Quality Improvement Through the Introduction of a Standardised Incident and Excellence Reporting Form on a Zambian Neonatal Unit

Background: It has long been acknowledged that learning from critical incidents is imperative to improving patient safety and the incident report (IR) is now one of the most widely used methods of improving it. The voluntary IR is a standard approach with higher numbers of IRs associated with a generally more effective safety culture. Improvements can be much simpler to action when unit-based IRs are utilized.

On the Neonatal Intensive Care Unit (NICU) in University Teaching Hospital, Lusaka, Zambia, IRs were written but with varying quality as there was no formal structure; they consisted of freehand text on paper. Informal discussions with nursing staff revealed that they had reservations about completing IRs due to concerns of repercussions. These concerns are common in nurses who report incidents and are sometimes well founded. Excellence reporting was not utilised but has been recognised as another tool to aid patient safety.

Methods: All documented IRs on NICU over a two-year period were retrospectively reviewed. Data on the shift and location of incidents was collected when possible. Common themes were identified and data on their occurrence in incidents collected. Based on this, a standardised incident and excellence reporting form was devised and teaching on its use delivered in a series of sessions.

Results: Further data collection awaited. Informal discussions with NICU nursing staff show that they understand and appreciate the importance of IR use but that they still have concerns about potential repercussions they could face. After an initial teaching session on the topic, attendees stated that they felt less reserved about completing an IR but more sessions are planned.

Conclusion: The use of IRs is important and staff do understand and recognise this. They need ongoing support to feel confident using IRs and this should be included as part of a wider culture change.