For which of the following situations should the nurse complete an incident report?

In this section of the NCLEX-RN examination, you will be expected to demonstrate your knowledge and skills of reporting incident, event, irregular occurrence, and variance in order to:

• Identify need/situation where reporting of incident/event/irregular occurrence/variance is appropriate
• Acknowledge and document practice error (e.g. incident report for medication error)
• Evaluate responses to error/event/occurrence

Identifying the Need or Situation Where Reporting of an Incident, Event, Irregular Occurrence or Variance is Appropriate

All incidents, events, irregular occurrences, and variances must be identified and reported according to the particular health care facility's policies and procedures. The purpose of this reporting is to give the health care facility and the health care professionals the opportunity to address the issue and prevent the occurrence of future incidents, events, irregular occurrences, and variances. The data collected on these reports is analyzed, tracked and trended over time in a blame free environment that is consistent with the health care facility's culture of safety.

Nurses must immediately report all client care issue, concern or problem to the supervising nurse, the charge nurse and/or the performance improvement or risk management department according to the reporting policies and procedures of the particular facility.

Generally speaking, all incidents, accidents, adverse events, irregular occurrence and variances require the completion of a written report that will be sent to the risk management and/or performance improvement department as per the specific facility's established policies and procedures.

Simply stated, incidents, accidents and events that must be reported and documented include occurrences that are not expected, not normal, irregular and potentially or actually harmful to the patient, staff, visitors and others.

Variances, or deviations from practice, that lead to a quality defect or problem are reported. Variances can be classified as a practitioner variance, a system/institutional variance, a patient variance, a random variance and a specific variance.

A practitioner variance is an irregularity that is associated with the care and/or service provided by a health care provider. For example, an untimely medical assessment upon admission is considered a practitioner variance.

A system/institutional variance is an irregularity that is associated with the care and/or service given by the facility. For example, the lack of necessary supplies and equipment to adequately and safely care for patients and the lack of staff education and competency validation are considered system/institutional variances.

A patient variance is an irregularity that is associated with the patient themselves and not the health care provider or the facility. For example, the development of a pressure ulcer secondary to the patient's immobility and poor nutritional status is an example of a patient related variance.

Information that is typically reported on a formal incident or accident report includes:

• The date, time and place of the incident or accident
• Clear, concise and objective data about the occurrence and any surrounding factors, like a wet floor, that may have led to the incident or accident
• The name of the person or persons who was affected with the incident or accident
• The names of any witnesses
• Any injuries that were sustained as a result of the incident or accident
• All care and treatment s that were provided to the person who was adversely affected with an incident or accident
• The names of people, such as the client's doctor, that were contacted and notified about the incident or accident

These reports are forwarded to the correct person, as indicated in the facility's policies and procedures. They are not put in the client's medical record nor mentioned in the client's medical record. These legal documents are considered confidential.

Acknowledging and Documenting a Practice Error

As previously discussed with "Performance Improvement", all medical errors and "near misses", or sentinel events, such as wrong site surgery, wrong patient surgery and medication errors must be recognized, documented and reported.

Historically, incidents and accidents are under reported. This under reporting results from a number of factors including the fact that the nurse, or another practitioner, does not know that they have performed a practice error, or the person fails to report the practice error because they have a fear of being blamed and penalized for the error, or they simply just do not want to take the time to follow the health care facility's policies and procedures relating to the reporting of incidents, accidents and practice errors.

In addition to reporting all medical errors, the nurse must assess the client's condition, render the care that the client needs as the result of the injury or accident, and also document the client's responses to these interventions.

Evaluating The Client Responses to An Error, Event or Occurrence

Whenever an error, event or irregular occurrence occurs, the nurse must immediately assess the client and their responses to it and provide the care that is indicated by the client's condition. For example, the client will be assessed for their neurological status and level of consciousness after a fall when it is possible that the client hit their head on the floor as a result of the fall.

The priority when an error, adverse event, occurrence or variance occurs is the patient and their physical as well as psychological health and wellbeing. After the priority needs of the affected patient are addressed, the nurse should complete the necessary reporting and documented. The priority is the patient at the time of an error, adverse event, occurrence or variance that leads to harm and/or potential harm.

RELATED CONTENT:

• Accident/Error and Incident Prevention
• Emergency Response Plans
• Ergonomic Principles
• Handling Hazardous and Infectious Materials
• Home Safety
• Reporting Incident/Event/ Irregular Occurrence/Variances (Currently here)
• Safe Use of Equipment
• Security Plans
• Standard Precautions/Transmission Based Precautions/Surgical Asepsis
• Use of Restraints/Safety Devices

SEE – Safety & Infection Control Practice Test Questions

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Alene Burke, RN, MSN

Alene Burke RN, MSN is a nationally recognized nursing educator. She began her work career as an elementary school teacher in New York City and later attended Queensborough Community College for her associate degree in nursing. She worked as a registered nurse in the critical care area of a local community hospital and, at this time, she was committed to become a nursing educator. She got her bachelor’s of science in nursing with Excelsior College, a part of the New York State University and immediately upon graduation she began graduate school at Adelphi University on Long Island, New York. She graduated Summa Cum Laude from Adelphi with a double masters degree in both Nursing Education and Nursing Administration and immediately began the PhD in nursing coursework at the same university. She has authored hundreds of courses for healthcare professionals including nurses, she serves as a nurse consultant for healthcare facilities and private corporations, she is also an approved provider of continuing education for nurses and other disciplines and has also served as a member of the American Nurses Association’s task force on competency and education for the nursing team members.

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