Testing an innovative method to collect adverse events data: A methodological study.

摘要

Purpose. The Shift Coupon was designed to provide a more accurate measure of adverse events occurring in the hospital setting by eliminating the two overriding barriers to reporting adverse events: “(1) fear and (2) lack of belief that it [reporting the adverse event] results in improvement” (Leape, 1999, p. 1). Thus, the study purposes were to test the ability of the Shift Coupon to collect adverse events data and to explore the hospital work environment as it related to registered nurses' reports of adverse events.; Methods. Design: Nonexperimental descriptive, comparative; Sample: 1,000 randomly selected registered nurses; Instruments : Shift Coupon and Blegen/Vaughn Work Environment Index; Procedure: Mailed registered nurses surveys following Dillman's (2000) Tailored Design Method. Registered nurses completed Shift Coupons for 5 shifts and the Blegen/Vaughn Work Environment Index then returned completed instruments; Data Analysis: Descriptive statistics and chi-square.; Results. 355 registered nurses returned 1937 Shift Coupons (46.7% response rate), with 247 (69.6%) registered nurses returning 1369 coupons for shifts worked in a hospital. On the majority of Shift Coupons (70.9%) registered nurses reported that no adverse event occurred. The most commonly reported adverse events were: patient complaints (21.4%), medication errors (18.9%), family complaints (17.6%), and patient falls (12.1%). Registered nurses identified lack of staff (36.8%), lack of communication (30.5%), and work overload (29.5%) as the most frequent causes of adverse events. Shift Coupons did collect more adverse events data than incident reports (p .001). Blegen/Vaughn Work Environment Index data supported the underreporting of adverse events and Shift Coupon findings and provided insights for future coupon studies.; Conclusion. The Shift Coupon is a viable method to collect adverse events data.; Implications. The Shift Coupon provides a method for collecting adverse events data in the hospital setting that attenuates barriers to reporting adverse events while placing front-line healthcare professionals in a position to identify direct and indirect adverse event cause(s). Shift Coupon data can be used to isolate areas needing quality improvement and to develop appropriate quality improvement initiative(s) to decrease the occurrence of adverse events.