Reporting Adverse Events and Near Misses

Reporting adverse events and near misses is an important nursing function and a legal duty. We owe this duty to our patient and our employer. Failure to report an adverse event or near miss; which could be foreseen to be material to the care and safety of a patient, is a breach of duty that can give rise to a claim of negligence. [ The Nurse Practice Act (or similar titled law) in each state contains the laws to which each nurse must lawfully abide.]

The under-reporting of adverse events and near-misses is well documented across all medical professions . Some reasons cited for under-reporting, include embarrassment, employer reprisal and fear of tort litigation (i.e. a legal suit naming the nurse). This is about to change.

The Centers for Medicare and Medicaid has altered its reimbursement policy for hospital acquired conditions (HACs). These changes will limit a provider's ability to bill the government for HACs that occur as a result of medical treatment. Only documented evidence of pre-existing conditions, associated with certain HACs may allow for payment. (Please see Appendix for list of the 14 HACs selected for 2013.)

Nursing will feel the effect in several ways:

It is time to reduce adverse events and eliminate HACs. Nurses are well positioned to do just that. To accomplish the task, nursing must receive its fair share of organizational resources. Organizational support for data collection, nursing research and evidence based practice combined with provider collaboration can improve patient care outcomes.