Adverse events in nursing care : a study of reports by patients, families and healthcare providers

Abstract

Background: Patient safety has, over the last decades, been increasingly established as an important global issue. Patient safety is jeopardized by for example adverse events and most of the current evidence on adverse events originates from hospitals, but many adverse events also happen in nursing homes. It is clear that adverse events occur in nursing care and can cause suffering and even death, which could have been avoided if adequate actions had been taken. While the literature on improving patient safety is extensive, there is a dearth of studies from the perspectives of patients and their relatives.

Aim: To gain new insights about adverse events in nursing care from the perspective of patients and their relatives as well as health care providers, and describe contributing factors to serious adverse events. The specific aim in paper I was to examine adverse events in nursing care as they are experienced by patients and relatives. In paper II the aim was to identify the most common serious adverse events that occur in nursing homes, and their most frequent contributing factors, in order to contribute to the improvement of safe nursing care.

Methods: The design was descriptive, based on a total sample of data collected from national registries in Sweden. The method was content analysis with both a qualitative and a quantitative approach.

Results: The findings in study I showed that experiences of adverse events in nursing care, reported by patients and relatives, included suffering from both physical and mental injuries caused by the nursing care. Lack of participation caused negative consequences for patients or relatives, as well as physical adverse events. The findings from study II showed that medication errors, falls, delayed or inappropriate interventions and missed nursing care caused the vast majority of the serious adverse events in nursing homes. The most common contributing factors to serious adverse events were 1) lack of competence 2) incomplete, or lack of documentation 3) teamwork failure 4) and inadequate communication. A comparison of the results of studies I and II showed that there were discrepancies between the adverse events reported by patients and their relatives and the serious adverse events reported by health care providers.

Conclusion: Carers, as well as leaders in health care, can learn from patients’ and relatives’ experiences of adverse events in nursing care in order to improve the quality of nursing care. The contributing factors to serious adverse events frequently interacted, yet they varied between different groups of serious adverse events. A holistic approach to improve safe care in nursing homes requires competence of the staff, safe environments as well as resident’s and relative’s participation.