Surprising Stats on Reporting Patient Harm

Tuesday, January 10, 2012 at 6:01 pm

No nurse deliberately intends to harm a patient. After all, that is in direct opposition of the role that nurses play. However, when caring for fragile geriatric patients or transferring injured individuals, accidents can unfortunately happen. As a student getting an ADN degree, how often would you guess that incidents are reported?

I found an article on FierceHealthCare.com written by Alicia Caramenico that shocked me. She states that, “Hospital workers reported only about 14 percent of the patient-safety incidents experienced by Medicare beneficiaries discharged in October 2008, according to a new report from the Office of the Inspector General (OIG)…Hospital staff failed to report the remaining 86 percent of patient harm events, partly due to staff misunderstanding what constitutes patient harm. Hospital administrators labeled 61 percent of the unreported events as those that staff did not identify as reportable and 25 percent as events that staff normally reported but did not report in this case, according to the OIG.”

14 percent!?! Is it just me, or do you find that horrifying? Unfortunately in the article and in the actual OIG report, I couldn’t find the definition for “patient harm” and the incidents that caused the nursing staff to “misunderstand what constitutes patient harm.” I would also like to know that if 86 percent of the incidents weren’t reported, then how did the study know that these incidents even existed. I feel like I’m seeing a lot of smoke and not a whole lot of fire…

The OIG report explains that, “As a condition of participation in the Medicare program, Federal regulations require that hospitals develop and maintain a Quality Assessment and Performance Improvement (QAPI) program. To satisfy QAPI requirements, hospitals must ‘track medical errors and adverse patient events, analyze their causes, and implement preventive actions and mechanisms that include feedback and learning throughout the hospital.’ To standardize hospital event reporting, AHRQ developed a set of event definitions and incident reporting tools known as the Common Formats. We requested and reviewed incident reports from hospitals regarding patient harm events.”

So here is my conclusion: there will always be reports and findings in the medical world and students with health care career training will have to use their discernment and experience to determine what is worth listening to and what does not apply to their work environment.

To read the complete article mentioned in this post, please visit
http://www.fiercehealthcare.com/story/hospital-workers-fail-report-86-patient-harm-events/2012-01-09?utm_medium=nl&utm_source=internal
and
http://oig.hhs.gov/oei/reports/oei-06-09-00091.asp