Determinación de los requerimientos

In order to determine whether feedback was provided within the study’s definition of short cycle (i.e. within 72 hours of when the incident was reported) the time interval between when the incident was reported into IIMS and when the feedback specialist provided feedback was measured. Additionally, in instances when the short cycle feedback period was not achieved the feedback specialist documented reasons why this did not occur. During the provision of short cycle feedback, the feedback specialist was required to complete a record of feedback provided. This documented record of feedback provided included:

i) IIMS ID; ii) incident date; iii) incident time;

iv) principal incident type; v) notifier designation; vi) notifier first name;

vii) notifier last name; viii) incident recorded date; ix) feedback date;

x) feedback time;

xi) feedback transmission; and xii) details of feedback.

The ‘details of feedback’ was a free-text field, which allowed the feedback specialist to indicate whether the reporting staff member believed the feedback provided had educational value in relation to day-to-day patient care tasks, should they volunteer this information.

The short cycle feedback intervention was the primary intervention phase of the study, in which staff members within the study ward would receive educational and formative feedback within a 72 hour period, from when they reported an incident into IIMS. The caveat being that the reporting staff member must identify themselves in the report. It was determined that it would be logistically difficult to provide generic feedback from anonymous incident reports to all study ward staff members and measure the effectiveness of this feedback in accordance with the parameters measured during this phase of the study.

Prior to the commencement of the short cycle feedback intervention phase it was understood that IIMS allowed staff members from other areas to enter an incident and assign it to the study ward. An example of such an incident was if a patient from the study ward is transferred

to another ward (in the study Hospital) and the standard clinical handover procedure is not followed. The receiving ward would be able to enter an incident into IIMS and assign it to the study ward, for appropriate management. It was determined that if any incidents of this nature were received during this phase of the study then no feedback would be provided as the reporting staff member is likely to be from a ward other than the study ward; hence, this circumstance would be beyond the scope of the study. Furthermore, such a reporting staff member would not have completed a consent form to participate in this study. However, it is noted that no incidents of this nature were reported in IIMS during this phase. The verbal query process continued throughout this phase.

Implementation

Due to the restrictions regarding access to incident reports from the IMMS database, the researcher was required to send de-identified incident reports to the feedback specialist. Automated distribution of incident reports to the feedback specialist was not possible due to the limited capabilities of IIMS. Additionally, to ensure continued clinical governance, the Nursing Unit Manager requested that feedback provided by the feedback specialist was advised to her, to ensure consistency of clinical practices within the study ward. Any standard methods of feedback provided by the Nursing Unit Manager continued during this phase of the study, as no interruption to regular clinical practices was a condition of ethics approval. Additionally, the Nursing Unit Manager confirmed that discussions normally take place with the reporting staff member in order to clarify incident details, so the Nursing Unit Manager can implement appropriate remedial action, if required. The Nursing Unit Manager noted that there was no

specific timeframe in which she liaised with a self-identified reporting staff member to clarify incident details; furthermore, it was advised that prompt clarification regarding an incident was dependent on her availability and the reporting staff member.

As per communiqués to study participants in previous phases, an email was exclusively provided to staff members of the study ward in preparation for the short cycle feedback intervention phase (Appendix 7). This email (provided both electronically and in hard-copy) introduced the feedback specialist and provided details on what staff members can expect if they reported an incident in IIMS during this phase.

Standard feedback form was provided to the feedback specialist, to enable standardised recording of information regarding the delivery of formative feedback to reporting staff

members from the study ward. The feedback specialist provided the completed feedback forms to the researcher for data entry into a spreadsheet.

Feedback Specialist

Selection of the feedback specialist was conducted with guidance from the Director of Nursing and Midwifery Services of the study Hospital. It was important that the feedback specialist is not in a position of authority over the staff members on the study ward, as staff perception of the feedback provided may be interpreted as punitive. The feedback specialist’s substantive position was largely based within a community health setting and not within the study or control ward. Furthermore, whilst the feedback specialist was considered a senior nursing staff

member, this was a reflection of the level of clinical expertise, rather than any managerial responsibility. To ensure the feedback provided was practical and clinically meaningful, the feedback specialist was a senior nurse with at least 5 years experience and involved in the ongoing education of clinical staff.