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The systems approach to error reduction: factors influencing inoculation injury reporting in the operating theatre

Jayne Cutter, Sue Jordan Orcid Logo

Journal of Nursing Management, Volume: 21, Issue: 8, Pages: 989 - 1000

Swansea University Authors: Jayne Cutter, Sue Jordan Orcid Logo

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DOI (Published version): 10.1111/j.1365-2834.2012.01435.x

Abstract

Aim To examine the frequency of, and factors influencing, reporting of mucocutaneous and percutaneous injuries in operating theatres. Background: the risk of acquiring a blood-borne viral infection during exposure prone procedures has been estimated as 0.3% for HIV, 3% for hepatitis C virus and appr...

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Published in: Journal of Nursing Management
ISSN: 09660429
Published: Blackwell Publishing 2013
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URI: https://cronfa.swan.ac.uk/Record/cronfa10810
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first_indexed 2013-07-23T12:04:19Z
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fullrecord <?xml version="1.0"?><rfc1807><datestamp>2017-12-15T09:05:42.5937306</datestamp><bib-version>v2</bib-version><id>10810</id><entry>2012-05-29</entry><title>The systems approach to error reduction: factors influencing inoculation injury reporting in the operating theatre</title><swanseaauthors><author><sid>3fe2e541e1d50a75aa2f9ce8c1052ed5</sid><firstname>Jayne</firstname><surname>Cutter</surname><name>Jayne Cutter</name><active>true</active><ethesisStudent>false</ethesisStudent></author><author><sid>24ce9db29b4bde1af4e83b388aae0ea1</sid><ORCID>0000-0002-5691-2987</ORCID><firstname>Sue</firstname><surname>Jordan</surname><name>Sue Jordan</name><active>true</active><ethesisStudent>false</ethesisStudent></author></swanseaauthors><date>2012-05-29</date><deptcode>HNU</deptcode><abstract>Aim To examine the frequency of, and factors influencing, reporting of mucocutaneous and percutaneous injuries in operating theatres. Background: the risk of acquiring a blood-borne viral infection during exposure prone procedures has been estimated as 0.3% for HIV, 3% for hepatitis C virus and approximately 30% for hepatitis B virus (HBV) among non-vaccinated personnel Appropriate floow up including first-aid and prophylactic treatment after an injury can reduce the risk of infection. However, injuries are often under-reported. The systems approach to error reduction relies on reporting incidents and near misses. Failure to report will compromise safety.Method A multi-site, cross sectional survey of all surgeons and peri-operative nurses engaged in exposure prone procedures in nine Welsh hospitals (n=315), semi-structured interviews with selected participants (n=16) and telephone interviews with Infection Control Nurses (n=6).Results The response rate was 51.47% (315/612). Most respondents reported one or more percutaneous (183/315, 58.1%) and/or mucocutaneous injuries (68/315, 21.6%) in the 5 years preceding the study. However, reporting was inconsistent with only 54.9% of respondents (112/204) reporting all injuries. 70/133 of surgeons (52.6%) vs 65/71 nurses (91.5%)reported all or &gt;50% of their injuries.Conclusions Injuries are frequently under-reported, possibly compromising safety in operating theatres. Understanding the factors that influence under-reporting can underpin measures to improve reporting and ultimately improve safety.</abstract><type>Journal Article</type><journal>Journal of Nursing Management</journal><volume>21</volume><journalNumber>8</journalNumber><paginationStart>989</paginationStart><paginationEnd>1000</paginationEnd><publisher>Blackwell Publishing</publisher><issnPrint>09660429</issnPrint><keywords>Error reduction, injury reporting, peri-operative nurses, surgeons,</keywords><publishedDay>30</publishedDay><publishedMonth>6</publishedMonth><publishedYear>2013</publishedYear><publishedDate>2013-06-30</publishedDate><doi>10.1111/j.1365-2834.2012.01435.x</doi><url/><notes>Published on line 16/06/12</notes><college>COLLEGE NANME</college><department>Nursing</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>HNU</DepartmentCode><institution>Swansea University</institution><apcterm/><lastEdited>2017-12-15T09:05:42.5937306</lastEdited><Created>2012-05-29T15:12:03.1947329</Created><path><level id="1">Faculty of Medicine, Health and Life Sciences</level><level id="2">School of Health and Social Care - Nursing</level></path><authors><author><firstname>Jayne</firstname><surname>Cutter</surname><order>1</order></author><author><firstname>Sue</firstname><surname>Jordan</surname><orcid>0000-0002-5691-2987</orcid><order>2</order></author></authors><documents/><OutputDurs/></rfc1807>
spelling 2017-12-15T09:05:42.5937306 v2 10810 2012-05-29 The systems approach to error reduction: factors influencing inoculation injury reporting in the operating theatre 3fe2e541e1d50a75aa2f9ce8c1052ed5 Jayne Cutter Jayne Cutter true false 24ce9db29b4bde1af4e83b388aae0ea1 0000-0002-5691-2987 Sue Jordan Sue Jordan true false 2012-05-29 HNU Aim To examine the frequency of, and factors influencing, reporting of mucocutaneous and percutaneous injuries in operating theatres. Background: the risk of acquiring a blood-borne viral infection during exposure prone procedures has been estimated as 0.3% for HIV, 3% for hepatitis C virus and approximately 30% for hepatitis B virus (HBV) among non-vaccinated personnel Appropriate floow up including first-aid and prophylactic treatment after an injury can reduce the risk of infection. However, injuries are often under-reported. The systems approach to error reduction relies on reporting incidents and near misses. Failure to report will compromise safety.Method A multi-site, cross sectional survey of all surgeons and peri-operative nurses engaged in exposure prone procedures in nine Welsh hospitals (n=315), semi-structured interviews with selected participants (n=16) and telephone interviews with Infection Control Nurses (n=6).Results The response rate was 51.47% (315/612). Most respondents reported one or more percutaneous (183/315, 58.1%) and/or mucocutaneous injuries (68/315, 21.6%) in the 5 years preceding the study. However, reporting was inconsistent with only 54.9% of respondents (112/204) reporting all injuries. 70/133 of surgeons (52.6%) vs 65/71 nurses (91.5%)reported all or >50% of their injuries.Conclusions Injuries are frequently under-reported, possibly compromising safety in operating theatres. Understanding the factors that influence under-reporting can underpin measures to improve reporting and ultimately improve safety. Journal Article Journal of Nursing Management 21 8 989 1000 Blackwell Publishing 09660429 Error reduction, injury reporting, peri-operative nurses, surgeons, 30 6 2013 2013-06-30 10.1111/j.1365-2834.2012.01435.x Published on line 16/06/12 COLLEGE NANME Nursing COLLEGE CODE HNU Swansea University 2017-12-15T09:05:42.5937306 2012-05-29T15:12:03.1947329 Faculty of Medicine, Health and Life Sciences School of Health and Social Care - Nursing Jayne Cutter 1 Sue Jordan 0000-0002-5691-2987 2
title The systems approach to error reduction: factors influencing inoculation injury reporting in the operating theatre
spellingShingle The systems approach to error reduction: factors influencing inoculation injury reporting in the operating theatre
Jayne Cutter
Sue Jordan
title_short The systems approach to error reduction: factors influencing inoculation injury reporting in the operating theatre
title_full The systems approach to error reduction: factors influencing inoculation injury reporting in the operating theatre
title_fullStr The systems approach to error reduction: factors influencing inoculation injury reporting in the operating theatre
title_full_unstemmed The systems approach to error reduction: factors influencing inoculation injury reporting in the operating theatre
title_sort The systems approach to error reduction: factors influencing inoculation injury reporting in the operating theatre
author_id_str_mv 3fe2e541e1d50a75aa2f9ce8c1052ed5
24ce9db29b4bde1af4e83b388aae0ea1
author_id_fullname_str_mv 3fe2e541e1d50a75aa2f9ce8c1052ed5_***_Jayne Cutter
24ce9db29b4bde1af4e83b388aae0ea1_***_Sue Jordan
author Jayne Cutter
Sue Jordan
author2 Jayne Cutter
Sue Jordan
format Journal article
container_title Journal of Nursing Management
container_volume 21
container_issue 8
container_start_page 989
publishDate 2013
institution Swansea University
issn 09660429
doi_str_mv 10.1111/j.1365-2834.2012.01435.x
publisher Blackwell Publishing
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str School of Health and Social Care - Nursing{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}School of Health and Social Care - Nursing
document_store_str 0
active_str 0
description Aim To examine the frequency of, and factors influencing, reporting of mucocutaneous and percutaneous injuries in operating theatres. Background: the risk of acquiring a blood-borne viral infection during exposure prone procedures has been estimated as 0.3% for HIV, 3% for hepatitis C virus and approximately 30% for hepatitis B virus (HBV) among non-vaccinated personnel Appropriate floow up including first-aid and prophylactic treatment after an injury can reduce the risk of infection. However, injuries are often under-reported. The systems approach to error reduction relies on reporting incidents and near misses. Failure to report will compromise safety.Method A multi-site, cross sectional survey of all surgeons and peri-operative nurses engaged in exposure prone procedures in nine Welsh hospitals (n=315), semi-structured interviews with selected participants (n=16) and telephone interviews with Infection Control Nurses (n=6).Results The response rate was 51.47% (315/612). Most respondents reported one or more percutaneous (183/315, 58.1%) and/or mucocutaneous injuries (68/315, 21.6%) in the 5 years preceding the study. However, reporting was inconsistent with only 54.9% of respondents (112/204) reporting all injuries. 70/133 of surgeons (52.6%) vs 65/71 nurses (91.5%)reported all or >50% of their injuries.Conclusions Injuries are frequently under-reported, possibly compromising safety in operating theatres. Understanding the factors that influence under-reporting can underpin measures to improve reporting and ultimately improve safety.
published_date 2013-06-30T03:12:19Z
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score 10.998093

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