1 Domestic and foreign "nursing errors, accidents" concept of similarities and differences
1.1 Domestic nursing errors and accidents related to the concept
Medical (nursing) accidents: refers to the medical institutions and their medical personnel in medical activities, in violation of the laws and administrative regulations of medical and health care, departmental rules and regulations, and diagnosis and treatment, negligence, and the use of medical equipment, medical equipment and medical equipment, and the use of medical equipment. Nursing norms, routines, negligence caused by the patient's personal injury accidents.
Nursing error: Where in the nursing work due to poor sense of responsibility, carelessness, not according to the rules and regulations of the work or low level of technology and the occurrence of errors, the patient directly or indirectly have an impact, but did not cause serious adverse consequences known as error.
Nursing errors are divided into general errors and serious errors. General errors are those that do not affect the patient, or have a mild impact on the patient, but do not cause adverse consequences. Serious error refers to the nursing staff's negligent behavior or technical negligence, causing some pain to the patient and prolonging the treatment time.
Nursing shortcomings (traps): in clinical work, the most common is that although there is a certain part of the error, but was found to be timely corrected, and happened to the patient (such as the wrong doctor's orders, but did not execute) the phenomenon known as nursing shortcomings.
Nursing shortcomings are often risk factors for constituting nursing errors, which in turn are risk factors for constituting nursing accidents. Therefore, the effective management of nursing errors and nursing shortcomings is an important means of preventing and eliminating nursing accidents.
1.2 Foreign related concepts
There is no foreign concept that corresponds exactly to it, but there are several concepts that are closely related to it.
Error: the failure to implement the correct plan or take incorrect measures to achieve the goal. Errors do not always result in harm.
Attempted negligence (near miss): in the medical process, there is indeed some error or anomaly, due to intentional or unintentional intervention in real time, the results of the error did not really happen to the patient.
Clinical incident: any event that results in injury, or the potential for injury, to a patient, visitor or staff member, or any event that results in dysfunction], damage or loss of equipment or property, or any event that may result in a complaint.
Medical adverse event: is an unintentional injury or complication that results in a patient's incapacity (disability), death, or prolonged hospitalization upon discharge from the hospital, which results from a healthcare disposition rather than the patient's disease process.
It can be seen that the foreign references to errors that do not lead to the consequences of harm to the patient, clinical abnormalities due to the error of the medical staff that have the potential to harm the patient, attempted negligence, etc. can be referred to as medical errors. Errors with injurious consequences are medical adverse events, or medical or nursing accidents as defined in China. It is worth noting that the scope of management of nursing errors and related contents in foreign countries is larger than that of nursing errors and accidents in China. This is something we should consider when managing nursing safety.
2. The theory and practice of error and accident management in foreign countries
2.1 The theoretical basis of nursing error and accident management
How to manage errors depends on people's understanding of the causes of errors. Reason, a British psychologist, put forward two different views, namely the personal view (personal approach) and the system approach.
The personal approach holds that errors are mainly caused by personal reasons, due to people's psychological disorders such as forgetfulness, inattention, lack of motivation, carelessness, negligence, and imprudence. Therefore, the countermeasure to prevent errors is to punish the person who made the error, such as naming, criticizing, educating, fining, or even threatening to prosecute, in order to remind the person concerned and other people to be more careful and to reduce the occurrence of personal abnormal behavior. The systems view, on the other hand, holds that it is human beings who make mistakes, and that even the best staff within the best organizations are likely to make mistakes. The causes of errors lie primarily in systemic problems rather than human misbehavior. These factors include the pitfalls of recurring errors in the work environment and the organizational processes that give rise to those errors. When an error occurs, the key is not to find out who made the mistake, but to figure out what went wrong with the system and why. The response to preventing errors is to systematically design the defense against them from an organizational perspective to reduce the circumstances and opportunities for making them.
The individual view and the systems view have very different perspectives on why and how errors occur. The individual view focuses on punishing people who make mistakes. It has two main drawbacks. One is that it isolates individual errors from the problems of the system as a whole; in fact, few errors are entirely personal. If no attention is paid to analyzing and improving the systemic problem, the same mistake may happen again even if the wrongdoer is punished. Another disadvantage is that the person who made the mistake, for fear of being blamed or humiliated, may hide a large number of mistakes that can be concealed, thus depriving the relevant departments or managers of the opportunity to learn from the mistakes. Therefore, many high-risk industries such as civil aviation and nuclear power have adopted a systematic view in error management. Dr. L, a professor at the Harvard School of Public **** Health and an expert on patient safety, suggests that the fear of being punished after an error is the single greatest barrier to patient safety promotion within healthcare organizations today. The underlying reason for the repetition of many errors within healthcare organizations lies in the problematic way we manage them.
2-2 Foreign Practices in the Management of Nursing Errors and Incidents
2.2.1 Safety culture based on an error management system view. Safety culture is the sum of values, attitudes, concepts, abilities and behaviors of individuals and groups to hold safety and safety management. Healthcare organizations should change the traditional "blame and shame" culture and build a positive safety culture. A positive safety culture includes four aspects: reporting culture, just culture, flexible culture, and learning culture. When an organization has a positive safety culture, it creates a climate within the organization where people are willing to report unusual incidents and attempted failures and learn from their mistakes. A "systematic + non-punitive environment" is a key hallmark of an advanced safety culture in hospitals. A positive safety culture is the soul of safety management and a decisive factor in its success.
2.2.2 Adverse event or clinical abnormality reporting system. In the United States, Australia and other countries or regions, different types of medical adverse event reporting mechanisms have been established. It includes internal reporting and external reporting; external reporting in turn includes voluntary reporting and involuntary reporting. Voluntary reporting is strongly advocated at present. There are various forms of patient safety reporting, including web-based reporting, telephone reporting, and written reporting. The reporter can report problems that have occurred to him/her or problems that he/she has seen occurring to others. The voluntary reporting system takes the form of anonymity and strict confidentiality of the reporter. The information reported cannot be used as evidence in court proceedings. The authorities concerned offer incentives and even rewards to those who report. Voluntary reporting systems for unusual events have been established in some areas, e.g., the reporting of nursing events in a hospital includes an adverse drug event notification system, a needlestick injury notification system, a fall notification system, a tube slip notification system, an unknown fever notification system, and an abnormal drug administration notification system. The reporting system encourages the collection of information on a variety of events involving patient safety and organizes professionals to analyze the reported information, identify problems, provide feedback to the relevant departments and clinics, and provide timely interventions to mitigate the severity of the consequences of the event if necessary.
2.3 Effects of the implementation of adverse events or clinical abnormalities reporting system
Countries or regions that have implemented the patient safety notification system have seen a significant increase in the number of adverse medical events notified. For example, after the implementation of this new reporting system in a hospital in the United States, the rate of erroneous reports increased by 60% in the first year. This has brought to the surface some of the original errors that were hidden under the tip of the iceberg, making it easier to analyze and improve. Voluntary notification systems have already had a positive effect on promoting patient safety. For example, the Joint Commission on Accreditation of Health Services Organizations (JCAHO) Outpost Incident Reporting Program in the U.S. withdrew high concentrations of potash chloride, which can be fatal, from nurse treatment rooms. The Clinical Incident Reporting System (CIRS), established by the Australian Patient Safety Foundation, resulted in 280 patient falls reported by medical staff in 2 years. In response to the falls, a falls risk assessment form was designed to assess the risk of falls for every patient over the age of 65 years who was hospitalized, and care was taken accordingly. As a result, there has been a significant reduction in the number of fractures caused by falls in patients in hospital.
3 Current situation of nursing error management in China
3.1 The error registration and reporting system
China's nursing error management still follows the relevant provisions of the "Hospital Work System and Hospital Staff Duties" issued by the Ministry of Health in 1982. The main content of the "each department to establish errors, accidents register, by the person in time to register the occurrence of errors, accidents, causes and consequences. The head nurse will organize discussions and summaries in a timely manner. After the occurrence of errors and accidents, according to their nature and circumstances, respectively organize the whole department or the whole hospital to discuss the relevant personnel, in order to raise awareness, learn a lesson, improve the work, and determine the nature of the accident, put forward the views of the treatment. Units or individuals who have committed errors or accidents, if they do not report them in accordance with the regulations and intentionally conceal them, and if they are found out afterwards by their leaders or others, they shall be punished according to the seriousness of the circumstances." For the reporting of medical (nursing) accidents, the provisions of Articles 13 and 14 of the Regulations on the Handling of Medical Accidents promulgated in September 2002 in China on the reporting system for medical accidents are the main provisions.
As can be seen from the relevant provisions, the reporting of nursing errors or accidents is still mandatory, or at least involuntary. The handling of errors is based on finding out the responsibility, and the responsible person or department will be dealt with accordingly. The methods of treatment include review, criticism and education, fines, prosecution, demotion, suspension, and even revocation of practicing certificates. It is not difficult to see that the principle of treatment is still to find out the person who made the mistake, ascertain the extent of his responsibility and criticize and punish the individual or department. Medical personnel and medical institutions, for fear of being criticized and punished, or of being exposed, etc., have to report only those incidents that have to be reported. In essence, it is still a cultural state of blame and shame, and the existing notification system lacks the analysis and utilization of reported information.
3.2 Nursing quality control of nursing errors and accidents in the management of the relevant provisions
Nursing quality management standards put forward the different levels of hospitals serious nursing errors, nursing accidents occurred in the number of provisions, such as the three hospitals 100 beds per year the number of serious errors not more than 05, accidents for zero. This obviously focuses on end-to-end management rather than process management. It cannot be ruled out that in order to achieve this standard, the department intentionally reduces the number of reported errors. From a process management perspective, the more fully errors are exposed, the better, and the number of errors reported does not represent the degree of patient safety. Rather, it reflects the degree to which the safety culture is advanced.
4 Improvement of China's nursing error-incident management methods set
Reform of the traditional culture, emphasis on the improvement of the system rather than the punishment of individuals, and the establishment of an effective patient safety incident notification system are the direction of nursing error-incident management reform.
4.1 Improvement of safety management quality evaluation criteria
Safety management should shift its focus to process management. Develop effective management methods and implement them. The level of ward safety management cannot be evaluated by the number of error reports.
4.2 Improving methods of managing errors and incidents
It is important to create an atmosphere in hospitals where everyone values patient safety, discusses patient safety, and mitigates or exempts those involved in errors and incidents from punishment. This requires a shift in the hospital's perspective from the highest level of leadership to the various clinical staff. For errors that do not result in injurious consequences or disputes, the parties involved may be exempted from punishment. If a dispute or litigation arises and compensation or reparation is required, the medical staff will be held responsible. Blanket exemption or blanket prosecution is not appropriate. We have seen some promising practices, such as Zhou Lining's introduction of the method of analyzing the causes of a nursing error from the whole system and taking targeted measures, but this is still localized. It is in an environment where there is no punishment that people are willing to expose more problems, which is more conducive to solving them.
4.3 Establishment of a voluntary reporting system for errors and incidents
is a necessary prerequisite and an important means of nursing error and incident management. The Chinese Physicians Association has published the 2007 Patient Safety Goals in 2006,*** there are 8 key goals, the 8th goal is to encourage the voluntary reporting of medical adverse events.
Reporting of nursing errors and accidents can be involved in a unified patient safety reporting system organized by physicians' associations and other organizations, or the establishment of a notification system for nursing errors or accidents organized by the Chinese Nursing Association or provincial and municipal nursing associations, and hospitals should set up a notification system for nursing errors and accidents within the hospital. Professionals at all levels of departments should analyze the reported errors and accidents, and provide the results of the analysis to relevant departments such as hospital leaders, relevant administrative departments, and clinical nursing staff in a timely manner. At the same time, relevant research should be vigorously carried out.
Both from the international development and our safety management requirements, the establishment of the voluntary notification of adverse events and related analysis mechanism is imperative. This should not remain on paper only, and it is time for the nursing administrators at large to take some immediate action.