Barriers to Incident Reporting among Nurses: A Qualitative Systematic Review

Factors influencing patient safety incident reporting in African healthcare organisations: a systematic integrative review

BACKGROUND

Patient safety incidents, defined as deviations from standard healthcare practices, contribute to significant mortality and financial burdens for healthcare systems globally each year. In response, international agencies advocate for patient safety incident reporting and learning systems to prevent the recurrence of safety incidents and promote learning. The effective design and implementation of these systems require the identification of factors that influence incident reporting practices. Therefore, the aim of this review was to systematically appraise and synthesise the current literature on factors influencing patient safety incident reporting practices in African healthcare organisations.

METHODS

A systematic integrative review was conducted. Five electronic databases, including PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL) via EBSCO host, Scopus, Web of Science, and Excerpta Medica Database (Embase), were searched to identify relevant articles. Peer-reviewed articles published in English were included in this review. Two independent reviewers screened the identified articles first by title and abstract, followed by full text evaluation. Quality appraisal was conducted using the Joanna Briggs Institute and the Quality Assessment with Diverse Studies tool. A thematic synthesis approach was used to analyse the data. The themes were presented with narrative descriptions.

RESULTS

A literature search identified 9,265 articles, of which 51 were included in the review, representing the perspectives of 15,089 healthcare professionals. Of the included articles, 88% were rated as moderate to high quality. Five descriptive themes were identified as barriers and facilitators that influenced patient safety incident reporting practices, including fear of reprisal within the prevailing patient safety culture, attitudes and perceptions towards patient safety incident reporting, the extent of knowledge and skills regarding patient safety incidents and reporting, the availability and attributes of reporting systems and processes, and the level of support from managers and rapport with staff.

CONCLUSION

The identified barriers and facilitators influencing patient safety incident reporting should be addressed to effectively design, implement, and improve patient safety incident reporting systems and practices.

PROTOCOL REGISTRATION

The review protocol was registered at the International Prospective Register of Systematic Reviews (PROSPERO) under registration number CRD42023455168.

The relationship between patient safety culture and attitudes toward incident reporting among registered nurses

BACKGROUND

Patient safety is a primary concern in healthcare due to errors and low incident reporting rates. A strong safety culture and positive attitudes towards reporting are crucial for improving patient safety culture (PSC). Overcoming barriers and conducting research can enhance incident reporting, foster a safety culture, and improve patient outcomes.

AIM

To investigate the relationship between patient safety culture and attitudes toward incident reporting among Jordanian nurses.

METHODOLOGY

This study employed a cross-sectional descriptive correlational design. A convenient sample of 307 registered staff nurses from Jordanian hospitals across different sectors was selected. Validated and translated questionnaires, which included the Incident Reporting Culture Questionnaire and the Hospital Survey on Patient Safety Culture, were used for data collection. Statistical analyses, such as descriptive and inferential statistics (including Pearson correlation, independent sample t-test, one-way ANOVA, and hierarchical regression analysis), were employed to address research questions using SPSS version 26.

RESULTS

The findings revealed that the Patient Safety Culture (PSC) organizational learning dimension had the highest positive response rate (70.6%), while the hands-off and transition dimension had the lowest score (24.9%). Approximately 43.6% of participants reported no events in the last 12 months, whereas only 4.2% reported experiencing 12 or more events. The overall perception of patient safety was rated as 'very good' by 55.7% of the participants. The results from the Incident Reporting Culture Questionnaire (IRCQ) indicated a moderate overall willingness among nurses to report incidents, along with positive attitudes toward implementing lessons learned from errors and offering feedback on incident reports. Significant differences in attitudes toward incident reporting were observed based on the type of hospital (p = 0.037) and working hours (p = 0.012). Moreover, significant correlations were found between Patient Safety Culture dimensions and Incident Reporting Culture Questionnaire dimensions. The most robust positive correlation was observed between the feedback and communication about errors dimension in Patient Safety Culture and the learning from errors dimension in Incident Reporting Culture Questionnaire (r = 0.401, p = 0.000). Through hierarchical multiple regression analysis, it was demonstrated that Patient Safety Culture significantly predicted attitudes toward incident reporting (β = 0.441, p < 0.001), while controlling for demographic variables.

CONCLUSION

This study discovered a positive correlation between patient safety culture and attitudes toward incident reporting among Jordanian nurses. Enhancing patient safety culture and adopting non-punitive measures can effectively improve incident reporting behavior within healthcare settings.

Factors Influencing Information Distortion in Electronic Nursing Records: Qualitative Study

BACKGROUND

Information distortion in nursing records poses significant risks to patient safety and impedes the enhancement of care quality. The introduction of information technologies, such as decision support systems and predictive models, expands the possibilities for using health data but also complicates the landscape of information distortion. Only by identifying influencing factors about information distortion can care quality and patient safety be ensured.

OBJECTIVE

This study aims to explore the factors influencing information distortion in electronic nursing records (ENRs) within the context of China's health care system and provide appropriate recommendations to address these distortions.

METHODS

This qualitative study used semistructured interviews conducted with 14 nurses from a Class-A tertiary hospital. Participants were primarily asked about their experiences with and observations of information distortion in clinical practice, as well as potential influencing factors and corresponding countermeasures. Data were analyzed using inductive content analysis, which involved initial preparation, line-by-line coding, the creation of categories, and abstraction.

RESULTS

The analysis identified 4 categories and 10 subcategories: (1) nurse-related factors-skills, awareness, and work habits; (2) patient-related factors-willingness and ability; (3) operational factors-work characteristics and system deficiencies; and (4) organizational factors-management system, organizational climate, and team collaboration.

CONCLUSIONS

Although some factors influencing information distortion in ENRs are similar to those observed in paper-based records, others are unique to the digital age. As health care continues to embrace digitalization, it is crucial to develop and implement strategies to mitigate information distortion. Regular training and education programs, robust systems and mechanisms, and optimized human resources and organizational practices are strongly recommended.

Barriers to reporting workplace violence: a qualitative study of nurses' perceptions in tertiary care settings

BACKGROUND

Workplace violence (WPV) remains a formidable concern among nurses worldwide, with up to 60% in Saudi Arabia reportedly experiencing some form of aggression. In tertiary care hospitals, robust hierarchies and cultural norms intensify underreporting, thwarting evidence-based prevention and obscuring vital data.

AIM

This qualitative study investigated the perceived barriers to WPV reporting among nurses in tertiary care settings in the Aljouf region of Saudi Arabia, specifically addressing how organizational and cultural factors converge to discourage formal incident reporting.

METHODS

A qualitative descriptive design was employed, guided by Ajzen's Theory of Planned Behavior and the Social Ecological Model. Thirty-six registered nurses, purposively sampled from three tertiary hospitals, participated in six semi-structured focus groups conducted in Arabic or English, depending on participant preference. Data were thematically analyzed in NVivo, with methodological rigor ensured through triangulation and inter-coder reliability.

RESULTS

Three principal themes emerged: (1) Emotional and Psychological Barriers (78%), encompassing distress, anxiety, and fears of professional blame; (2) Organizational Ineffectiveness (65%), marked by convoluted reporting processes and perceived managerial indifference; and (3) Cultural and Hierarchical Influences (57%), reflecting deference to authority and normalization of violence. These themes illustrate how attitudes, subjective norms, and perceived behavioral control shaped by socio-cultural dynamics collectively contribute to persistent underreporting.

CONCLUSIONS

Mitigating WPV underreporting in Saudi tertiary care hospitals requires streamlined, user-friendly reporting channels, leadership accountability, and holistic psychosocial support. Implementing interprofessional education aimed at dismantling hierarchical imbalances can foster a zero-tolerance ethos toward violence. Longitudinal and comparative research should further examine evolving reporting behaviors to refine context-specific, culturally attuned strategies for addressing WPV.

CLINICAL TRIAL NUMBER

Not applicable.

Training Hospital Nurses to Write Detailed Narratives and Describe Contributing Factors in Incident Reports: The SAFER Education Program

BACKGROUND

In high-risk industries, the primary purpose of incident reporting is to obtain insights into contributing factors. Incident reporting systems in hospitals receive numerous reports from nurses but often lack detailed, actionable information. Enriching the information captured by incident reports would facilitate local efforts to improve patient safety.

METHODS

The authors developed the Systems Approach For Event Reporting (SAFER) educational program to train nurses to (1) write detailed narratives and (2) describe contributing factors. To achieve these objectives, the research team incorporated the Situation, Background, Assessment, Recommendation (SBAR) model and the Systems Engineering Initiative for Patient Safety (SEIPS) model. The authors conducted pilot tests with nurses, made iterative refinements, then deployed SAFER on eight nursing units at an academic medical center.

RESULTS

An online learning module provides background information, a detailed curriculum leveraging SBAR and SEIPS models, interactive exercises, real-world examples of enhanced reports, and concluding information on how enhanced reporting benefits both nursing practice and patient safety. Nurses received a badge buddy-a laminated, double-sided reminder card to hang behind identification badges that reinforces key elements of SBAR and SEIPS models. In pilot testing, nurses reported that completing the module took 10 to 20 minutes, the material was clear and easy to understand, and they understood its purpose and objectives. The completion rate for implementation of SAFER online training was 88.7% (809/912 eligible nurses).

CONCLUSION

SAFER is an innovative program that introduces human factors principles to nurses and trains them to incorporate SBAR and SEIPS into incident reporting. SAFER is acceptable and feasible. Ongoing work includes testing the impact of SAFER on improving the utility of incident reports.

Rationale for Nurse Underreporting of Workplace Violence: A Qualitative Systematic Review

Workplace violence is a major global societal issue that demands attention. Nurses commonly underreport workplace violence (WPV) perpetrated by patients and visitors, which not only poses risks to their physical and emotional health but also disrupts the regular operation of health care services. We used a qualitative thematic synthesis to evaluate the rationale behind the underreporting of WPV systematically. We identified 4 thematic analysis results. We found that to reduce underreporting of WPV, health care organizations should improve their policies and training, and management should prioritize nursing safety, increase awareness of regulations, and work together to maintain safe environments.

The Association Between Nurse Staffing and Conflict and Containment in Acute Mental Health Care: A Systematic Review

Conflict and containment are the most frequently reported incidents in acute mental health care settings. This systematic review seeks to examine and synthesise existing evidence on the association between nurse staffing levels, nursing skill-mix and the occurrence of these incidents in acute mental health wards. Systematic review of quantitative studies examining nurse staffing levels and skill-mix (proportion of nursing shift that are registered or experience levels). Searches were undertaken in CINAHL, Cochrane, Embase, MEDLINE, PsycINFO, SCOPUS and Web of Science. Thirty-five observational studies were reviewed, including 32 on staffing levels (44 analyses) and 12 on skill-mix (14 analyses). Nine analyses found that higher staffing levels were associated with a reduction in reported conflict and containment incidents, while nine found lower staffing levels were associated with reduced incidents. Twenty-six studies found no significant association. For skill-mix, six analyses found that higher skill-mix was associated with a reduction in incidents, seven found no significant association, while one analysis showed reduced skill-mix was associated with a reduction in incidents. The results from analyses are mixed, with no clear conclusions on the relationship of staffing on incident rates. Studies often rely on routine or staff-reported data that are prone to measurement and observer bias, where most analyses did not control for important factors, e.g., patient case-mix or other patient-related factors which could have influenced the results. Although higher staffing levels are sometimes associated with increased incident reporting, this may reflect greater interaction and reporting, or residual (unmeasured) confounding and/or lack of control for mediators and effect modifiers. The review highlights the need for better risk adjustment in observational studies, more refined methodologies and clearer definitions of outcomes to guide workforce planning and policy. Further large-scale research is necessary to understand the complex relationships between staffing, skill-mix and safety in mental health care. There is a major staffing crisis in mental health nursing, but evidence to understand the impact of this on patient outcomes and to guide staffing policies is missing, with several significant limitations in the existing evidence that need to be resolved. Identified evidence on mental health nurse staffing levels and skill-mix is mixed and inconclusive; therefore, no clear implications for workforce planning or deployment can be recommended. However, this prompts debate on the nature and efficacy of routinely collected patient outcomes in clinical practice.

Developing and evaluating a dental incident reporting system: a user-centered approach to risk management

BACKGROUND

Patient safety is critical in healthcare, and adverse events (AEs) in dental care require tailored reporting systems for accurate documentation and risk management. Generalized systems fail to address the unique needs of dentistry, necessitating a specialized approach. This study introduces the dental incident reporting system (DIRS), a user-centered framework designed to overcome the barriers in dental incident reporting.

METHODS

This mixed-methods study was conducted in three phases. Phase 1 involved the development of a comprehensive classification system for dental AEs using 752 patient safety incidents reported over 5 years at the Dental Hospital, Faculty of Dentistry, Chulalongkorn University. Phase 2 involved the design and refinement of the DIRS, integrating features such as automated risk assessment and classification assistance, validated through heuristic evaluations. Phase 3 comprised usability testing with 16 end users using the system usability scale (SUS) and user acceptance test (UAT) to assess perceived effectiveness, usefulness, and satisfaction.

RESULTS

The classification system categorized dental-specific AEs, aligning with the hospital accreditation standards. The DIRS achieved a mean SUS score of 69.7, indicating above-average usability. The UAT showed high user ratings for effectiveness (mean, 3.15; SD, 0.49), usefulness (mean, 3.15; SD, 0.51), and satisfaction (mean, 3.38; SD, 0.48). Strong reliability (intraclass correlation coefficient, 0.91; 95% CI, 0.81-0.96) was demonstrated across the evaluations.

CONCLUSIONS

The DIRS addresses gaps in dental incident reporting by offering a user-friendly, standardized system. Its potential to enhance reporting accuracy and foster a culture of transparency highlights its significance for improving dental patient safety. Future efforts should focus on refining usability, expanding testing, and exploring scalability for broader adoption.

Evaluating nurses' psychological and operational preparedness for mass-casualty events in Saudi Arabia

AIM

This study assessed nurses' psychological and operational preparedness for mass-casualty events in healthcare settings.

BACKGROUND

Nurses are vital responders in mass-casualty events, which demand quick and effective actions. Both psychological and operational preparedness are key to ensuring their ability to manage such high-pressure situations.

METHODS

A multicenter, cross-sectional study was conducted among 156 emergency nurses in Saudi Arabia. Data were collected using a structured questionnaire based on the Transactional Model of Stress and Coping and the Hospital Emergency Incident Command System to assess psychological and operational preparedness. Data collection included demographic information, previous training, incident response experience, preparedness priorities for various mass-casualty events, and perceived challenges and barriers to response. The data were analyzed using descriptive and inferential statistics.

FINDINGS

Discrepancies were observed between training and response experience for mass-casualty events, with natural disasters showing the highest alignment and priority, while transportation and fire-related incidents had a greater response than training, suggesting reliance on practical experience rather than formal education. War injuries were among the highly prioritized, with training exceeding response, potentially reflecting geopolitical concerns. Psychological and operational preparedness were moderately rated, with a strong correlation between the two, indicating that enhancing psychological resilience could improve overall preparedness. Key perceived barriers included staff shortages, inadequate resources, psychological stress, insufficient training, and unclear protocols or lack of guidelines.

CONCLUSION

The study highlights moderate preparedness levels, with a need for more targeted training and systemic improvements to address identified barriers.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

Health policies should prioritize comprehensive disaster preparedness programs with mental health support, clear protocols, and adequate training to improve nurse preparedness for mass-casualty events. Addressing perceived barriers will strengthen the healthcare system's emergency response.

Systematic review of types of safety incidents and the processes and systems used for safety incident reporting in care homes

AIMS

To identify the safety incident reporting systems and processes used within care homes to capture staff reports of safety incidents, and the types and characteristics of safety incidents captured by safety incident reporting systems.

DESIGN

Systematic review following PRISMA reporting guidelines.

METHODS

Databases were searched January 2023 for studies published after year 2000, written in English, focus on care homes and incident reporting systems. Data were extracted using a bespoke data extraction tool, and quality was assessed. Data were analysed descriptively and using narrative synthesis, with types and characteristics of incidents analysed using the International Classification for Patient Safety.

DATA SOURCES

Databases were CINAHL, MEDLINE, PsycINFO, EMBASE, HMIC, ASSISA, Nursing and Allied Health Database, MedNar and OpenGrey.

RESULTS

We identified 8150 papers with 106 studies eligible for inclusion, all conducted in high-income countries. Numerous incident reporting processes and systems were identified. Using modalities, typical incident reporting systems captured all types of incidents via electronic computerized reporting, with reports made by nursing staff and captured information about patient demographics, the incident and post-incident actions, whilst some reporting systems included medication- and falls-specific information. Reports were most often used to summarize data and identify trends. Incidents categories most often were patient behaviour, clinical process/procedure, documentation, medication/intravenous fluids and falls. Various contributing and mitigating factors and actions to reduce risk were identified. The most reported action to reduce risk was to improve safety culture. Individual outcomes were often reported, but social/economic impact of incidents and organizational outcomes were rarely reported.

CONCLUSIONS

This review has demonstrated a complex picture of incident reporting in care homes with evidence limited to high-income countries, highlighting a significant knowledge gap. The findings emphasize the central role of nursing staff in reporting safety incidents and the lack of standardized reporting systems and processes.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

The findings from this study can inform the development or adaptation of safety incident reporting systems in care home settings, which is of relevance for nurses, care home managers, commissioners and regulators. This can help to improve patient care by identifying common safety issues across various types of care home and inform learning responses, which require further research.

IMPACT

This study addresses a gap in the literature on the systems and processes used to report safety incidents in care homes across many countries, and provides a comprehensive overview of safety issues identified via incident reporting.

REPORTING METHOD

PRISMA.

PATIENT OR PUBLIC CONTRIBUTION

A member of the research team is a patient and public representative, involved from study conception.

An Analysis of the Implementation and Use of (Critical) Incident Reporting Systems ((C)IRSs) in German Hospitals: A Retrospective Cross-Sectional Study from 2017 to 2022

Background: Incident reporting systems (IRSs) have become a central instrument for improving patient safety in hospitals. In Germany, hospitals are legally required to implement internal IRSs, while participation in cross-institutional IRSs is voluntary. Methods: In a retrospective, descriptive cross-sectional study, the structured quality reports of all German hospitals from 2017 to 2022 (2598-2408 hospitals (2017-2022)) were analysed. The participation of hospitals in internal and cross-institutional IRSs was examined, as was the frequency of training and evaluations of incident reports. Results: The rate of participation in internal IRSs increased from 94.0% in 2017 to 96.6% in 2019 and remained stable at 96.0% in 2022. About 85% of hospitals conducted internal evaluations of the incident reports, with monthly evaluations being the most common (33.9%). Training on how to use IRSs was mostly provided on an ad hoc basis (41.6% in 2022), with regular training being less common. Participation in cross-institutional IRSs increased significantly from 44.5% in 2017 to 55% in 2019 and remained stable until 2022. Participation in hospital IRSs showed significant increases, while specialised systems exhibited lower participation rates. Conclusions: Internal IRSs have been established in German hospitals; however, there is still room for improvement in conducting regular training sessions and evaluations. Although participation in cross-institutional IRSs has increased, it remains fragmented. Further centralisation and standardisation could enhance efficiency and contribute to an improvement in patient safety.

Implementation of a novel TRIZ-based model to increase the reporting of adverse events in the healthcare center

Underreporting of adverse events in healthcare systems is a global concern. This study aims to address the underreporting of adverse events (AE) by implementing a TRIZ-based model to identify and overcome barriers to reporting, thus filling gaps in current reporting practices and improving incident recognition. A TRIZ (Theory of Inventive Problem Solving) approach was adopted, integrating with SERVQUAL methodologies to design interventions. Preintervention and postintervention surveys were conducted to evaluate changes in the recognition of adverse events and barriers to reporting. Statistical analyses were performed to assess the effectiveness of the interventions. Recognition improved and barriers to reporting AEs significantly decreased. Monthly reported cases rose from 33.7 to 50.3 (p = 0.000), demonstrating the effectiveness of the TRIZ-based interventions. Implementing a TRIZ-based model significantly improved adverse event reporting by enhancing the recognition of reportable events and overcoming identified barriers. Future research should explore the long-term sustainability of these interventions and their broader applicability in diverse healthcare settings.

Paediatric medication incident reporting: a multicentre comparison study of medication errors identified at audit, detected by staff and reported to an incident system

OBJECTIVES

To compare medication errors identified at audit and via direct observation with medication errors reported to an incident reporting system at paediatric hospitals and to investigate differences in types and severity of errors detected and reported by staff.

METHODS

This is a comparison study at two tertiary referral paediatric hospitals between 2016 and 2020 in Australia. Prescribing errors were identified from a medication chart audit of 7785 patient records. Medication administration errors were identified from a prospective direct observational study of 5137 medication administration doses to 1530 patients. Medication errors reported to the hospitals' incident reporting system were identified and matched with errors identified at audit and observation.

RESULTS

Of 11 302 clinical prescribing errors identified at audit, 3.2 per 1000 errors (95% CI 2.3 to 4.4, n=36) had an incident report. Of 2224 potentially serious prescribing errors from audit, 26.1% (95% CI 24.3 to 27.9, n=580) were detected by staff and 11.2 per 1000 errors (95% CI 7.6 to 16.5, n=25) were reported to the incident system. Although the prescribing error detection rates varied between the two hospitals, there was no difference in incident reporting rates regardless of error severity. Of 40 errors associated with actual patient harm, only 7 (17.5%; 95% CI 8.7% to 31.9%) were detected by staff and 4 (10.0%; 95% CI 4.0% to 23.1%) had an incident report. None of the 2883 clinical medication administration errors observed, including 903 potentially serious errors and 144 errors associated with actual patient harm, had incident reports.

CONCLUSION

Incident reporting data do not provide an accurate reflection of medication errors and related harm to children in hospitals. Failure to detect medication errors is likely to be a significant contributor to low error reporting rates. In an era of electronic health records, new automated approaches to monitor medication safety should be pursued to provide real-time monitoring.

Health professionals' perceptions of the development needs of incident reporting software: A qualitative systematic review

AIM

To systemically identify and synthesize information on health professionals' and students' perceptions regarding the development needs of incident reporting software.

DESIGN

A systematic review of qualitative studies.

DATA SOURCES

A database search was conducted using Medline, CINAHL, Scopus, Web of Science and Medic without time or language limits in February 2023.

REVIEW METHODS

A total of 4359 studies were identified. Qualitative studies concerning the perceptions of health professionals and students regarding the development needs of incident reporting software were included, based on screening and critical appraisal by two independent reviewers. A thematic synthesis was conducted.

RESULTS

From 10 included studies, five analytical themes were analysed. Health professionals and students desired the following improvements or changes to incident reporting software: (1) the design of reporting software, (2) the anonymity of reporting, (3) the accessibility of reporting software, (4) the classification of fields and answer options and (5) feedback and tracking of reports. Wanted features included suitable reporting forms for various specialized fields that could be integrated into existing hospital information systems. Rapid, user-friendly reporting software using multiple reporting platforms and with flexible fields and predefined answer options was preferred. While anonymous reporting was favoured, the idea of reporting serious incidents with both patient and reporter names was also suggested.

CONCLUSION

Health professionals and students provided concrete insights into the development needs for reporting software. Considering the underreporting of healthcare cases, the perspectives of healthcare professionals must be considered while developing user-friendly reporting tools. Reporting software that facilitates the reporting process could reduce underreporting.

REPORTING METHOD

The ENTREQ reporting guideline was used to support the reporting of this systematic review.

PATIENT OR PUBLIC CONTRIBUTION

There was no patient or public contribution.

PROTOCOL REGISTRATION

The protocol is registered in the International Prospective Register of Systematic Reviews with register number CRD42023393804.

Patient safety incident reporting software: A cross-sectional survey of nurses and other users' perspectives

AIM

To investigate nurses' and other users' perceptions and knowledge regarding patient safety incident reporting software and incident reporting.

DESIGN

A cross-sectional online survey.

METHODS

The survey, 'The Users' Perceptions of Patient Safety Incident Reporting Software', was developed and used for data collection January-February 2024. We aimed to invite all potential users of reporting software in two wellbeing service counties in Finland to participate in the survey. Potential users (reporters/handlers/others) were nurses, other health professionals and employees. Satisfaction was classified as dissatisfied, neutral, or satisfied. The association between overall satisfaction and demographics was tested using cross-tabulation and a Chi-square test.

RESULTS

The completion rate was 54% (n = 755). Some respondents (n = 25) had never used reporting software, most often due to no perceived need to report, although their average work experience was 15 years. Of other respondents (n = 730), mostly nurses (n = 432), under half agreed that the software was quick to use and easy to navigate. The biggest dissatisfaction was with the report processing features. Over a fifth did not trust that reporting was anonymous. Training and frequency of using the software were associated with overall satisfaction.

CONCLUSION

Reporting software has not reached its full potential and needs development. Report handling is essential for shared learning; however, the processing features require the most improvements. Users' perceptions must be considered when developing reporting software and processes.

IMPACT

Incident reporting software usability is central to reporting, but nurses' and other users' perceptions of software are poorly understood. This survey shows weaknesses in reporting software and emphasizes the importance of training. The survey can contribute to paying more attention to organizing training, getting users to participate in software development, and deepening knowledge of issues in reporting software. Making the needed improvements could improve patient safety.

REPORTING METHOD

The STROBE Checklist (Supplement-S1).

PATIENT OR PUBLIC CONTRIBUTION

No Patient or Public Contribution.

Construction of a Multi-Label Classifier for Extracting Multiple Incident Factors From Medication Incident Reports in Residential Care Facilities: Natural Language Processing Approach

BACKGROUND

Medication safety in residential care facilities is a critical concern, particularly when nonmedical staff provide medication assistance. The complex nature of medication-related incidents in these settings, coupled with the psychological impact on health care providers, underscores the need for effective incident analysis and preventive strategies. A thorough understanding of the root causes, typically through incident-report analysis, is essential for mitigating medication-related incidents.

OBJECTIVE

We aimed to develop and evaluate a multilabel classifier using natural language processing to identify factors contributing to medication-related incidents using incident report descriptions from residential care facilities, with a focus on incidents involving nonmedical staff.

METHODS

We analyzed 2143 incident reports, comprising 7121 sentences, from residential care facilities in Japan between April 1, 2015, and March 31, 2016. The incident factors were annotated using sentences based on an established organizational factor model and previous research findings. The following 9 factors were defined: procedure adherence, medicine, resident, resident family, nonmedical staff, medical staff, team, environment, and organizational management. To assess the label criteria, 2 researchers with relevant medical knowledge annotated a subset of 50 reports; the interannotator agreement was measured using Cohen κ. The entire data set was subsequently annotated by 1 researcher. Multiple labels were assigned to each sentence. A multilabel classifier was developed using deep learning models, including 2 Bidirectional Encoder Representations From Transformers (BERT)-type models (Tohoku-BERT and a University of Tokyo Hospital BERT pretrained with Japanese clinical text: UTH-BERT) and an Efficiently Learning Encoder That Classifies Token Replacements Accurately (ELECTRA), pretrained on Japanese text. Both sentence- and report-level training were performed; the performance was evaluated by the F1-score and exact match accuracy through 5-fold cross-validation.

RESULTS

Among all 7121 sentences, 1167, 694, 2455, 23, 1905, 46, 195, 1104, and 195 included "procedure adherence," "medicine," "resident," "resident family," "nonmedical staff," "medical staff," "team," "environment," and "organizational management," respectively. Owing to limited labels, "resident family" and "medical staff" were omitted from the model development process. The interannotator agreement values were higher than 0.6 for each label. A total of 10, 278, and 1855 reports contained no, 1, and multiple labels, respectively. The models trained using the report data outperformed those trained using sentences, with macro F1-scores of 0.744, 0.675, and 0.735 for Tohoku-BERT, UTH-BERT, and ELECTRA, respectively. The report-trained models also demonstrated better exact match accuracy, with 0.411, 0.389, and 0.399 for Tohoku-BERT, UTH-BERT, and ELECTRA, respectively. Notably, the accuracy was consistent even when the analysis was confined to reports containing multiple labels.

CONCLUSIONS

The multilabel classifier developed in our study demonstrated potential for identifying various factors associated with medication-related incidents using incident reports from residential care facilities. Thus, this classifier can facilitate prompt analysis of incident factors, thereby contributing to risk management and the development of preventive strategies.

Iranian nurses' attitudes towards the disclosure of patient safety incidents: a qualitative study

OBJECTIVE

Statistics suggests that patients and officials are unaware of a large number of patient safety incidents in healthcare centres. This study aimed to explore the concept of disclosure of patient safety incidents from the perspectives of Iranian nurses.

DESIGN

Qualitative content analysis.

SETTING

The study population was nurses working in hospitals affiliated with The Hormozgan University of Medical Sciences, military hospitals and private hospitals in Bandar Abbas, Iran. Sampling was done from January 2021 to September 2021.

PARTICIPANTS

11 female and 6 male nurses aged 27-59 years with a work experience of 3-34 years were included.

PRIMARY AND SECONDARY OUTCOME MEASURES

This qualitative content analysis was to explore the experiences of Iranian nurses (n=17) using purposive sampling and semistructured, in-depth interviews. Maximum variation sampling (age, sex, work experience, education level, type of hospital and type of ward) was considered to obtain rich information. Guba and Lincoln criteria were used to increase the study's trustworthiness and rigour, and the Graneheim and Lundman method and MAXQDA 2020 were used to analyse data.

RESULTS

We extracted one theme, four categories and nine subcategories. The main theme was the mental schemas of disclosure of patient safety incidents with four categories: (1) misconceptions of harm to the organisation or self, (2) attributes of the disclosure process and its outcomes, (3) reactions to the disclosing incidents and (4) interpersonal conflicts.

CONCLUSION

Our study identified factors influencing the disclosure of patient safety incidents among nurses, including concerns about reputation, fear of consequences and perceptions of the disclosure process. Positive attitudes towards incident disclosure were associated with supportive organisational environments and transparent communication. Barriers to disclosure included patient and companion reactions, misinterpretation and anxiety. Healthcare organisations should foster a non-punitive reporting culture to enhance patient safety and accountability.

Medication Safety Event Reporting: Factors That Contribute to Safety Events During Times of Organizational Stress

BACKGROUND

Incident reports submitted during times of organizational stress may reveal unique insights.

PURPOSE

To understand the insights conveyed in hospital incident reports about how work system factors affected medication safety during a coronavirus disease-2019 (COVID-19) surge.

METHODS

We randomly selected 100 medication safety incident reports from an academic medical center (December 2020 to January 2021), identified near misses and errors, and classified contributing work system factors using the Human Factors Analysis and Classification System-Healthcare.

RESULTS

Among 35 near misses/errors, incident reports described contributing factors (mean 1.3/report) involving skill-based errors (n = 20), communication (n = 8), and tools/technology (n = 4). Reporters linked 7 events to COVID-19.

CONCLUSIONS

Skill-based errors were the most common contributing factors for medication safety events during a COVID-19 surge. Reporters rarely deemed events to be related to COVID-19, despite the tremendous strain of the surge on nurses. Future efforts to improve the utility of incident reports should emphasize the importance of describing work system factors.

Perceptions of medical error among general practitioners in rural China: a qualitative interview study

BACKGROUND

Medical error (ME) is a serious public health problem and a leading cause of death. The reported adverse incidents in China were much less than western countries, and the research on patient safety in rural China's primary care institutions was scarce. This study aims to identify the factors contributing to the under-reporting of ME among general practitioners in township health centres (THCs).

METHODS

A qualitative semi-structured interview study was conducted with 31 general practitioners working in 30 THCs across 6 provinces. Thematic analysis was conducted using a grounded theory approach.

RESULTS

The understanding of ME was not unified, from only mild consequence to only almost equivalent to medical malpractice. Common coping strategies for THCs after ME occurs included concealing and punishment. None of the participants reported adverse events through the National Clinical Improvement System website since they worked in THCs. Discussions about ME always focused on physicians rather than the system.

CONCLUSIONS

The low reported incidence of ME could be explained by unclear concept, unawareness and blame culture. It is imperative to provide supportive environment, patient safety training and good examples of error-based improvements to rural primary care institutions so that ME could be fully discussed, and systemic factors of ME could be recognised and improved there in the future.

Making Neglect Invisible: A Qualitative Study among Nursing Home Staff in Norway

BACKGROUND

Research shows that nursing home residents' basic care needs are often neglected, potentially resulting in incidents that threaten patients' safety and quality of care. Nursing staff are at the frontline for identifying such care practices but may also be at the root of the problem. The aim of this study was to generate new knowledge on reporting instances of neglect in nursing homes based on the research question "How is neglect reported and communicated by nursing home staff?"

METHODS

A qualitative design guided by the principles of constructivist grounded theory was used. The study was based on five focus-group discussions (20 participants) and 10 individual interviews with nursing staff from 17 nursing homes in Norway.

RESULTS

Neglect in nursing homes is sometimes invisible due to a combination of personal and organizational factors. Staff may minimize "missed care" and not consider it neglect, so it is not reported. In addition, they may be reluctant to acknowledge or reveal their own or colleagues' neglectful practices.

CONCLUSION

Neglect of residents in nursing homes may continue to occur if nursing staff's reporting practices are making neglect invisible, thus proceeding to compromise a resident's safety and quality of care for the foreseeable future.

Nurses' rationale for underreporting of patient and visitor perpetrated workplace violence: a systematic review

BACKGROUND

Patient and visitor perpetrated workplace violence (WPV) is a problem within healthcare and is known to be underreported by nurses and other healthcare workers. However, there are multiple and diverse reasons identified in the literature as to why nurses do not report. This systematic review aimed to investigate nurses' reasons and rationale related to underreporting of violence that occurs in the workplace.

METHODS

Following PRISMA guidelines for systematic review reporting, studies conducted between 2011 and early 2022 were identified from MEDLINE, CINAHL, APA PsychInfo, and Psychological and Behavioral Sciences Collection via EBSCOHost. Quantitative studies related to patient and visitor perpetrated violence containing explanations, reasons, or rationale related to underreporting were included.

RESULTS

After quality appraisals, 19 studies representing 16 countries were included. The resulting categories identified nursing, management, and organizational factors. The most prominent nursing factors included nurses' fear of consequences after reporting, nurses' perceptions, and their lack of knowledge about the reporting process. Common management factors which contributed to nursing underreporting included lack of visible changes after reporting, non-supportive culture in which to report, and the lack of penalties for perpetrators. Organizational factors included the lack of policies/procedures/training for WPV, as well as a lack of an efficient and user-friendly reporting system. Supportive interventions from management, organizations, and community sources were summarized to provide insight to improve nurse reporting of WPV events.

CONCLUSION

Underreporting of WPV is a complex and multi-faceted problem. An investigation into the rationale for underreporting a workplace violent event illustrates nurses, management, and organizations contribute to the problem. Clear and actionable interventions such as educational support for staff and the development of a clear and concise reporting processes are recommended to encourage staff reporting and to help address WPV in healthcare.

The Effect of a System-Level Tiered Huddle System on Reporting Patient Safety Events: An Interrupted Time Series Analysis

BACKGROUND

The objective of this research was to evaluate the effect of implementing a system-level tiered huddle system (THS) on the reporting of patient safety events into the official event reporting system.

METHODS

A quasi-experimental study using interrupted time series was conducted to assess the impact and changes to trends in the reporting of patient safety events pre- (February-July 2020; six months) and post- (September 2020-February 2021; six months) THS implementation within one health care system (238 clinics and 4 hospitals). The severity of harm was analyzed in July 2021 using a modified Agency for Healthcare Research and Quality (AHRQ) harm score classification. The primary outcome measure was the number of patient safety events reported per month. Secondary outcomes included the number of patient safety events reported per month by each AHRQ harm score classification.

RESULTS

The system-level THS implementation led to a significant and immediate increase in the total number of patient safety events reported per month (777.73, 95% confidence interval [CI] 310.78-1,244.68, p = 0.004). Similar significant increases were seen for reported numbers of unsafe conditions, near misses, no-harm events that reached patients, and temporary harm (p < 0.05 for each). Reporting of events with permanent harm and deaths also increased but was not statistically significant, likely due to the small number of reported events involving actual harm.

CONCLUSION

These findings suggest that system-level THS implementation may increase reporting of patient safety events in the official event reporting system.

Nurses' perceptions of quality of work life in private hospitals in Enugu, Nigeria: A qualitative study

Despite being essential for retaining nurses, not much is known about nurses' quality of work life (QWL) in private hospitals in sub-Saharan Africa, including Nigeria. We explored nurses' perceptions of QWL, factors influencing it, how it affects motivation, and strategies for its improvement. The study was conducted in seven private hospitals in Enugu, Nigeria. The design was qualitative, using focus group discussion (n = 7) with registered nurses (n = 66) purposively selected using maximum variation sampling and the inclusion criteria. Data were analyzed using verbatim transcription and thematic analysis. The nurses understood QWL from work-family life, work design, work context and work world perspectives. Opportunities for skill acquisition, resource availability, helpfulness from colleagues, and a hygienic work environment improved the QWL and motivation of nurses. Work-family life factors including caring obligations, night shifts, long hours, burnout, and inappropriate leave policies; work design factors including declining autonomy, inadequate staffing, and a high workload; work context factors consisting of a lack of participatory decision-making, blaming nurses for gaps, restrictive training policy, limited training opportunity, and insecurity; and work world factors related to poor remuneration, poor community view of nursing and ease of job termination undermined QWL and demotivated nurses. Strategies identified by the nurses to improve QWL included improving staffing, vacation, care coordination, supportive supervision, teamwork, promotion, participatory decision-making, training opportunities, timely hand-over of shifts, job recognition, and compensation. The quality of nursing work life in private hospitals in Enugu needs improvement. Quality improvement programs addressing the barriers to nurses' QWL are warranted.

Development of Consensus-Based Recommendations to Prevent/Minimize Medication Errors in the Perioperative Care of Patients with Epilepsy: A Mixed-Method

BACKGROUND

This study explored medication errors in the perioperative care of patients with epilepsy and developed consensus-based recommendations to prevent/minimize these errors.

METHODS

A mixed method was used in this study. Medication error situations were explored in semi-structured in-depth interviews with nurses (n = 12), anesthesiologists (n = 5), anesthesia technicians (n = 5), surgeons (n = 4), neurologists (n = 4), and patients with epilepsy (n = 10). The qualitative data were analyzed using the qualitative interpretive description approach. A two-round Delphi technique was used among nurses (n = 22), anesthesiologists (n = 9), anesthesia technicians (n = 7), surgeons (n = 7), and neurologists (n = 5).

RESULTS

A total of 1400 minutes of interview time was analyzed in this study. Of the panelists, 39 (78.0%) agreed that patients with epilepsy present unique challenges to providers of perioperative care that make them prone to medication errors. The interviewees in this study described 32 different medication error situations that occurred while providing perioperative care services to patients with epilepsy. In this study, 35 consensus-based recommendations to prevent/minimize medication errors in the perioperative care of patients with epilepsy were developed.

CONCLUSIONS

The findings of this study are informative to decision-makers in health care facilities and other stakeholders in health regulatory authorities who need to design measures to prevent/minimize medication errors and improve perioperative outcomes of patients with epilepsy. Studies are needed to investigate if these recommendations can be effective in preventing/reducing medication errors in the perioperative care of patients with epilepsy.

Scientific View of the Global Literature on Medical Error Reporting and Reporting Systems From 1977 to 2021: A Bibliometric Analysis

BACKGROUND

Error reporting is vital for the prevention of medical errors. Despite the importance of error reporting, underreporting of medical errors is a common reality in many countries. Therefore, barriers to error reporting and reporting systems are a constantly evolving field of research. For this reason, studies on medical error reporting and reporting systems should be evaluated multidimensionally.

AIM

The aim of this study is to evaluate the global research on medical error reporting and reporting systems through bibliometric analysis to obtain a structured macroscopic overview of the features and developments.

METHODS

A bibliometric analysis of 1464 publications from 1970 to 2021 was performed to map the literature of medical error reporting and assess the structure of the scientific community.

RESULTS

After 2000, the number of publications increased annually until a maximum of 2020 was reached. The International Journal for Quality in Health Care and the Journal of Patient Safety have been the most productive journals when it comes to publishing on the subject. Trend topics of keyword plus have changed over time. The United States (1399), England (580), and Australia (478) are the 3 nations with the highest number of publications. On the other hand, it is seen that the subject has yet to be discussed in a few developing or underdeveloped countries.

CONCLUSIONS

This bibliometric analysis shows that the number of publications and authors and cross-country cooperation are low regarding error reporting. The low number of publications and the lack of cooperation, especially in developing countries, reveal the importance of global cooperation.

Factors Influencing Military Nurses' Reporting of Patient Safety Events in South Korea: A Structural Equation Modeling Approach

PURPOSE

This study explored how just culture, authentic leadership, safety climate, patient safety knowledge, and safety motivation all affect military nurses' reporting of patient safety events.

METHODS

This study adopted a cross-sectional and descriptive correlational design. Data were collected from 303 nurses working across eight military hospitals under the jurisdiction of the Armed Forces Medical Command in South Korea, from June 17 to July 25, 2020. The hypothesized model was then validated using structural equation modeling.

RESULTS

The participating military nurses did not show any proactive attitudes toward reporting near misses when compared with their responses to adverse or no-harm events. The final model exhibited goodness of fit. Herein, both safety climate (β = 0.35, p = .009) and patient safety knowledge (β = 0.17, p = .025) directly influence patient safety event reporting. Moreover, just culture indirectly influences patient safety event reporting (β = 0.31, p = .002). The discovered influencing factors account for 22.9% of the variance in explaining patient safety event reporting.

CONCLUSIONS

Our findings indicate that just culture, safety climate, and patient safety knowledge either directly or indirectly affected patient safety event reporting among military nurses. These findings then serve to provide a theoretical basis for developing more effective strategies that would then improve military nurses' patient safety behaviors.

The horizon of pediatric cardiac critical care

Pediatric Cardiac Critical Care (PCCC) is a challenging discipline where decisions require a high degree of preparation and clinical expertise. In the modern era, outcomes of neonates and children with congenital heart defects have dramatically improved, largely by transformative technologies and an expanding collection of pharmacotherapies. Exponential advances in science and technology are occurring at a breathtaking rate, and applying these advances to the PCCC patient is essential to further advancing the science and practice of the field. In this article, we identified and elaborate on seven key elements within the PCCC that will pave the way for the future.

Perceived Barriers of Incident Reporting Among Internists: Results from Hamad Medical Corporation in Qatar

Background Adverse events (AE) are responsible for annual deaths that exceed deaths due to motor vehicle accidents, breast cancer, and AIDS. Many AE are considered preventable. Thus, AE needs to be detected and analyzed. Incident reporting systems (IRS) are crucial in identifying AE. Nevertheless, the incident report (IR) process is flawed with underreporting, especially from the physicians' side. This limits its efficiency in detecting AE. Therefore, we aimed to assess the practice and identify the barriers associated with incident reporting among internal medicine physicians in a large tertiary hospital through a survey.

Methods A cross-sectional descriptive study. We distributed an online survey to physicians working in the Internal Medicine Department of Qatar's largest tertiary academic institute. The questionnaire was validated and piloted ahead of the start of the trial. The response rate was 53%.

Results A total of 115 physicians completed the survey; 59% acknowledged the availability of an institutional IRS. However, only 29% knew how to submit an online IR, and 20% have ever submitted an IR. The survey revealed that participants were less likely to submit an IR when they or a colleague is involved in the incident; 46% and 63%, respectively. The main barriers of reporting incidents were unawareness about the IRS (36%) and the perception that IR will not bring a system change (13%); moreover, there exists the fear of retaliation (13%). When asked about solutions, 57% recommended training and awareness, and 22% recommended sharing learnings and actions from previous IR.

Conclusions IRS is underutilized by internal medicine physicians. The main barrier at the time of the survey is the lack of training and awareness. Promoting awareness and sharing previous learning and actions may improve the utilization of the IRS.

Nurses' experiences in voluntary error reporting: An integrative literature review

OBJECTIVE

This integrative review aimed to examine and understand nurses' experiences of voluntary error reporting (VER) and elucidate factors underlying their decision to engage in VER.

METHOD

This is an integrative review based on Whittemore & Knafl five-stage framework. A systematic search guided by the PRISMA 2020 approach was performed on four electronic databases: CINAHL, Medline (PubMed), Scopus, and Embase. Peer-reviewed articles published in the English language from January 2010 to December 2020 were retrieved and screened for relevancy.

RESULTS

Totally 31 papers were included in this review following the quality appraisal. A constant comparative approach was used to synthesize findings of eligible studies to report nurses' experiences of VER represented by three major themes: nurses' beliefs, behavior, and sentiments towards VER; nurses' perceived enabling factors of VER and nurses' perceived inhibiting factors of VER. Findings of this review revealed that nurses' experiences of VER were less than ideal. Firstly, these negative experiences were accounted for by the interplays of factors that influenced their attitudes, perceptions, emotions, and practices. Additionally, their negative experiences were underpinned by a spectrum of system, administrative and organizational factors that focuses on attributing the error to human failure characterized by an unsupportive, blaming, and punitive approach to error management.

CONCLUSION

Findings of this review add to the body of knowledge to inform on the areas of focus to guide nursing management perspectives to strengthen institutional efforts to improve nurses' recognition, reception, and contribution towards VER. It is recommended that nursing leaders prioritize and invest in strategies to enhance existing institutional error management approaches to establish a just and open patient safety culture that would promote positivity in nurses' overall experiences towards VER.

Nurses' Decisions in Error Reporting and Disclosing Based on Error Scenarios: A Mixed-method Study

Background: It is ensured that nurses’ error reporting and disclosing improve services to patients and are considered a movement toward creating a culture of transparency in the healthcare system. Objectives: This study aimed to investigate the nurses' decisions on reporting and disclosing Medical Errors (MEs). Methods: This research followed a mixed-method embedded design that was performed in five hospitals in Iran in 2018. A total of 491 nurses participated in the quantitative phase of the study with stratified sampling, followed by a simple random sampling technique. Also, 22 nurses joined the qualitative phase. Data were collected using a researcher-made questionnaire and semi-structured interviews through a scenario-based method. Quantitative data analysis was performed using descriptive and analytical statistics by SPSS 21.0 and Expert Choice 10.0 software. The qualitative data were analyzed based on the content analysis approach. Results: The most important perceived barriers with the highest impact coincided with educational (57.17%) and motivational (56.77%) factors based on SEM analysis (ES: 1.33, SE: 0.16). Regression analysis showed that error-reporting mechanisms, educational factors, and reporting consequences were significantly associated with age, sex, and work experience (P-Value ≤0.05). Error scenarios were thematized into three categories: Error perception (including ambiguity and weakness in error definition, the severity of the error, unawareness of guidelines, deviation from standards, and untrained staff), error reporting (including ineffective reporting system, hesitation in reporting to a formal system, increased workload, improper reaction, punitive responses, and concerns about consequences), and error disclosure (including no disclosure, partial disclosure, and full disclosure). Conclusions: The obtained results contributed to a better understanding of the barriers to error reporting and disclosing. In addition, these results can help hospitals encourage error reporting and ultimately make organizational changes, which reduce the incidence of errors.