Most hospitals require the nursing staff to fill out incident reports when a problem in medical care delivery has occurred. These reports are meant to be nonjudgmental, factual reports of the problem and its consequences. Unfortunately, the term incident has gained a pejorative connotation that makes it more difficult to ensure that incidents will be reported. The risk manager must persuade the nurses that filing an incident report is not tantamount to blaming a fellow employee for the problem. More importantly, it should be made clear that filing an incident report is not an admission of negligence. Incident reports are simply records of all events that are not part of routine medical care. The hospital administration should promulgate lists of events whose occurrence requires that filing of an incident report. The staff must also be free to file a report even if the event does not appear on the list of mandatory reports. This allows the incident report to be used as a way of formally asking a question about a questionable procedure. Nurses must feel that they can question the orders of a physician through the filing of an incident report without feeling that they are thereby claiming that the physician is wrong. The quality control manager does not want potentially useful information to go unreported because of the reluctance of a staff member to criticize a physician or fellow staff member.
The nonjudgmental nature of an incident report is very important because in most cases the incident report will be discoverable in litigation. An accusatory remark in an incident report may gain unintended weight in a legal proceeding. For example, an incident report could say that a patient slipped on a puddle of water. This would be a neutral report. If the report said the puddle was left by the cleaning crew after the nurse had warned the crew to clean up the water, it would be legally sensitive report. The basic information is that the patient fell because of water on the floor. The information that the nurse warned the cleaning crew not to leave water on the floor. This is important for the quality control manager to know, but it assigns blame if it appears in the incident report. If it is necessary, the assignment of blame should be developed in the follow-up investigation of specific incident reports. Such investigations will be easier to protect from discovery because they are clearly related to preparation for litigation and can fall under the attorney-client privilege.
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