Dealing with Clinical Incidents in Nursing

In life, mistakes happen. Accidents happen. Errors happen. In healthcare, mistakes, accidents, and errors can be the difference between life and death. Nurses and other healthcare professionals strive to avoid such occurrences. Several measures are put in place to avoid such events, generally referred to as clinical incidents.

Clinical incidents are unintended or unforeseen events that lead to harm or potentially lead to harm to the patient/patients in our care. They include medication errors, patients falls, surgical complications, conflicts and so on. For nurses, medication errors are common, including, giving the wrong medication or wrong dose or using the wrong route.

In the few years I have been an RN, I have been involved with two major clinical incidents indirectly. One happened when I was the nurse in charge of the shift where the wrong dose of insulin was given and the other happened when I was the patient's primary nurse, just after my shift. Reflecting back now, I have learned key lessons on how to avoid incidents and what to do when they occur.

Before we delve into how to react when incidents occur, let's first talk about how to avoid them in the first place. Below are a few things to have in mind:

• Competence. Competence. Competence. Before you perform any procedures or administer any medication, make sure you are competent and signed off for it.

  
  

• When in doubt, seek advice. You might be skilled but lack confidence or encounter something new. Always request guidance from a senior colleague. For medication, you can consult colleagues or trustworthy sources like the BNF or Medusa.

  
  

• Speak Up. This is especially crucial in matters of staffing. In an earlier post, I mentioned that "accepting responsibility also means accepting liability." Taking care of numerous patients simultaneously increases the risk of making errors, whether by commission or omission. Therefore, express your concerns before taking on responsibility. Additionally, if necessary, seek assistance when feeling overwhelmed.

  
  

• Always document your work. We've heard it over and over. If its not documented then it did not happen. The second incident I was involved with, was raised months after I had taken care of that patient. It is through my notes that I could even recall the specifics of what happened on that night.

Accepting Responsibility also means Accepting Liability

Even with all the safety precautions, errors can still occur. Here's how to handle clinical incidents as a nurse:

Escalate

When incidents happen, there is a temptation to sweep them under the rug and handle them yourself. This may stem from fear of consequences. However, escalating is the best course of action to even protect yourself. Sometimes, the error may not have an immediate impact but will affect the patient later. Speak to the nurse in charge about it. Involve the medical team as soon as possible. This way, countermeasures can be put in place in good time. The patient may need emergency treatment; therefore, escalating appropriately might save a life. Additionally, by escalating, you may receive the necessary support to prevent future incidents.

Duty of Candour

The duty of candour is essentially about honesty. We consistently maintain transparency with patients and their families regarding their diagnosis, treatment, and prognosis. Similarly, we must be truthful when incidents happen. The fear of potential repercussions might cause a hesitation to inform the patient. However, it is their right to be informed, and we must communicate with them. Consider how you would feel in their position; you would want to be informed if a medical error occurred during your care.

Duty of candour also has the following benefits:

• Improved Patient Trust: Promotes transparency and builds trust between healthcare providers and patients.

• Enhanced Patient Safety: Encourages open discussions about errors and near misses, leading to improved safety practices.

• Better Communication: Fosters a culture of open communication, which can lead to better patient outcomes and satisfaction.

• Accountability: Holds healthcare providers accountable for their actions, encouraging a culture of responsibility.

• Learning Opportunities: Provides valuable insights for organizations to learn from mistakes and implement changes to prevent future incidents.

• Legal Protection: Can potentially reduce legal risks by demonstrating a commitment to transparency and patient care.

• Regulatory Compliance: Aligns with healthcare regulations and standards, ensuring organizations meet their legal obligations.

• Empowerment of Patients: Empowers patients to make informed decisions about their care based on full disclosure of information.

  
  

Complete Incident Report

Follow your hospital's protocol to fill out an incident report. Incident reports are utilized not only for audits but also to comprehend why the event happened and how to prevent them from occurring in the future. Once more, honesty and transparency are crucial when completing the report.

By analyzing reported incidents, healthcare organizations can implement changes that improve the overall quality of care provided to patients. They can identify patterns and address systemic problems effectively. Also, opportunities for staff training can be identified. On the part of the staff, by completing an incident report, you will demonstrate a commitment to transparency and continuous improvement that may help you in case there is a legal issue.

Writing a Statement

In the most recent incident I was involved in, all nurses who attended to that patient were required to write statements about the events. This occurred months after caring for the patient. Luckily, my notes from that shift had clearly documented the patient's condition and my interventions. Without going into specific details, this patient had OSA and used a CPAP machine for sleep. However, the machine had not been used in the ward for some time because it malfunctioned and required servicing. Since I was on a night shift, there was little to follow up on because the relevant departments operated only during the day.

In my statement, I highlighted everything I could remember referring to my notes. What I did not do was consult extensively or research on how to write a proper statement. I ended up taking on some responsibility that I shouldn't have. The Royal College of Nurses offers advice on how to write statements here. If unsure, always consult a senior colleague, a lawyer, or a union rep.

Overall, as healthcare providers, we strive to avoid clinical incidents but when they happen, the steps you take will determine if the incident has positive or negative repercussions in the aftermath.