Situational Analysis of Incident Reporting in Medical Intensive Care Unit 1 Nakornping Hospital, Chiang Mai Province

Abstract

Risk management is an important tool for managing the quality and safety of healthcare service. Incident reporting is a step of risk management process for gaining lessons learned and ways to address and prevent risks. This descriptive study sought to describe the situation of incident reporting and to propose ways to solve incident reporting problems at the Medical Intensive Care Unit 1 at Nakornping Hospital, Chiang Mai Province. The study population included 21 registered nurses involved in reporting incidence. The data were collected using semi-structured interviewing, focus group discussion, and document review. Data were analyzed using content analysis according to the conceptual framework of Donabedian (2003)’s quality assessment which includes:1) structural aspect, 2) processing aspect, and 3) outcome aspect.

            The study results were as follows:

1. Structure. The Medical Intensive Care Unit (ICU) had policies regarding incident reporting which were consistent with those of the hospital that were integrated into the hospital risk policies. At the hospital level, the hospital risk management committee was responsible for incident reporting. However, for the Medical ICU, the head nurse, nurse coordinator for quality assurance at the unit, and all personnel were responsible for reporting risk incidents. Items that supported incident reporting were the incident report recording form, a computer, as well as an information technology system for incident reporting. Ways to report incidents included verbal reports, submitting the form, and reporting through the computer program. Problems identified were: insufficient communication regarding the incidence reporting policy; overwork load for the head nurse; lack of skills and experience in incident reporting among the personnel; and the filing system was not convenient to use. Suggestion included: discussion and sharing experiences regarding the incident reporting policy; personnel should be trained on incident reporting; and the unit should organize the filing system.
2. Process. It was revealed that the incident reporting process corresponded to the hospital's process which consisting of 4 steps: 1) assessing the severity of the incident; 2) reporting incidents; 3) recording; and 4) submitting the report. The following problems were found: nursing personnel assessed the severity of incidents incorrectly and incident reporting was incomplete and inaccurate. Submitting the incident report was not in accordance with the guide to submit the report in both paths and the time frame. Therefore, the head nurse should monitor and supervise her staff about the incident reporting process closely. Nurse administrators should support the development of personnel’s competencies regarding their knowledge and skills of incident reporting.
3. Outcome. It was found that the percentage of incident reporting and of reports that were recorded correctly were low.

            The results of this study could provide the hospital and nurse administrators with basic information about incident reporting in Medical Intensive Care Unit 1 at Nakornping Hospital, Chiang Mai Province. They could apply these findings to generate the strategies for improving incident reporting in the Medical Intensive Care Unit 1 and in the hospital, accordingly.