Nurses' perceptions of error communication and reporting in the intensive care unit.
Developing and promoting incident reporting systems is essential to ensuring a culture of safety. However, many barriers—real and perceived—prevent frontline clinicians from reporting errors. This study compared nurses' responses during focus groups to institutional safety culture measurements, and found that although nurses reported adequate access to reporting systems, few actually reported errors, for both practical and cultural reasons. An AHRQ WebM&M commentary discusses a case where a nurse was discouraged from reporting a medication error.