A Novel Indicator for How Fairly Hospitals Treat Healthcare Professionals’ Safety Improvement Efforts: Differences in Hospital Responses to Medical Error Reports Depending the Type of Healthcare Professional Reporting the Event

Abstract

Error reports and subsequent improvement actions are critical components in patient safety, possibly preventing the same events from occurring again. This study investigates how fairly or differently hospitals respond to healthcare professionals' medication error reports according to their job types (i.e., physicians, nurses, and pharmacists). Data from a national voluntary medication error reporting system (MEDMARX) in the US from 1997 through 2007 were utilized for this study. A logistic regression model was applied to understand the difference in the odds that an error report leads a hospital to take actions depending on types of reporters. Actions were acknowledged only when solid changes took place following reports. Because harmful errors generally induce more actions than nonharmful errors, we examined the effect of the reporter separately in harmful and nonharmful error reports. In addition, the differences in responses among different types of hospital owners-namely, government hospitals (GH) and nongovernment hospitals (NGH)-were analyzed to see whether they influence responses to error reports. Phases of the medication use processes such as prescribing, transcribing, dispensing, administering, and monitoring medication related to reporter type (e.g., pharmacists tend to detect most prescribing errors) and, thus, are controlled in the analysis. In addition, to address any clustering of reports within hospitals, the model included a random intercept for hospitals. Ultimately, 605,422 medication error reports were collected from 574 hospitals (153 GH and 421 NGH) for analysis. For nonharmful error reports, compared to hospital responses to reports from physicians, reports from nurses induced significantly fewer actions in both GH (OR=0.63, 95% CI: 0.52-0.77) and NGH (OR=0.62, 95% CI: 0.53-0.72). The ORs for pharmacists (compared to physicians' reports) were 0.25 (95% CI: 0.20-0.30) in GH and 0.56 (95% CI: 0.48-0.66) in NGH. For harmful errors, in GH, reports from nurses and pharmacists were also less likely to lead to action compared to physicians ' reports (nurses: OR=0.58, pharmacists: OR=0.60,. Ideally, error reports should initiate improvement actions regardless of types of reporters. However, this study shows that hospitals are less likely to respond to reports from nurses and pharmacists compared to those from physicians. When healthcare professionals' reports are not addressed well, it can decrease the professionals' morale. Healthcare organizations with error reporting systems need to take full advantage of these underutilized error reports, not only because they are a rich potential source of information, but also because they propel healthcare providers to pursue safety improvements.