would hardly call the 2003 study by Linda Aiken, et al, bad nursing research. It was published in the Journal of the American Medical Association, was obviously rigorously peer-reviewed.

If you have not read the wholw study, I would invite you to do so. It is available on the web at

http://jama.ama-assn.org/cgi/content/full/290/12/1617

(Registration is required).

Dr. Aiken researched a huge population of 232,000 patients. This same population was used to analyze mortality based on nurse-patient ratios, in which it was found that the higher the number of patients a nurse has, the higher the mortality. Do you think this study is also bad research? Or is it only research that you disagree with?

This study is a ground-breaking, highly respected study. I would suggest you read it before condemning it as bad research.

Oldiebutgoodie

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SharonH, RN specializes in Med/Surg, Geriatrics.

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Would like to see the study. It would mean something if they tallied all errors, classified them according to gravity, and identified who made the error and who caught it. The simple statement that it's nurses catching doctors' errors and not vv. doesn't cut it without data. Why gather data only on errors nurses catch? With full data, that would be something else. With only part of the data one would expect, and with the profession's collection of axes to grind, well...

The point of the study was to study the contribution of nursing to intercepting medical errors not only by physicians but by other medical professionals. The authors stated that because nurse staffing in the ICU has been threatened, they wanted data to try to understand what role nursing plays in enhancing patient safety. I guess the axe to grind is patient safety and safe nurse-patient ratios.

You don't really explain why you believe that only data on errors nurses catch is somehow insignificant. If nurses have the most contact with patients and they are in the best position to catch errors, then a great starting point for reducing patient errors is to see how exactly this works.

As for bad nursing research, would it make you feel better to know that this team of researchers included 5 physicians? Does that legitimize the results somewhat for you?

An axe to grind indeed..........

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1,982 Posts; 33,457 Profile Views

The point of the study was to study the contribution of nursing to intercepting medical errors not only by physicians but by other medical professionals. The authors stated that because nurse staffing in the ICU has been threatened, they wanted data to try to understand what role nursing plays in enhancing patient safety. I guess the axe to grind is patient safety and safe nurse-patient ratios.

You don't really explain why you believe that only data on errors nurses catch is somehow insignificant. If nurses have the most contact with patients and they are in the best position to catch errors, then a great starting point for reducing patient errors is to see how exactly this works.

As for bad nursing research, would it make you feel better to know that this team of researchers included 5 physicians? Does that legitimize the results somewhat for you?

An axe to grind indeed..........

Could someone explain to me why this data is NOT on the 6:00 news, and disseminated to the public? Perhaps the public would find a reason to respect the nursing profession, instead of confusing us with unlicensed assistive personnel who have been disguised by the hospital administration as nurses.

The public seems to think that ONLY DOCTORS save lives, and are important to positive patient outcomes. This is, of course, re-inforced by shows like ER, and Grey's Anatomy, where nurses, and the contributions to patient care are invisible. My own sister in law, whose sister was also a nurse, asked me if I watch these shows. When I told her that I didn't, she was surprised, and could not understand why.

I went on to explain my feelings and views on these shows, and how they misrepresented, denigrated the work, portrayed nurses as invisable to patient care, and safety, and the general image of nurses. She is a college graduate, and not a dummy. She went on to disagree with me, telling me that I was reading too much into the shows, and the public cannot possible think less of nurses because of the way that they represent nurses in the episodes on the show. She thought that I was nuts. I asked her what she thought we did, and if we were really as important to patient outcomes, and she said that she guessed, but could not name a thing that nurses do that is important. We have a long way to go.

Lindarn, RN, BSN, CCRN

Spokane, Washington

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Unfortunately, only one in ten nurses will report errors or precursers to errors. Nurses who raise issues that affect patient care are viewed as trouble makers and delt with accordingly. Once the others see the consequences of reporting they fall into the catagory of intimidated into silence. Then job security overtakes reporting. A shameful secret of the profession. I rememeber when nurse practice acts that stated we have a duty to report meant something.

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snowfreeze is a BSN, RN and specializes in ICU, CCU, Trauma, neuro, Geriatrics.

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rnpatrick,

If truly only 1 out of 10 nurses REPORT errors or precursors to errors is it really because they will be viewed as trouble makers or is it because the "sentinal event" paperwork is overwhelming? Tagging an error that could cause harm or death takes time, something most nurses don't have. Proper staffing ratios would help with that.

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Myxel67 specializes in Diabetes ED, (CDE), CCU, Pulmonary/HIV.

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Would like to see the study. It would mean something if they tallied all errors, classified them according to gravity, and identified who made the error and who caught it. The simple statement that it's nurses catching doctors' errors and not vv. doesn't cut it without data. Why gather data only on errors nurses catch? With full data, that would be something else. With only part of the data one would expect, and with the profession's collection of axes to grind, well...

We see bad nursing research all the time. Remember that study that purported to prove hospitals with a higher proportion of nurses with BSNs had lower mortality? Someone had a real axe to grind there. Did they study how many of those BSNs were previously diploma nurses? If they'd counted up the proportion of diploma nurses regardless of added degrees, that would have said something different. Did they check the nature of the hospitals, whether teaching hospitals? The majority of nurses at a university hospital could be expected to be BSNs, and that would have meant something altogether different. How about rural versus urban and the proportions of degrees there? One region against another? VA vs. Catholic vs. you name it?

If the profession wants credibility, it needs to produce credible research.

Hey Nony,

They did classify the errors to some extent:

Recovered medical errors were divided into three main categories: intercepted potential adverse events, mitigated potential adverse events, and ameliorated adverse events. Two physicians then independently rated the errors as significant, severe, and life-threatening. They also rated their preventability using a five-point scale and classified them as planning, execution, or surveillance/ monitoring errors.

Since this was a teaching hospital, nurses were catching errors of interns and physicians. And you know, it is always up to the nurse to check everything and make sure everything gets done.

This particular study was designed to support the need for adequate nurse staffing to improve pt care and reduce errors.

How about a study in an understaffed area showing nurses catching other nurses' errors. And how many take the time to report the error or "near miss." (they're understaffed already; who's got time to write incident report?)

I agree with you about study of BSN vs ADN and Diploma nurses.

We all know that studies can be designed to support whatever hypothesis you choose. Then you can always manipulate the numbers. Statistics are malleable in clever hands.

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There are all kinds of precursor to errors. Many are never documented. My personal frustration is that one reports something and then it disappears into a black hole.We never know the outcome. JACHO is this way. If something is reported to them they will not divulge the investigative results so they set a bad precident. Why stick your neck out if you don't know its doing any good. QA/PI topics seem to be mandated flavor of the day JACHO stuff while the real daily problems go unaddressed. AORN put out an issue on near misses and all of them were attributed to pressure put on the nurses to keep things moving.Some were very frightening. Imagine a young female patient coming in for an upper extremity procedure almost getting a total vaginal hysterectomy.

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rnpatrick,

If truly only 1 out of 10 nurses REPORT errors or precursors to errors is it really because they will be viewed as trouble makers or is it because the "sentinal event" paperwork is overwhelming? Tagging an error that could cause harm or death takes time, something most nurses don't have. Proper staffing ratios would help with that.

You both are right, even in hospitals where systems are in place that do not punish reporting the paperwork is daunting. I have worked in both kinds. The kind that do not punish the persons that report but require so much paper work that you feel like you are being punished. I have also worked in places that had an "how dare you say this place isn't perfect" attitude.

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