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Quality and Safety 53

Case study
You have just been assigned the role of Quality and Safety Coordina- in this chapter and the related learning activities to prepare a brief
tor for your clinical area. As a part of your role you have been asked project plan outlining how this problem can be addressed. For the
to implement a multi-faceted quality improvement project that purposes of this exercise, focus on what you would include in a
targets hospital-acquired pressure ulcers – a highly prevalent pressure ulcer prevention toolkit (i.e. targeted strategies to improve
adverse event occurring in your unit. Use the information contained care) and how you would evaluate its effectiveness.

Research vignette

Epsin S, Wickson-Griffiths A, Wilson M, Lingard L. To report or not data. The use of scenarios and semi-structured interviews were
to report: A descriptive study exploring ICU nurses’ perceptions of appropriate data collection methods to examine nurses’ percep-
error and error reporting. Intensive and Critical Care Nursing 2010; tions of errors and near misses. The researchers should be com-
26: 1–9. mended on first, training the participants in the ‘think aloud’
Abstract method and then piloting various forms of observational data
Objective collection.
To explore the emergent factors influencing nurses’ error reporting The sample size of 37 nurses, 12–13 from each type of ICU is actu-
preferences, scenarios were developed to probe reporting situa- ally quite large for a predominantly qualitative study, but it allowed
tions in the intensive care unit. the researchers to identify differences in responses based on prac-
Setting tice setting. No information was given on how the participants
Three Canadian intensive care unit settings including: one urban were chosen, although the researchers do identify that predomi-
academic tertiary hospital, one community hospital and one aca- nantly participants were female and varied in levels of experience.
demic paediatric hospital. It would have been helpful to be told exactly how many nurses
were asked the two interview questions that were added later in
Research methodology/design data collection.
Using qualitative descriptive methodology, semi-structured inter-
views were guided by a script which included a series of both In terms of data analysis, it is not clear how the ‘constant compari-
closed and open-ended questions. One near miss and four error son’ method was used to identify primary and secondary themes.
scenarios were used as prompts during interview. Four of the five The constant comparison method is often referred to in grounded
scenarios were identical across all three sites; however, one sce- theory studies, where the researchers move their analysis from
nario differed in the community site to reflect the distinct practice within a single participant, to across participants and to the litera-
environment. ture, using open, axial and selective coding, resulting in the iden-
tification of a core category and other categories. However, in this
Main outcome measures
Three key points of analysis included: nurses’ error perception, study, primary and secondary themes, not categories, were identi-
decision to report the scenario and style of reporting (formal and/ fied. It would have been helpful had a more detailed description
or informal). of how the qualitative analysis was given. On the positive side, it is
commendable that two analysts were used and discrepancies
Results resolved by together returning to the data. Additionally, all themes
At least 81% of the 37 participants stated that they would report were described and explained very well. The quantitative analysis
the events in the respective scenarios. Deviations from standards was straightforward and the table easy to understand, however
of practice emerged as the primary rationale for participants’ per- including raw frequencies in addition to percentages is a sugges-
ception of error. tion for improvement, to make these results more transparent (i.e.
Conclusion missing data could have been identified had raw frequencies been
Nurses working in the intensive care unit readily perceive and are given).
willing to report errors or near misses; however they may choose The researchers should be commended for their insight into the
informal or formal methods to report. limitations of their study. An additional limitation that could have
Critique been mentioned was the fact that what the nurses said they would
The aims of the study were easy to identify and clearly stated. The do and what they really would do in clinical practice may have
researchers explained how this study arose from their previous differed, thus this study reflects the former and not the latter.
research and situated it in the current literature on adverse events However, by providing both Appendices (scenarios and interview
and errors in ICU. While the researchers stated that this study was questions), others could easily replicate their research in other set-
qualitative in nature, the fact that they were able to calculate per- tings. Overall, this study provides new evidence about how critical
centages of responses means that it did involve some quantitative care nurses perceive error in clinical practice.