Meurier, Clency Emmanuel; (1998) Improving the quality of nursing care: A study of nursing errors and their reduction. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Errors and adverse events are common in clinical practice, and have a significant impact on quality and safety issues. They are also a major source of complaints and litigation. However, the study of errors in nursing (apart from medication errors) has been a neglected area of research enquiry. As a result, very little is known of the interaction between professional, contextual, organisational and psychological factors in the production of errors and in their prevention. A series of studies were carried out to investigate the antecedents, types, and incidence of errors as well as nurses' responses to them, principally to identify the types of strategies that may be most effective in reducing errors in nursing care. Using a critical incident technique, the types of errors that were made by nurses and their responses to them were investigated. These were found to occur at various stages of the nursing process. Accepting responsibility for one's error was linked to constructive changes in their practice. The frequency of omissions in the assessment records of patients with chest pain was then examined. The assessment records were found to be very superficially completed and to contain a number of important omissions. When these omissions were compared with nurses' reported omissions, a wide discrepancy was observed. Nurses not only reported significantly less omissions but also attributed their causes mainly to external factors such as job overload rather than internal factors such as lack of knowledge or experience, although they could achieve only 50 % of the expected score in a recall test on chest pain. This may be because they may not have considered these omissions as errors. When they were presented with scenarios describing 'real' errors, they tended to attribute their causes predominantly to internal factors. On the basis of these findings, a system of care pathways was implemented for patients admitted with chest pain to ascertain whether this structured approach to care would be effective in reducing omissions in assessment and care of these patients. The results showed significant improvement in the assessment records of the patients as well as a positive impact on various clinical indicators, including better awareness of patients' needs and improved patients' satisfaction. The results of these studies have implications for the management of errors in nursing and for improving the standard of care given to patients. The evidence suggests that a system approach should be used both for investigating errors in nursing and for reducing their incidence.

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