Nature of nursing errors and their contributing factors in intensive care units

Background Errors tend to be multifactorial and so learning from nurses' experiences with them would be a powerful tool toward promoting patient safety. Aim To identify the nature of nursing errors and their contributing factors in intensive care units (ICUs). Methods A semi-structured interview with 112 critical care nurses to elicit the reports about their encountered errors followed by a content analysis. Results A total of 300 errors were reported. Most of them (94 center dot 3%) were classified in more than one error category, e.g. 'lack of intervention', 'lack of attentiveness' and 'documentation errors': these were the most frequently involved error categories. Approximately 40% of reported errors contributed to significant harm or death of the involved patients, with system-related factors being involved in 84 center dot 3% of them. More errors occur during the evening shift than the night and morning shifts (42 center dot 7% versus 28 center dot 7% and 16 center dot 7%, respectively). There is a statistically significant relation (p <= 0 center dot 001) between error disclosure to a nursing supervisor and its impact on the patient. Conclusions Nurses are more likely to report their errors when they feel safe and when the reporting system is not burdensome, although an internationally standardized language to define and analyse nursing errors is needed. Improving the health care system, particularly the managerial and environmental aspects, might reduce nursing errors in ICUs in terms of their incidence and seriousness. Relevance to clinical practice Targeting error-liable times in the ICU, such as mid-evening and mid-night shifts, along with improved supervision and adequate staff reallocation, might tackle the incidence and seriousness of nursing errors. Development of individualized nursing interventions for patients with low health literacy and patients in isolation might create more meaningful dialogue for ICU health care safety.