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No blame, no pain?

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Kate Lawler, RN.

Freelance Nurse Practitioner

Awareness is increasing of potential error and litigation within health care. Errors receive great media attention, with regular debates about causes and compensation.

Awareness is increasing of potential error and litigation within health care. Errors receive great media attention, with regular debates about causes and compensation.

It is important to view errors 'holistically'. It can be easier to blame an individual than to explore complex processes (McSherry and Pearce, 2002), but health-care governance takes the scrutiny of error away from the narrow context of individual blame. Rather than viewing incidents within the context of an individual's performance, risk managers are encouraged to see the complexity of corporate processes and embrace a 'no-blame culture'.

After the lifting of Crown Immunity in 1995 and the setting up of the Clinical Negligence Scheme for Trusts (CNST), trusts are striving to attain standards of risk management to reduce insurance premiums. These include effective systems of incident reporting. As Steve Haigh's paper points out, initiatives such as anonymous reporting aim to ensure this happens promptly and openly. In the case of drug errors it should apply as much to 'near misses' as actual errors, to highlight the need for further training in basic maths skills.

However, a degree of balance is needed. Professional accountability is still a personal issue, and there is no such thing as partial accountability. 'No blame' should not equate with 'easy-going'. Complacency arising from a no-blame culture would be detrimental. We should be wary of the notion of 'unconscious incompetence' where the need for skills updating goes unrecognised.

McSherry, R., Pearce, P. (2002)Clinical Governance: A guide to implementation for healthcare professionals. Oxford: Blackwell Science.

OPINION - Reasons to offer Entonox to patients at home
As a tissue viability clinical nurse specialist who visits patients at home, pain can be an overriding problem at dressing changes. In one study (Hofman, 1997) 69% of venous leg ulcer patients described the pain as horrible or excruciating, yet 25% had not been prescribed any analgesia. Pain can be eased by using non-adherent wound-care products or soaking dressings off. In the community, pain control with oral analgesia can be difficult, due to the unpredictable timing of visits and the amounts prescribed by doctors. If the patient does not report or display pain at times other than dressing changes, increased analgesia is unlikely to be prescribed.

Such pain could be avoided by using Entonox. It acts fast and the patient controls its administration.

Recently our tissue viability team saw a patient discharged from hospital on VAC therapy. The foam in their abdominal cavity wound was so well adhered that it took two nurses two hours to change the dressing. Some patients with surgical wounds remain in hospital solely for pain control at dressing changes. Administering Entonox would be an ideal way to ease suffering and save money.

- Sarah Pankhurst, BSc Hons, RN, Clinical Nurse Specialist Tissue Viability, Nottingham City Primary Care NHS Trust.

Hofman, D. (1997)Assessing and managing pain in leg ulcers. Community Nurse (Nurse Prescriber) 3: 6, 40-43.

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