Study: Nurses deflect medical errors in cardiac OR

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Helping Hands - 54.60 Kb

Administrators may want to think twice before reducing nursing staff if they care about patient safety in their cardiovascular operating rooms. Circulating nurses prevented or corrected on average 11.11 medical errors—either potentially harmful incidents or incidents they stopped before harm was done—related to cardiac surgical procedures, according to a recently published study.

“The ultimate goal of research on healthcare errors is to identify systems and human behaviors that minimize the frequency and effect of healthcare errors,” wrote Y. Tony Yang, ScD, LLM, MPH, of the health administration and policy department at George Mason University in Fairfax, Va., and colleagues in the June issue of the Association of periOperative Registered Nurses Journal. “Achieving this objective requires recognizing and explaining the systems that will either prevent errors completely or rapidly detect them and prevent them from reaching the patient.”

Nurses play a key role in efforts to achieve and maintain high-quality patient care, but their contributions may fall under the radar in team settings where their vigilance may not be fully recognized or appreciated. Those contributions include what Yang and colleagues termed “error recovery,” which they categorized as potential errors nurses prevent from reaching the patient (intercepted), potential errors that nurses recover before they can harm the patient (mitigated) and errors that nurses stop before harm occurs to the patient (ameliorated).  

For their analysis, they applied a model used in industry to identify workplace errors that had been modified for nursing practices. They chose as their study site the cardiovascular operating room at Inova Heart and Vascular Institute in Falls Church, Va. Three experienced perioperative nurses observed a convenience sample of 18 CABG, isolated valve or combined CABG-valve procedures performed between June and September 2010, with a focus on the circulating nurses.

The observers recorded and rated all medical errors that were intercepted, mitigated and ameliorated by the nurses. They excluded such errors deflected by physicians, pharmacists or other staff. Errors were further categorized as skill-based, rule-based or knowledge-based mistakes due to individual, organizational or technical failures.

Overall, the observers recorded 200 potential errors or errors in progress for an average of 11.11 errors per procedure. Of that total, 78 were medical errors that observers thought actually occurred as opposed to potential errors. The most common recovered medical error involved aseptic techniques and surgical prep (46 percent), with infection assessment or prevention accounting for 10 percent of errors and counting and errors involving skin or tissue injury each claiming 8 percent.

Most errors were deemed skill based (79 percent) and the vast majority were at the individual level (95 percent). The researchers ranked 94 percent of the incidents as potentially significant and 75 percent as definitely preventable. They noted that no adverse events occurred to patients as a result of the incidents.

“Through their assessment and patient care processes, circulating nurses are positioned to consistently identify variances as they arise,” Yang and colleagues wrote. “They also play a significant role as front-line clinicians in identifying and moderating potentially harmful incidents.”

They noted that without circulating nurses, some of the errors that were caught or corrected in the study period might have led to serious adverse events, reinforcing the critical role circulating nurses play in cardiac care. They recommended further research to ascertain factors that help and hinder error recovery, which then could be a resource for both clinicians and educators.