Original article
Strategies used by nurses to recover medical errors in an academic emergency department setting

https://doi.org/10.1016/j.apnr.2005.05.006Get rights and content

Abstract

Purpose

The purpose of this study was to gain insight into how nurses recover medical errors in the emergency department (ED) setting.

Methods

The research method was of exploratory descriptive design with qualitative analysis. Subjects who signed the informed consent participated in one of four focus groups centering on nurse's role in recovering errors. Questions were asked during the focus groups to elicit information regarding nurse's role in the three phases of error recovery, namely, identifying, interrupting, and correcting the error.

Results

Five themes emerged to describe methods used by nurses to identify errors in the ED setting. These themes included: surveillance, anticipation, double checking, awareness of the “big picture,” and experiential “knowing.” Five themes emerged as methods used to interrupt errors: patient advocacy, offer of assistance, clarification, verbal interruption, and creation of delay. The themes for correcting an error were assembling the team and involving leadership.

Conclusion

The results of this study provide preliminary evidence of the strategies used by ED nurses in the recovery of medical error. Further research is needed to generalize these findings to other ED settings. Knowledge of effective recovery strategies can ultimately be used to develop interventions for reducing medical error and improving patient safety.

Introduction

The Committee on Quality of Health in America, Institute of Medicine [IOM] (2001) reported that an estimated 98,000 persons die each year due to medical errors (Kohn, Corrigan, & Donaldson, 1999). Nurses, in their role as providers of direct patient care, are in a position to play an important role in preventing medical errors. The emergency department (ED) serves as the port of entry for many patients entering the hospital. Errors occurring in this setting are of particular concern because of their potential impact on patients' entire hospital experience. Nurses working in the ED have the potential to play a pivotal role in influencing patient safety.

The concept of “human recovery” of errors has long been of interest to experts in the field of safety (Van der Schaaf, 1992). When the recovery process is effective, the result is termed a “near miss”—meaning that an adverse outcome was averted. This concept has important implications for nurses, who are in key positions to recover errors. The recovery process involves three steps: identification, interruption, and correction (Van der Schaaf, 1992).

The ability to reduce medical errors will depend, in part, on nurses who are able to recover errors before they affect the patient. Recent research suggests that ED nurses play an important role in error recovery (Henneman, Blank, Smithline, Li, Santoro, Schmidt, Benjamin, & Henneman, 2005). The mechanisms used by ED nurses to recover medical error are unknown.

The purpose of this study was to gain insight into how nurses recover medical errors in the ED setting. Insight into strategies used by ED nurses will guide the development and testing of interventions that are aimed at decreasing the number of medical errors and at improving patient outcomes in the ED setting.

Section snippets

Review of the literature

The 1998 IOM report To Err Is Human: Building a Safer Health System was a call-to-action to the medical community to begin to systematically address the issue of medical errors (Kohn et al., 1999). This action plan required investigating both the root causes of errors and the methods for reducing the occurrence of errors. Although the ED has been identified as a site where adverse patient outcomes are likely to be attributable to medical error, few studies have quantified the number of errors

Theoretical framework

The Eindhoven model, which is the theoretical framework for this study, was used to investigate near-miss situations (Van der Schaaf, 1992) and was adopted to demonstrate the nurse's role in preventing adverse patient outcomes (Fig. 1). Originally developed for use in the chemical process industry, the Eindhoven model appeared to have applications for use in other settings and has already been used to develop an error classification system for transfusion therapy (Battles et al., 1998, Kaplan

Design

The research method was of exploratory descriptive design with qualitative analysis. Subjects who signed the informed consent participated in one of four focus groups centering on identifying the nurse's role in recovering errors. Questions were asked during the focus groups to elicit information regarding the nurse's role in the three phases of error recovery: identifying, interrupting, and correcting the error. The researchers developed questions based on their clinical experience,

Results

Twenty nurses participated in the study. All nurses participating in the study had at least 6 months of experience and worked in either a staff nurse or a charge nurse position.

Discussion

The results of this study provide further evidence of the role played by ED nurses in the recovery of medical errors (Henneman et al., 2005). The study also adds new insights into nurses' perspective of error recovery and into strategies nurses use to protect patients from harm. The results also provide empirical support for the categories of error recovery identified in the Eindhoven model, namely, identification, interruption, and correction.

The nurses in this study clearly play an active

Conclusion

The results of this study provide preliminary evidence of the strategies used by ED nurses in the recovery of medical error. Further research is needed to be able to generalize these findings to other ED settings. Knowledge of effective recovery strategies can ultimately be used to develop interventions for reducing medical error and improving patient safety.

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