Normas oficiales de envases y embalajes

The measurement between reported incidents and observed (unreported) incidents was measured to quantify the magnitude of underreporting within the study and control ward. It is acknowledged that this was a departure from typical practice of both wards, which can be

considered an intervention in itself; however, no follow-up was undertaken to confirm if staff members reported any incidents they may have observed. The number of incidents observed was quantified via an incident observation document that was completed by staff following the completion of their shift. In order to mitigate ‘double-counting’ of observed incidents (i.e. 2 staff members that observed the same incident) the time and nature of the incident was recorded on the incident observation document, which was reviewed by the principal researcher to determine whether ‘double-counting’ was present.

The disparity between the number of incidents reported and incidents observed was measured over phases 2 to 4 (3 month period) of the study. As described in the literature (Mahajan 2010) the presence of short cycle feedback to the reporting staff member may increase the utility of incident reporting systems; potentially resulting in an inflated number of incidents reported, which could suggest a sudden rise in adverse events and near misses. Nonetheless, when incidents reported were compared to the number of incidents observed, the actual number of incidents was then deduced.

Implementation

The study encompassed all shifts on the study and control wards, to avoid a roster bias. The verbal query of observed incidents, which was recorded by the Clinical Support Officer during business hours, was assigned to in-charge nursing staff for evening shifts. Additionally, the feedback provided by the Clinical Nurse Consultant to evening shift staff was conducted by

face-to-face communication when the relevant nursing staff were rostered on shifts that coincided with business hours.

The verbal query form sought the following information from each participant: i) date and time the verbal query was asked;

ii) the number of incidents observed during the course of the participant’s shift; iii) a brief description of the incident; and

iv) the profession of the participant.

The brief description was used to identify whether more than 1 staff member observed the same incident; thus, this would inaccurately increase the number of observed incidents. If the participant refused a verbal query, the staff member assisting in the verbal query process was encouraged to seek a reason why the participating staff member declined. It is noted that there were no staff members that refused to answer a verbal query.

Clinical Support Officers and In-Charge Nurses

In order to establish the presence and extent of underreporting in the study and control wards a verbal querying process was undertaken. The Clinical Support Officers of the study and control wards were asked to assist in the verbal querying process, following consultation with the Nursing Unit Managers of these wards. In accordance with their normal business hours work pattern, Clinical Support Officers asked all staff members (regardless of profession) within their respective ward whether they observed any incidents. The relevant Clinical Support

Officer was advised of the 1 staff member that refused to participate in the study to ensure that the verbal querying of observed incidents was not asked. Additionally, the Clinical Support Officer and Nursing Unit Manager from the control ward were provided with a list of staff that had consented to participate in the study, as there had been a lower response rate compared to the study ward. As nursing staff members were the largest staffing group in both the study and control ward, a list of consenting nursing staff members from the latter was particularly required, as there had been a response rate of 8 out of 23 potential participants, compared to the study ward’s response rate of 31 out of 33 potential participants. In addition to the Clinical Support Officers, who were able to only facilitate the verbal querying process during business hours (8:30 am – 5:00 pm), Mondays to Fridays, the Nurses in-charge of the afternoon shift (2:30 pm – 11:00 pm) and evening shift (11:00 pm – 7:00 am) were also asked to assist. Whilst the Nursing Unit Manager sought the support of the Nurses in-charge, the researcher met with these staff members to explain the correct procedure regarding verbal querying was

understood.

The Clinical Support Officers and Nurses in-charge were each provided with a one-page instruction document regarding the verbal querying process. A concern raised by Nursing Unit Managers was the disruption that the verbal querying process could cause staff members as they undertake clinical tasks. Therefore, it was emphasised in the instruction document that no staff member was to be approached if they were performing a clinical task. Additionally, the assisting staff members and Nursing Unit Manager of each Ward were provided with a list of participants, per the signed consent form. As such, instructions were issued for the staff

members assisting with the verbal query to avoid approaching non-participants. Verbal queries were asked of staff members towards the end of their shift. The Clinical Support Officers and Nurses in-charge were verbally encouraged to seek verbal queries during the last 90 minutes of the participant’s shift. This timeframe was nominated in consultation with Nursing Unit

Managers, particularly to allow for the time spent towards the end of a staff member’s shift on clinical handover to staff on the next shift. To facilitate the verbal querying process, standard forms were provided to the Clinical Support Officers and Nurses in-charge for them to complete at each verbal query. These completed forms would then be placed into a drop-box located at the nurses’ station of the study and control ward. The drop-box was marked with signage, which showed that it was the drop-box for verbal query forms as part of the study. Additionally, to ensure the forms were secure, the drop-box was securely locked with a padlock and the researcher was the only person that had the key. The researcher would then regularly collect these completed verbal query forms and enter this data into a spreadsheet.

As the verbal querying process occurred for 3 consecutive months, and simultaneously with the short cycle feedback intervention for 1 month, the researcher regularly met on an informal basis with the Clinical Support Officers, Nurses in-charge and Nursing Unit Managers throughout the verbal query phases of the study (April 2012 to June 2012). The researcher aimed to provide any support to the staff involved in the verbal querying process, including regularly supply of verbal querying forms.

During the month of June, the Clinical Support Officer of the study ward went on 2 weeks annual leave. The Ward Clerk within the study ward provided relief support to the Clinical Support Officer’s role, and as such, the verbal querying responsibilities. It is noted that the Ward Clerk received the one-page instruction document regarding the verbal querying process, as initially provided to the Clinical Support Officers and in-charge nursing staff at the beginning of phase 2. Nonetheless, the number of verbal queries decreased compared to the 2 previous months. This procedural issue is further discussed in the results chapter of this dissertation.