Chul-Hoon Kim1, Myoungsoo Kim2. 1. Associate Professor, Oral and Maxillofacial Surgery, Department of Dentistry, Dong-a University Medical Center, Busan, Korea. 2. Assistant Professor, Department of Nursing, Ulsan College, Ulsan, Korea.
Abstract
PURPOSE: The aim of the present study was to delineate and evaluate the feasibility of a web-based error reporting system using the International Classification of Patient Safety (ICPS) in a Korean university hospital. METHOD: Seventy-five staff nurses were encouraged to complete error reports on the website during an 8-week period from December, 2008 to February, 2009. To solve the research question, χ(2) test, t test and descriptive statistics were used. RESULTS: Of the 75 enrolled participants, 36% (n = 27) completed at least one web-based report during the 8-week period. There were no significant mean differences in demographics and job-related characteristics between the two groups (compliance group vs. non-compliance group). Error reports were distinguished between those observed that involved others (77%) and those that involved themselves (23%). The majority of incident types involved medications (60.9%), in particular their administration (77.6% of the medication errors). About 90% of events caused "no harm and no change in monitoring" or "no harm, but monitoring initiated or increased". About 45% percent of errors increased in required resource allocation for patients (13.1/10,000 patient-days) and 33.9% of errors augmented to a "formal complaint" (9.8/10,000 patient-days). CONCLUSION: The web-based error reporting system using ICPS proved to be an easy, feasible system for hospitals in Korea. This system will be helpful for inducing general agreement upon errors within clinical nursing practice and bring more attention to any errors made or near misses. Also, it will be able to ameliorate the punitive culture for errors and transform error reporting into a habit for healthcare providers.
PURPOSE: The aim of the present study was to delineate and evaluate the feasibility of a web-based error reporting system using the International Classification of Patient Safety (ICPS) in a Korean university hospital. METHOD: Seventy-five staff nurses were encouraged to complete error reports on the website during an 8-week period from December, 2008 to February, 2009. To solve the research question, χ(2) test, t test and descriptive statistics were used. RESULTS: Of the 75 enrolled participants, 36% (n = 27) completed at least one web-based report during the 8-week period. There were no significant mean differences in demographics and job-related characteristics between the two groups (compliance group vs. non-compliance group). Error reports were distinguished between those observed that involved others (77%) and those that involved themselves (23%). The majority of incident types involved medications (60.9%), in particular their administration (77.6% of the medication errors). About 90% of events caused "no harm and no change in monitoring" or "no harm, but monitoring initiated or increased". About 45% percent of errors increased in required resource allocation for patients (13.1/10,000 patient-days) and 33.9% of errors augmented to a "formal complaint" (9.8/10,000 patient-days). CONCLUSION: The web-based error reporting system using ICPS proved to be an easy, feasible system for hospitals in Korea. This system will be helpful for inducing general agreement upon errors within clinical nursing practice and bring more attention to any errors made or near misses. Also, it will be able to ameliorate the punitive culture for errors and transform error reporting into a habit for healthcare providers.