Registered nurses' experiences of near misses in ambulance care - A critical incident technique study.
Ambulance care
Critical incident technique
Emergency medical services
Near misses
Nurses
Patient safety
Journal
International emergency nursing
ISSN: 1878-013X
Titre abrégé: Int Emerg Nurs
Pays: England
ID NLM: 101472191
Informations de publication
Date de publication:
11 2019
11 2019
Historique:
received:
08
10
2018
revised:
06
05
2019
accepted:
30
05
2019
pubmed:
25
7
2019
medline:
12
5
2020
entrez:
24
7
2019
Statut:
ppublish
Résumé
In hospitals, potentially harmful near misses occur daily exposing patients to adverse events and safety risks. The same applies to ambulance care, but it is unclear what the risks are and why near misses arise. To explore registered nurses' experiences and behaviours associated with near misses where patient safety in the ambulance service was jeopardized. Based on critical incident technique, a retrospective and descriptive design with individual qualitative interviews was used. Ten men and five women from the Swedish ambulance service participated. Seventy-three critical incidents of near misses constituted four main areas: Drug management; Human-technology interactions; Assessment and care and Patient protection actions. Incidents were found in drug management with incorrect drug mixing and dosage. In human-technology interactions, near misses were found in handling of electrocardiography, mechanical chest compression devices and other equipment. Misjudgement and delayed treatment were found in patient assessments and care measures while patient protection actions failed in transport safety, hygiene and local area knowledge. Experiencing near misses led to stress, guilt and shame. The typical behaviour in response to near misses was to immediately correct the action. Occasionally, however, the near miss was not discovered until later without causing any harm.
Sections du résumé
BACKGROUND
In hospitals, potentially harmful near misses occur daily exposing patients to adverse events and safety risks. The same applies to ambulance care, but it is unclear what the risks are and why near misses arise.
AIM
To explore registered nurses' experiences and behaviours associated with near misses where patient safety in the ambulance service was jeopardized.
METHODS
Based on critical incident technique, a retrospective and descriptive design with individual qualitative interviews was used. Ten men and five women from the Swedish ambulance service participated.
RESULTS
Seventy-three critical incidents of near misses constituted four main areas: Drug management; Human-technology interactions; Assessment and care and Patient protection actions. Incidents were found in drug management with incorrect drug mixing and dosage. In human-technology interactions, near misses were found in handling of electrocardiography, mechanical chest compression devices and other equipment. Misjudgement and delayed treatment were found in patient assessments and care measures while patient protection actions failed in transport safety, hygiene and local area knowledge.
CONCLUSIONS
Experiencing near misses led to stress, guilt and shame. The typical behaviour in response to near misses was to immediately correct the action. Occasionally, however, the near miss was not discovered until later without causing any harm.
Identifiants
pubmed: 31331835
pii: S1755-599X(19)30054-0
doi: 10.1016/j.ienj.2019.05.002
pii:
doi:
Types de publication
Journal Article
Langues
eng
Pagination
100776Informations de copyright
Copyright © 2019 Elsevier Ltd. All rights reserved.