Resolution: Incident reporting

This resolution passed.

Reporting incidents/near misses is key to the reduction/prevention of workplace occurrences, which can result in unexpected and unwanted consequences for staff, patients, and others.

Incident reporting can demonstrate where required practice has taken place, identify where expectations have been exceeded and where practice has positively influenced the outcome. An embedded culture of learning from what went well in managing an incident may balance fears around ‘blame/fault’ and promote reporting of all incidents/near misses.

Factors around the willingness of nursing staff to submit incident reports, and therefore the amount and quality of information received, can be divided into two areas; the reporting system itself, and the organisational/team culture, within which the system is being used.

Staff fearing the negative consequences of submitting incident reports is not new, however the impact of the pandemic, alongside unsustainable pressures, exhaustion, and work-related stress, is leading many nursing staff to become defensive about their practice (Allen, 2021).

Consequently, there are situations where the individual is viewed to be avoiding being found at fault, attributing blame to others, or being seen as malicious, which is often not the intent. The Health and Social Care (HSC) staff survey (Northern Ireland) showed only 68% of respondents have the confidence to submit reports, with under half agreeing that the staff involved are treated fairly (Northern Ireland Statistics and Research Agency, 2021).

This is not a healthy motivation for, or response to, the reporting of incidents/near misses. This situation needs to be recognised and addressed so staff can feel confident in being able to report openly. Furthermore, those involved in the incident/near miss need to be assured appropriate action will be taken to find out what/why it went wrong and what can be done to prevent reoccurrence. The emphasis should be on learning from the incident, rather than apportioning blame, even when mistakes have happened, as learning from mistakes is the foundation of any incident reporting system (Hasanpoor et al.,2022).

Whilst culture within a team greatly influences how effective incident reporting is, managers have a lead role in developing/sustaining this, including making sure there is a prompt/proportionate response to all those involved. In the HSC study, only 26% of respondents said senior managers act on staff feedback. Data from Scotland (Hasanpoor et al., 2022) indicates nursing staff/nursing students feel they are not always encouraged to report incidents or feel psychologically safe when reporting. Without this response, staff can be discouraged from completing often lengthy and detailed forms as they see no evidence of change being affected, and opportunities to improve quality/safety of services being missed.

In Wales, a Duty of Quality Statutory Guidance 2023/Quality Standards 2023 (Duty of quality statutory guidance - gov.wales 2023) requires quality-driven decision-making and planning to deliver better outcomes for all those requiring health services. That means the health service will monitor/report and escalate indicators/measures through governance structures, ensuring appropriate action is taken at every level in terms of learning/improvement, and accountability.

It is important the positives of incident reporting are recognised/celebrated and factors affecting the rate of incident reporting addressed. The RCN Raising Concerns Toolkit acknowledges a learning culture is required to ensure patient safety and promote high-quality person-centred care.

Nursing staff should be confident that doing the right things – reporting incidents/near misses/concerns, being candid about mistakes, talking openly about errors and sharing ideas for improvements – are welcomed and encouraged. They should be confident their team/organisation will focus on system learning, not individual blame and should be psychologically safe when raising concerns.

Reading list for this debate available at rcn.libguides.com/congress2023.

References
Allen D (2021) Have you ever been ‘Datixed’? How to end weaponised incident reporting, Nursing Management, 28(6), pp.6-8. Available at: https://journals.rcni.com/nursing-management/analysis/have-you-ever-been-datixed-how-to-end-weaponised-incident-reporting-nm.28.6.6.s2/full (Accessed 16 March 2023).

Birkeli GH, Jacobsen HK and Ballangrud R (2022) Nurses’ experience of incident reporting culture before and after implementing the Green Cross Method: a quality improvement project, Intensive & Critical Care Nursing, 69. https://doi.org/10.1016/j.iccn.2021.103166

Hasanpoor E, Haghgoshayie E and Abdekhoda M (2022) What are the barriers to nurses reporting incidents?, Evidence Based Nursing, 25(3), p.97. https://doi.org/10.1136/ebnurs-2021-103440

Northern Ireland Statistics and Research Agency (2019) 2019 HSC Staff Survey - Regional Benchmark Report. Available at: https://www.health-ni.gov.uk/publications/2019-hsc-staff-survey-regional-benchmark-report (Accessed 16 March 2023).

Duty of quality statutory guidance - gov.wales. (2023). Available at: https://www.gov.wales/sites/default/files/consultations/2022-10/the-duty-of-quality-statutory-guidance-2023-and-quality-standards-2023.pdf (Accessed 16 March 2023)