Study finds failure to include nurses in process of admitting errors to patients, families

Even though nurses routinely disclose nursing errors to their patients, a new study published in the January 2009 issue of The Joint Commission Journal on Quality and Patient Safety shows that nurses often are not included when physicians tell patients about more serious mistakes.

Nurses play such a hands-on role at the bedside of their patients that the study's authors conclude that the absence of nurses from discussions to plan for or disclose errors can diminish the quality of the disclosure experienced by the patient or their family. For example, when nurses are not involved in the planning for disclosure, they may seem evasive in answering patients' questions or stall by encouraging families to write down their questions or set up a meeting with doctors. The study, "Disclosing Errors to Patients: Perspectives of Registered Nurses," systematically explores nurses' attitudes toward and experiences with error disclosure to patients.

"Improving the quality of error disclosure to patients is a top priority in health care," says Sarah E. Shannon, Ph.D., R.N., vice associate dean for academic services in the University of Washington School of Nursing, associate professor of behavioral nursing and health systems at the University of Washington, and lead author of the study. "Error disclosure needs to be a team sport. This means quickly sharing information among the team about the error: what happened, why it occurred, what is being done to mitigate potential harm and prevent future errors, and what the patient has been told, will be told, and when."

The study of nearly 100 nurses reports that nurses say they talk with patients about errors that are within their control, such as late or missed medications or treatments. But nurses in the study said they hesitate to independently disclose errors that involved serious harm or actions of other members of the health care team. In these situations, the nurses said the responsibility fell to the patient's attending physician. The nurses said, however, that they would like a role in the disclosure process as a way to both communicate directly with the patient about nursing's role in the event and to avoid being blamed for the event. The study also found low awareness of institutional disclosure policies.

The study's authors -- three nurses and one physician -- conclude that a team disclosure process is best and recommend that health care organizations establish policies that permit nurses and other caregivers to participate in and raise concerns about the disclosure process. The authors point out that a lack of collaboration and communication in the disclosure process may lead to moral distress, increased job dissatisfaction and job turnover among nurses. In addition, the authors suggest that nurse managers should receive training on how to tell patients and families that a mistake has occurred.

This study was supported by the Greenwall Faculty Scholars Program and the Agency for Healthcare Research and Quality.

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