Role of Protocol Adherence and Lack of Protocol in the Precipitation of Nursing Care Errors amongst the Patients Admitted in the Intensive Care Units of a Tertiary Care Hospital

Abstract

The common problem in the complex intensive care unit (ICU) is errors. The aim of the present study was to understand the role of protocol adherence versus lack of protocol in the precipitation of nursing care. A qualitative approach was carried out to get into the detail of the phenomenon of nursing care errors. The researcher worked closely with the nursing staff in the main ICU and was involved in participant observation. Also, review of patient records and informal interviews with staff were done to get to the cause of the incidents. The data collected was analyzed by using Colaizzi’s phenomenological data interpretation method and inferences were derived. Each error incident was analyzed for its relation with the existence or lack of protocols/ guidelines. Twelve incidents were recorded and analyzed over a period of one and a half months. Multiple system based contributing factors were identified. Inadequate protocol was seen in 6 instances. These included administrative and practice protocols. Seventeen instances of lack of protocol adherence were noted. These included protocols on communication, narcotic drug handling, maintenance of adequate nurse patient ratio, supervision and supervisory roles, certain procedural protocols etc. The system factors like supervision and routine audits were not adequate in checking and limiting the effects or preventing the occurrence of errors. Maintaining protocol adherence is very important in the prevention and control of the menace of medical errors. Protocols should be practicable in the administrative and the ground conditions. Proper awareness regarding the existence and the obligations of the protocol should be made available to both the staff and the supervisors.