Evaluating Harm Scores in Incident Reporting Key to Improving Patient Safety

WASHINGTON, DC—Organizational leaders who establish an environment and processes that focus on monitoring systems in which nurses and other health care providers function is key to staff consistently understanding and interpreting definitions of harm scores in incident reporting, research presented at the Oncology Nursing Society (ONS) 38th Annual Congress has found.

The degree to which patient safety incident reports are underreported is not known,” noted Toni Abbasi, RN, MBA, of the MD Anderson Cancer Center, Houston, TX. “Incorrect data may alter the accuracy of error rates and promote invalid measures of patient safety.”

Noting that “incident reporting is a key initiative to improving patient safety,” Abbasi and colleagues have designed a quality improvement project with the goal of improving rater accuracy and interrater reliability in an incident reporting system. Their goal: to evaluate the accuracy of harm scores entered into the incident reporting system by clinical nursing staff on inpatient units.

A random sample of 85 bachelors's prepared (BSN) nurses, who have myriad experience and education levels, were selected from the two 26-bed inpatient medical and surgical units at the cancer center (53 nurses from Unit A, a surgical unit, and 32 nurses from Unit B, a medical unit).

Only full-time or part-time clinical nursing staff employed since the Patient Safety Net (PSN) incident reporting system was instituted participated in the survey, which is comprised of the AHRQ Harm Scales v.1.1 and 1.2 survey and was placed in Survey Monkey and sent as a link.

Nurses completed the survey between January 15 and February 3, 2013. Participants were given 20 minutes to complete the survey. Unit A (the surgical unit) had a baseline completion rate of 83% (63/64), and Unit B (the medical unit) had a baseline completion rate of 82% (32/39).

Safety scenarios were scored to determine the level of harm. The researchers found that overall agreement for both scales demonstrated only moderate inter-rater reliability. In addition, they found that inpatient nurses do not agree on the application of harm scores entered using the current harm scale in the incident reporting system, and that developing a scale that applies to a wide range of event types is challenging.

“The routine incident reporting system may not provide an accurate picture of the extent and severity of harm reported in patient safety incidents,” she noted. “Little attention has been paid to how this process actually occurs in healthcare organizations. The definition and classification of safety related events may influence information gathering, incentive allocation and data analysis in hospitals. The way in which events are defined and classified in incident reporting systems by nurses influences the ability of a hospital to learn from medical errors.”

Improving rater accuracy when entering incidents is vital for patient safety, the authors concluded. In addition, nurses should ensure that all nursing staff are properly educated in the use of the harm scale and incident reporting system. Further assessment is needed to assess the reliability of the harm score scale, they added.

The research team plans to reevaluate the current AHRQ Common Formats Harm Scale 1.1, reeducate staff about how to use the incident reporting system and harm scale, develop an intervention for improving the accuracy of incident reporting, and encourage nursing leaders to review reported events randomly for accuracy.

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