Types of Error

Internal bias occurs when the Clinician attributes values to a patient or situation and ignores objective evidence to the contrary. Attributed values may come from the Clinician’s:

• Beliefs
• View on patient/doctor relationship
• Level of engagement or interest before patient

External bias can come from the external working environment for example; peer opinion of constraints of time, resources and skills.

Resulting errors can be:

Knowledge based

• Conscious
• Overloaded
• Lack of rules

Skill based

• Slips & lapses
• Interruptions
• Multiple procedures
• Most familiar sequence

Rule based

• Bad rule
• Good rule applied badly
• Routine
• Thrill seekers

Why are rules broken?

Situational violations occur when the rules are broken due to pressure to complete the task, or because it is difficult to comply with the rule in the circumstances.

Routine violations occur when rules are deliberately ignored.
An example of a situational violation.

A nurse on night shift lifts an elderly patient who has fallen back into bed, without using a hoist.

Possible reasons

• The hoist is difficult to don and takes up a substantial amount of time to fit
• Hoists are not available on every ward
• The culture of the organisation does not adequately communicate the need to use hoists

Solutions

In this case the employer may need to:

• Provide appropriate staff training to address the issue
• Provide a hoist on every ward
• Establish a positive safety culture