| Learning Objective #1: Articulate the relationship between work enviornment and the occurrance of medical errors | |||
| Learning Objective #2: Describe the methodology of a case-crossover study design |
Objective: To determine if medical errors are triggered by specific working conditions.
Design: An ongoing case-crossover study involving a research partnership between medical and nursing researchers and a regional hospital network.
Population, Sample, Setting: Nurses (anticipated n=300) employed throughout a large hospital system.
Concept or Variables Studied Together: Changing work conditions such as work pace, staffing levels, shift duration, sleep deprivation, distractions, and unfamiliar equipment or work unit.
Methods: We are interviewing nurses who report that they made an error and are comparing the working conditions on the error shift with a non-error shift.
Findings: Preliminary data (n=21) indicate that errors occur when the nursing shift has fewer staff, is “more hectic”, or involves higher acuity patients. On the error shift, nurses feel more ill, rushed, and distracted. They also have additional nursing responsibilities (eg. being in charge, orientating new staff members, being on the code team) on the error shift. Over 50% of nurses state the quality of report on the error shift is less than adequate. Interestingly, on both error and non-error shifts, over 80% of nurses report that they’re missing important patient information.
Conclusions: Errors tend to occur on shifts associated with decreased staffing, sicker patients, and when nurses have increased responsibilities. Nurses are missing important patient information on both error and non-error shifts.
Implications: Errors tend to occur on busier, more demanding shifts even though the majority of nurses report missing important information on all shifts. This suggests that on non-error shifts, nurses have the opportunity to clarify existing information or obtain additional information to ensure proper patient care. Alterations to the work environment, including limiting nursing responsibilities to direct patient care, may lead to reductions in medical errors and improve patient care.
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