Disclosing and Reporting Practice Errors by Nurses in Residential Long-Term Care Settings: A Systematic Review

Abstract

Patient safety is crucial for the sustainability of the healthcare system. However, this may be jeopardized by the high prevalence of practice errors, particularly in residential long-term care. Development of improvement initiatives depends on full reporting and disclosure of practice errors. This systematic review aimed to understand factors that influence disclosing and reporting practice errors by nurses in residential long-term care settings. A systematic review using an integrative design was conducted. Electronic databases including PubMed (including Medline), Scopus, CINAHL, Embase, and Nordic and Spanish databases were searched using keywords relating to reporting and disclosing practice errors by nurses in residential long-term care facilities to retrieve articles published between 2010 and 2019. The search identified five articles, including a survey, a prospective cohort, one mixed-methods and two qualitative studies. The review findings were presented under the categories of the theoretical domains of Vincent’s framework for analyzing risk and safety in clinical practice: ‘patient’, ‘healthcare provider’, ‘task’, ‘work environment’, and ‘organisation & management’. The review findings highlighted the roles of older people and their families, nurses’ individual responsibilities, knowledge and collaboration, workplace atmosphere, and support by nurse leaders for reporting and disclosing practice errors, which had implications for improving the quality of healthcare services in residential long-term care settings.

Barriers to Incident Reporting among Nurses: A Qualitative Systematic Review

“…A previous systematic review in 2016 included a majority of studies conducted in western countries (Vrbnjak et al, 2016), also confirming the findings of this review, while a global study on error reporting systems and barriers in 16 different countries from Africa, Australia, Europe, and North America showed a major commonality between perceived barriers to incident reporting (Holmström et al, 2012). Furthermore, a review in primary care identified that there is a lack of safety culture (Lainer et al, 2015) while studies supported partially the findings of this review both in primary care (Michel et al, 2017) and in long term care settings (Vaismoradi et al, 2020).…”

A Systematic Review of the Legal Considerations Surrounding Medicines Management

“…Collaboration through communication, sharing information and the provision of regular feedback can improve adherence to the principles of safe medication practice [ 39 ]. Nurses have the required knowledge and skills regarding medicines management and spend more time with patients than physicians and pharmacists, increasing their chances of detecting medicines discrepancies and near misses [ 67 , 68 , 69 ]. Therefore, nurses’ role, accountability and knowledge of medications should be taken into account when strategies are devised to improve medicines management [ 19 , 66 , 70 ].…”

Looking for the “Little Things”: A Multi-Disciplinary Approach to Medicines Monitoring for Older People Using the ADRe Resource

“…Nonetheless, the majority of ADRs and other medicine-related harms arise from poor monitoring rather than errors in prescribing [ 32 , 33 , 40 , 41 , 42 , 43 ], being primarily dose-related [ 44 ]. The situation can be greatly improved by enhanced monitoring and reporting [ 18 , 19 , 47 ]. ADRe was developed from earlier research on nurse-led medication checking, originally in relation to mental health medicines prescribed for clients of community mental health teams [ 48 , 49 , 50 ].…”