Study finds nurses need more support in disclosing errors in nursing homes

Nurses in skilled nursing facilities need more support from facility and industry stakeholders in disclosing the errors and adverse events that are an inevitable part of care, according to a new study.

In the study, “Nurses’ Perceptions of Error Reporting and Disclosure in Nursing Homes,” published in the January 2012 issue of the Journal of Nursing Care Quality, the authors found the majority of the 1,180 registered nurse respondents reported error disclosure and responding to be a difficult process in their workplaces.

Nursing errors refer to a nurse’s action that adversely affected, or could have adversely affected, a patient’s safety, quality of care or both. Examples of nursing errors include lack of prevention (e.g., breach of infection control precautions), inappropriate judgment or attentiveness, misinterpreting a physician’s order or documentation errors.

“While we don’t know the exact prevalence of errors that have occurred in nursing homes, we do know they are common based on our research,” said Laura M. Wagner, PhD, RN, GNP-BC, assistant professor of nursing, New York University College of Nursing. “Our study … underscores the importance that further efforts need to occur for error reporting and disclosure to be less difficult for nurses. Our research highlights the need for nursing homes to improve communication processes and policies, ultimately rendering a culture of safety in nursing homes.

“Registered nurse respondents and nurses who had prior experience disclosing a serious error were more likely to disclose a serious error,” said Wagner. “It appears that nurses’ personal experience and level of education are more likely to influence error disclosure, rather than other factors such as the institutional culture in which they work,” she said.

The authors found that multiple barriers exist that might inhibit disclosure; almost one-third of the respondents were less likely to disclose if they believed they might be sued or reprimanded. In addition, respondents believed that current efforts toward educating and supporting nurses with regard to errors were inadequate.

“Regardless of the healthcare provider’s attitude about error disclosure, most patients or residents and their families want to know if an error has occurred, even if minor,” said Wagner. “If nurses do not acknowledge that errors occur and they are a serious problem, then improving patient safety in this setting will be even more difficult.”

The authors acknowledge that the obstacles to improving quality and safety in nursing homes and encouraging error disclosure by nursing staff are powerful. The study supports the need for stakeholders in the nursing home industry to carefully consider how transparency can be used as a vehicle for positive change. For example, SNFs need to introduce explicit disclosure policies by creating their own approaches using guidelines related to the steps and processes of disclosure.

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