Sykepleieres erfaring med å skrive avvik på en intensivavdeling

Abstract

Introduksjon Uønskede hendelser i helsetjenesten finner sted jevnlig, og rapportering av disse er en viktig del av pasientsikkerheten. Man har ikke data for å kvantifisere den nøyaktige forekomsten av uønskede hendelser i helsetjenesten, men det antas at det er en betydelig underrapportering.

Hensikt Hensikten med oppgaven er å utforske hvilke erfaringer sykepleiere på en intensivavdeling har med å skrive avvik. Det ønskes å finne ut av hvilke faktorer som fremmer avviksrapportering, og hvilke faktorer som kan virke hemmende.

Metode Det ble utført en kvalitativ studie med semistrukturerte intervju. Informantene bestod av syv sykepleiere fra to intensivavdelinger, rekruttert fra to lokalsykehus i Norge. Malteruds systematiske tekstkondensering (STC) ble brukt som analysemetode.

Resultat Felles for informantene var at ingen hadde hatt systematisk opplæring i avvikshåndtering. Informantene presenterte mangel på tid som en betydelig hemmende faktor. Dersom det derimot var pasientskade involvert, ble det av informantene prioritert avviksrapportering. Flere av sykepleierne kviet seg for å skrive avvik på sine kolleger, da dette kunne bli sett på som angiveri. Det kom frem i studien at en avgjørende faktor som fremmer avviksrapportering, er tilbakemelding og respons fra ledelsen.

Introduction Adverse incidents in health care occur on a regular basis, and reporting these incidents is an important part of patient safety. There is no data to quantify exact incidence of adverse events, however it is assumed to be a significant underreporting.

Purpose The purpose of the thesis is to explore what experiences nurses in an intensive care unit have with reporting deviation. It is desired to find which factors that promote deviation reporting and which factors that may have an inhibitory effect.

Method A qualitative study was conducted by semi structured interviews. The informants consisted of seven nurses from two different intensive care units, recruited from two local hospitals in Norway. As method of analysis Systematic Text Condensation (STC) by Malterud was used.

Result None of the informants have had any systematic training in handling deviations. The informants presented lack of time as a substantial inhibiting factor in reporting deviation. In cases of patient injury however, deviation reporting is prioritized. Several of the nurses are uncomfortable with reporting deviations concerning their colleagues, as this could be considered as slandering. The study shows that a crucial factor that promotes deviation reporting is feedback and response from the management.

Conclusion The nurses are clear on the importance of reporting deviations. Barriers such as time pressure, different priorities, reporting culture and diffuse definitions on what is considered as adverse incidents constitute obstacles to a uniform reporting culture. The employees must receive sufficient and systematic training. It must be structured and facilitated for reporting deviation during working hours, and work must be done to create more openness around adverse incidents and deviation reporting to improve reporting culture.