by Jeremy Groves, Consultant in Anaesthesia and Critical Care
“The only real mistake is the one from which we learn nothing.” – John Powell
No one likes making a clinical error. If I look back and consider the mistakes I have made in my career they engender mixed feelings. There is the obvious embarrassment that they occurred in the first place, the feeling that, maybe I should have known better, and the concern that I would be professionally belittled by my peers if they knew about them. I recall one particular theatre list in an eminent London teaching institution shortly after I qualified. I hadn’t written up the pre-op bowel prep for a colorectal case – no one had told me it was needed – and was ritually humiliated in theatre as a consequence. Hardly the way to teach a trainee to be open and honest when things go wrong.
errors need to be out in the open if we are to learn by them.
Yet errors need to be out in the open if we are to learn by them. This is well recognised in the Health Service, and a report by NHS England in 2015 (1) indicated that the number of incidents reported to the National Reporting and Learning System was increasing.
The article by Peyrovi, Nasrabadi and Valiee in the August issue of JICS gives us an insight into some of the barriers to reporting incidents reported by a small cohort of Iranian nurses. They used a structured interview followed by content analysis to explore the issue.
Four barriers were highlighted:
- fear of the consequences
- a feeling of insecurity
- the belief that there wouldn’t be an investigation of the root cause
Subgroups within these included:
- the stigma that would be attached to an individual with potential blame for other incidents
- the reputation of the profession
- fear of punishment
- guilt by association
It is a paradox that, while the management generally are keen for incidents to be reported, there was a fear of lack of managerial support if an individual did report an error. In the NHS I perceive that for many errors, especially the lesser ones, we get the investigation, but seldom see any real change as a result.
The barriers identified in this Iranian study strike me as being pretty universal. The challenge, as identified by the authors in their conclusion, is how to engender an atmosphere based on mutual trust between nurses and nursing managers in which transparency and impartiality prevail. Perhaps we also need to remember the wisdom of Theodore Roosevelt that ‘the man who never makes a mistake is the man who never does anything’.
Exploration of the barriers of reporting nursing errors in intensive care units: A qualitative study
H Peyrovi, A N Nasrabadi, S Valiee
University of Tehran & Sanandaj