Check your hospital's policy and procedure handbooks to make sure that they require reporting of both actual errors and all situations with the potential to cause errors. Nurses usually initiate incident reports because they often uncover the error and they're the last health care professional in a position to recognize the error before the drug is administered. In a punitive climate, nurses tend not to report, especially if there's no patient harm, because they fear disciplinary action. 9 Research has substantiated that completed incident reports are just the tip of the iceberg when reviewing medication errors. 10 Other investigators have compared the number of incident reports filed with the number of errors detected by observation, and have produced similar results.
Some hospitals use information from incident reports to identify and punish nurses.
A punitive system is reactive and focuses on the nurse's weakness, resulting in accusations and finger-pointing. Nurses may receive written or verbal warnings, individual remedial education, suspension, transfer, demotion, or even termination. Not surprisingly, the blame-game approach to medication error prevention creates strong pressure for nurses to cover up mistakes rather than admit them. If it's not my fault, it's not an error. Late drug administration or omission may occur when the patient is off the unit or when the prescribed drug isn't available in the unit.