A model of recovering medical errors in the coronary care unit

The purpose of this study was to explore the thoughts, interpersonal processes, and actions used by nurses who had recently intervened to protect coronary care unit (CCU) patients from potential medical errors.

The study used semistructured interviews conducted with 18 very experienced CCU nurses in two academic medical centers. Content analysis was used to code and analyze text segments. Core codes were used for developing an empirically derived model.

There were more than 1000 data bits of accounts of involvement in the near-miss events, thought processes and actions surrounding the events, communication strategies used, feelings, outcomes, reflection about the event and consequences, and environment/context in which the events occurred. A three-stage temporally ordered model illustrates the process of recovering medical errors. In stage one, the presence of the evolving clinical scenario and nursing knowledge and expertise plus the CCU context are the antecedents that lead to processes and actions of identification, interruption, and correction of the error in stage two. Outcomes of whether or not the near miss was recovered lead to an adverse event (or not), and reflections on the process and outcome lead to the nurse's feelings about the event in stage three.

The model can guide nursing administration, practice, education, and research to recognize and value this responsibility, to teach others, and to test strategies to enhance the vital nursing role of recovering near-miss events that leads to safer and better patient care.