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Study: Reluctance to Speak Up Encourages Medical Errors
Date:3/22/2011

TUESDAY, March 22 (HealthDay News) -- Nurses often don't speak up about incompetent colleagues or when they see fellow health-care workers making mistakes that could harm patients, new research finds.

In recent years, many hospitals have taken steps to reduce medical errors through measures such as checklists, patient handoff protocols, computerized order entry systems and automated medication-dispensing systems.

But the study, which included 6,500 nurses and nurse managers across the United States, found that too often, nurses don't alert their colleagues when they see a safety measure being violated.

About 85 percent of nurses said a safety measure had warned them about a problem that might have been missed and could have resulted in patient harm. However, 58 percent of these workers admitted that even though they received the warning, they failed to speak up and solve the problem.

More than 80 percent of nurses said they had concerns about three "undiscussable" issues demonstrated by colleagues: dangerous shortcuts, incompetence and disrespect, the investigators found.

On the issue of shortcuts, more than 50 percent of the study participants said they had witnessed events in which dangerous shortcuts led to near misses or caused harm to patients, but only 17 percent of those nurses discussed their concerns with colleagues.

The study also found that more than one-third of participants reported witnessing incompetence that had led to a near miss or actual harm to a patient, but only 11 percent of these witnesses confronted the colleague that they considered incompetent.

The third "undiscussable" issue, disrespect, was cited as the reason why more than half of the study participants could not get others to listen to them or value their professional opinion. Only 16 percent of those who felt ignored actually confronted their disrespectful colleague, the study noted.

The findings show that while safety measures can help prevent medical errors, cultures of silence in U.S. hospitals may undermine their effectiveness, the researchers noted.

"The report confirms that tools don't create safety; people do. Safety tools will never compensate for communication failures in the hospital," David Maxfield, vice president of research at VitalSmarts and lead researcher of the study, said in a news release from the American Association of Critical-Care Nurses.

The American Association of Critical-Care Nurses and the Association of periOperative Registered Nurses partnered with VitalSmarts, a corporate training and organizational performance consulting firm, in an attempt to see how communication barriers can lead to medical errors.

The study, "The Silent Treatment," was to be released March 22.

Because this study was presented at a briefing, the data and conclusions should be viewed as preliminary until published in a peer-reviewed journal.

More information

The U.S. Centers for Disease Control and Prevention offers patient safety tips.

-- Robert Preidt

SOURCE: American Association of Critical-Care Nurses, news release, March 22, 2011


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