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:
Intake nurses may be under increasing pressure to find, document, and report any hint of a pre-existing condition that is associated with the selected HACs.
Hospitals now have financial incentive to preempt adverse events by utilizing data acquired from near-misses.
The public will come to expect total elimination of HACs.
Nursing will increasingly be targeted as a scapegoat for HACs. Nursing legal risk may significantly increase.
The Massachusetts Nursing Association (MNA) reports increasing instances of nurses being reported to the "BORN by a disgruntled supervisor, administrator, colleague, family member, team member—or even a nurse who has been 'caught' in an investigation." Most investigations involve a DPH investigator examining a hospital's condition(s). Since the hospital (ultimately responsible for system errors resulting in patient-centered errors) "doesn't have a face and name," blame must be placed somewhere, and the nurse is the individual closest to the patient.
The MNA also reports that “The National Patient Safety Foundation" electronic mailing list has been buzzing in recent weeks over the issue of how to get hospital staff to increase their reporting of “mistakes.” A Milwaukee hospital is offering baseball tickets to encourage staff to report med errors and near misses—contests, anonymous reporting [is] being encouraged, etc. This is real and it’s happening now, near you!
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.