Article Text

  1. B Thyagarajan1,
  2. R Jarugula1,
  3. C Harrison1
  1. 1Neonatal Unit, St. James University Hosptial, Leeds, UK


Aim Many neonatal units have a robust risk reporting and analysis system. However, disparities exist in perceiving risks which leads to variable levels of reporting. This study aimed to understand these disparities and suggest ways to improve reporting systems.

Methods Medical and nursing staff based on the tertiary neonatal unit at St James’s University Hospital, Leeds were invited to a presentation and a photo quiz on situations with potential risks involved. Participants then completed a questionnaire on their knowledge, frequency and behaviour of incident reporting, unreported incidents and suggestions to improve reporting.

Results 25 participants completed the questionnaire: doctors 66% and nurses 34%. All thought reporting was good practice but reporting was higher amongst nurses (90%) compared to doctors (74%). Only 12% felt they received satisfactory feedback (consultants 33.3%, senior nurses 20%, junior doctors 7.7%). 28% never reported clinical incidents. The reasons given for not reporting included: lack of feedback, lack of time and interest, lack of appropriate action and doubts about its usefulness. Only 48% felt reporting changed practice and only 24% felt their reporting led to action. 74% respondents knew where to find incident forms on the unit.

Suggested ways to improve reporting practice were: regular risk awareness lectures, providing simpler forms, providing good feedback, dissemination of results amongst team members.

Conclusions There are many reasons affecting attitudes and behaviour towards incident reporting, mainly hierarchical differences, poor feedback rate and perceived lack of action. Proactive reporting may be improved if reporting staff received prompt, adequate and satisfactory feedback.

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