A safe haven for nurses to report medication errors? Clarian and Spectrum Health Systems prove it is possible!

摘要

Often the degree of punishment following an error was directly tied to the level of harm that resulted or to how frequently we had been involved in other errors. That is, if the error resulted in patient harm, it was more likely that we could expect a note in our file, a bad performance evaluation, suspension, job loss, reporting to our state board, or even liability issues. More importantly, having been involved in a previous error would most surely be considered a negative finding when determining our fate. For those of us not directly involved, we would only find out about the error through the hospital grapevine, or by learning about it the hard way. . .when we too made the same mistake. In this punitive environment of unspoken problems, patients continued to be harmed by preventable mistakes.