Perceptions of Canadian labour and delivery nurses about incident reporting: A qualitative descriptive focus group study

Abstract Background Estimates of incidents (adverse events) occurring during inpatient hospital stays suggest patient safety demands attention. Improving the safety of health care systems requires understanding incidents and their causes. Labour and delivery nurses can contribute to understanding incidents and incident reporting because they actively identify and report incidents in practice. Objectives To explore Canadian labour and delivery nurses' perceptions about reporting incidents in practice and identify factors facilitating or constraining incident reporting. Design A descriptive qualitative study design using focus groups to collect data. Settings Three labour and delivery units within one health authority in the province of British Columbia. Participants Sixteen registered nurses participated in one of four focus groups between 2009 and 2010. Methods We audio-taped interviews, transcribed the data, and analysed interview data using inductive content analysis and constant comparison. Results We identified four main themes. The themes included determining an incident, the labour and delivery context, and barriers and facilitating factors for incident reporting. The nurses viewed incidents they identified as unique to their practice. Rather than being a single error, a series of events, which nurses often regarded as out of their control, could lead to incidents. The practice context for labour and delivery, specifically fear of litigation and complexity of decision-making about incidents, affected nurses' perceptions of incidents and incident reporting. Positive team dynamics complicated the process of incident identification and reporting. Nurses viewed lack of time and fatigue, inadequate reporting tools, and unit culture as barriers to incident reporting. Facilitating factors were learning opportunities, practice improvement, and professional responsibility. Conclusions Team work in Canadian labour and delivery practice settings influences determinations of what constitutes incidents and how they are managed. The complexity of incidents that occur in perinatal practice contexts suggests new approaches would be valuable for incident reporting.