An Intervention to Optimize Attitudes Toward Adverse Events Reporting Among Tunisian Critical Care Nurses

Abstract

Objective: This study aimed at evaluating the impact of a combined-strategies intervention on ICUs nurses' attitudes toward AE reporting.Methods: We conducted a quasi-experimental study from January to October 2020 which consisted of an intervention to improve attitudes toward incident reporting among nurses working in 10 intensive care units at a university hospital using the Reporting of Clinical Adverse Events Scale. The intervention consisted of a 2-hour educational presentation for nurse unit managers and a 30-minute in-units educational training for intensive care unit nurses, which encompassed technical aspects of reporting, the reporting process, a nonpunitive environment, and the importance of submitting reports. The educational presentation was reinforced with distributing posters and brochures and biweekly patient safety rounds that inquired about events, reinforced education, and provided follow-up to incident reports.Results: All dimensions were significantly improved. Score increased from 27.4% to 42.1% ( P < 0.01) for perceived blame, from 35.2% to 52.5% for perceived criteria for identifying events that should be reported ( P < 0.01), from 34.3% to 46% for perceptions of colleagues' expectations ( P = 0.04), from 37.1% to 51.4% for perceived benefits of reporting ( P = 0.01), and from 29.2% to 51.4% for perceived clarity of reporting procedures ( P < 0.01).Conclusions: Interventions using a combination of several strategies such as training, safety round, and messaging can be effective and should be considered by hospitals attempting to increase adverse events reporting. Results reinforce the assumption that a nonpunitive environment and the resulting feeling of safety and reassurance are crucial to foster the submission of reports.

Attitudes of Internal Medicine Nurses, Surgical Nurses and Midwives towards Reporting of Clinical Adverse Events

“…Interestingly, the RoCAES questionnaire was used to evaluate the effectiveness of the educational measures taken on adverse event reporting. Improvements in all dimensions of the RoCAES scale were found as a result of training [ 28 ]. A report of a nationwide survey of the opinions of medical and nursing staff (3410 participants) on adverse event reporting and the requirements that reporting systems in healthcare should have, conducted in 2015 using a postal survey technique, shows that ward managers demonstrated high acceptance of an adverse event reporting system.…”

Impact of an educational intervention on patient safety culture among gynecology-obstetrics’ healthcare professionals

“…Additionally, during the intervention, concrete examples of improvement actions that were made following AEs occurrence were presented, including training sessions and AEs prevention policies in response to reports received. Mentioning to participants that these improvements were implemented in response to reported AEs makes them more confident that reports will really result in positive changes, which in turn motivates them to report more, reinforces learning culture and strengthens the mindset of continuous improvement where errors and AEs are viewed as learning opportunities [ 19 ]. This could explain the significant improvement in the score of the dimensions “organizational learning and continuous improvement” (D4), and “non-punitive response to error” (D7) which could in turn explain the improvement in the dimension “frequency of events reported” (D2).…”

“…The low score related to reporting AEs in our study would probably be linked to the fear of being judged and blamed for committing an error. Indeed, the reporting of these AEs, whose main goal should be to identify their underlying causes and prevent their future recurrence [19] often results in blame and punishment; which is a main contributor to decreased quality of care and institutional stagnation [20][21][22]. The dimension "Non-punitive response to error" (D7) may confirm this where, before the intervention, it had a score of 21.1%, meaning that the majority of staff feel that mistakes are blamed on them and that when an event is reported, it is the person who is singled out and not the problem.…”