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1Department of Biochemistry, Father Muller College of Allied Health Sciences, Kankanady, Mangalore, Karnataka, India
2Dr. Shailaja Katti, Professor, Department of Biochemistry, Father Muller College of Allied Health Sciences, Kankanady, Mangalore, Karnataka, India.
*Corresponding Author:
Dr. Shailaja Katti, Professor, Department of Biochemistry, Father Muller College of Allied Health Sciences, Kankanady, Mangalore, Karnataka, India., Email: shailajadimpy@fathermuller.in
Abstract
Background: Incident reporting is a critical component in a tertiary care hospital laboratory. Incidents that are recognized and appropriately handled are a reliable sign of ongoing quality improvement. The knowledge and attitude of signatory authorities, postgraduates, staff, and clerical staff regarding incident reporting must be verified.
Objective: To assess the knowledge, attitude, practice and impact of training on incident reporting among the signatory authorities, postgraduates, technical staff, and clerical staff of a tertiary care hospital laboratory.
Methods: A pre-test questionnaire was administered to collect data from the signatory authorities (3), postgraduates (18), technical staff (59), and clerical staff (6) of a tertiary care hospital. Following pre-test, all study participants underwent training session on the topic of ‘incident reporting’. A post-test was then conducted to evaluate the improvement in knowledge and attitude resulting from the training intervention.
Results: Out of 86 participants, 38.37% scored in the ‘excellent’ category and 37.2% scored in the ‘very good’ category in the post-test-an improvement that was not observed in the pre-test. A statistically significant increase in knowledge was observed, with a P value of <0.001. Additionally, 72.42% of participants demonstrated a positive attitude toward an incident reporting in pre-test, which increased to 76.26% in the post-test. About 80.6% of the staff were found to be actively participating in the incident reporting process.
Conclusion: The study demonstrated a significant improvement in the knowledge and attitude of participants toward incident reporting following the training intervention. Implementing regular training programs on incident reporting is likely to improve the overall performance of the laboratory.
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Introduction
Incidents are undesirable events that occur in the field of medicine.1 Enhanced knowledge, attitudes, and practices of this concept contribute to improved quality of care.2
It is widely recognized that reporting incidents enhances safety by altering staff attitudes and understanding, in addition to promoting improvements in critical procedures.3
Systems for reporting incidents are essential for addressing these issues, as they enable monitoring of occurrence rates over time, identification of new threats, and eventually prevent expensive adverse events from occuring.4 Reporting the incident is important for the development and implementation of improvement strategies.5
Laboratories typically have incident reporting systems in place, either through hard copy forms or online platforms, to report incidents to users or the hospital’s central quality wing. Incident reporting includes events occurring during preanalytical, analytical and post analytical phases.6 The majority of errors are observed in pre-analytical phase, which can affect the patient outcomes.7 Common laboratory testing incidents include delayed reports, lost specimens, unlabelled specimens, misidentified patients, and other incidents with respect to their phases.8
Junior physicians, in particular, appear to have low participation in incident reporting systems and should receive comprehensive training on incident reporting and patient safety.8 Enhancing the user-friendliness of the form and providing better feedback could encourage doctors to report incidents and foster a safe culture.9
In the case of laboratory incident report management, employees, signature authorities, postgraduates, and clerical staff possess greater knowledge.10 If assured protection from administrative consequences, staff members are more likely to allocate time from their busy schedules to submit incident reports, and ensure that the reporting is used to bring about changes in the system.11
Regular training sessions and seminars are essential. Physicians should facilitate a simple and accessible reporting process to avoid future incidents.12 Qualitative research is required to more effectively explore the correlation between the risk variables and the incidence of exposure episodes.13
Root Cause Analysis (RCA) can help reduce the likelihood of similar incidents recurring by identifying the cause of unfavourable incidents that result in patient harm.14 Unit-based incident reporting systems provide specific information, making it easier to implement corrective and preventive action.15
Our hospital records approximately 300 incident reports per year, with the majority related to patient feedback. However, incidents that occur in the lab may go unreported.
The present study aimed to analyze the knowledge, attitude, and practice of incident reporting among signatory authorities, postgraduates, technical staff, and clerical staff in the laboratory of a tertiary care hospital.
Materials & Methods
A purposive sampling technique was employed involving all signatory authorities, postgraduates, technical staff, and clerical staff of a tertiary care hospital laboratory, totaling 86 participants.
Study Duration
This study was conducted over a period of one year, following approval from the Institutional Ethics Committee. Ethical clearance was granted by the committee on 26 April 2023.
Selection Criteria
Inclusion criteria
- Postgraduates of laboratory departments
- Technical staff of the laboratory
- Clerical staff of laboratory
- Authorized signatories
Exclusion criteria
Active administrative heads of various laboratory departments.
Method of Data Collection
Knowledge and attitude assessment
Assessment was conducted using a questionnaire that was validated by five experts, including technical in-charges and signatory authorities. The reliability of the questionnaire was tested through a pilot administration to 10 participants.
Training
Training on the incident reporting process was provided to staff, postgraduate trainees, clerical staff, and signatory authorities of the central laboratory. The sessions were conducted in three batches, with an average of 30 members per session. Prior to the training, a set of pre-test questionnaires covering knowledge, attitude, and practice-related questions were administered. Following this, the training session was conducted. At the end of training session, a post-test questionnaire was administered, focusing on knowledge and attitude based questions. Participant feedback was collected, and certificates of participation were issued. A debriefing session was also conducted at the conclusion of each training session.
Post training assessment
The effectiveness of training was assessed by administering the knowledge and attitude questionnaire as a post-test, to assess the short-term outcomes of the intervention.
Statistical Analysis
A total of 86 staff members participated in the study and data were collected. Therefore, sample size calculation was not applicable. Data were expressed as numbers and percentages for knowledge and attitude. The significance of differences between pre-test and post-test scores was analysed using paired t-test. A P value of <0.001 was considered statistically significant.
Results
Demographic Details of the Participants
No demographic details were collected; regardless all participants were included in the study.
Assessment of Knowledge
The grading criteria for the knowledge questionnaire classified scores of 76%-90% as ‘Very good’ and 91%-100% as ‘Excellent’. In the pre-test, 22 participants (25.58%) scored ‘Very good’, while 8 participants (9.30%) scored ‘Excellent’. In the post-test, these numbers increased to 32 (37.2%) and 33 (38.37%) respectively, indicating a significant improvement in knowledge following training.
Among different groups, signatory authorities, postgraduates, and technical staff demonstrated higher levels of knowledge followed by clerical staff. The average post-test score was 15.57% higher than the pre-test score. This difference was statistically significant (Figures 1 and 2).
Assessment of Attitude
The participants’ attitudes were assessed through a questionnaire, and their responses were recorded in percentages.
In the pre-test, 76.7% of participants agreed that a lack of staff responsibility contributed to the majority incidents, while 16.3% were neutral and 7% disagreed. In the posttest, the percentage of participants who agreed increased to 94.2%, indicating a shift in their attitude.
In the pre-test, 94.2% of participants agreed that incidents must be recorded, which slightly increased to 95.3% in the post-test.
About 74.4% of participants agreed that regular maintenance of instruments can prevent breakdown, while 14% disagreed. Following the training, the percentage of participants who agreed with this statement increased to 81.4%.
In the pre-test, 96% of participants were aware that needle stick injuries (NSI) must be reported to the Hospital Infection Control committee (HICC), which slightly increased to 97% in the post-test.
Regarding the responsibility of the quality manager in handling incidents, 39.5% of participants agreed and 14% disagreed in the pre-test. Following the training, the agreement rate increased to 81.4%.
In the pre-test, 77.9% participants were aware that missmatched samples must be recorded in the incident register, while 88.4% agreed with the same in the post-test. About 50% of participants disagreed that names should be included when reporting an incident in the pre-test. Additionally, 87.2% agreed that training is necessary for handling incidents in the pre-test, with this figure rising to 91.8% in the post-test.
In pre-test, 50% of participants agreed that the incidents should be reviewed by quality manager, while 59.3% agreed for the same in the post-test. About 94.3% of participants agreed that precautions must be taken to ensure patient and staff safety, which slightly increased to 95% in the post-test.
Among the 86 participants for attitude assessment, 72.42% agreed, 8.48% were neutral, and 18.86% disagreed in the pre-test. In the post-test, 76.26% agreed, 4.94% were neutral, and 17.50% disagreed.
Overall, there was a notable change in the attitude scores when comparing the pre-test and post-test responses.
Assessment of Practice
In the overall assessment of participants during the pre-test, 52.54% of staff, 66.66% of postgraduates, 50% of clerical staff, and 100% of signatory authorities considered negative patient feedback as an incident. In contrast, 47.4% of staff did not consider it as such.
The majority of staff (98.3%), postgraduates (100%), clerical staff (100%) and signatory authorities (100%) reported incidents observed by them. All participants agreed that outliers in quality control (QC) should not be recorded in the incident register. Regarding clinical satisfaction, 62.1% of staff, 44% of postgraduates, 66.66% of clerical staff and 100% of signatory authorities considered it as an incident to be reported.
More than 95% of all participants agreed that training is essential for the continuous quality improvement of laboratory personnel. Over 82% of participants reported improper disposal of biomedical waste (BMW) as an incident, and more than 93.5% followed HICC protocol in cases of NSI. A total of 93.22% of staff, 88.88% of postgraduates, 83.33% of clerical staff, and 100% of signatory authorities reported communicating critical values within 15 minutes. Regarding the documentation of incidents and accidents, 94.91% of staff, 83.33% of postgraduates, 66.66% of clerical staff, and 100% of signatory authorities agreed that such events should be recorded in the incidents and accident register.
Furthermore, 96.6% of staff, and 100% of postgraduates, clerical staff, and signatory authorities expressed willingness to assist others in understanding the incident reporting process. Accordingly, all participants confirmed adherence to specific protocols for recording and processing incident reports within the tertiary care hospital laboratory. The corresponding percentage of ‘Yes’ and ‘No’ responses are illustrated in Figure 3 and 4.
Among the 86 participants, 80.6% responded ‘Yes’, while 19.2% responded ‘No’. Of those who answered ‘Yes’, 82.02% were staff, 77.20% were postgraduates, 73.33% were clerical staff, and 90% were signatory authorities.
Among the 86 participants, 80.6% responded ‘Yes’ and 19.2% responded ‘No’. Of those who responded ‘No’, 17.91% were staff, 22.77% were postgraduates, 26.66% were clerical staff, and 10% were signatory authorities.
Discussion
The present study was conducted among 86 participants studying and working in hospital and laboratory settings. The cohort included 59 laboratory staff, 18 postgraduate students, six clerical staff, and three signatory authorities. The training on incident reporting proved effective in enhancing the knowledge of the participants. Overall, a positive shift in attitude was observed in the post-test compared to the pre-test, particularly regarding the importance of incident reporting and the necessity of related trainings. Participants demonstrated good current practices. To monitor sustained effectiveness, a followup audit is recommended after six months.
With regard to knowledge, 22 participants (25.58%) and 32 participants (37.2%) scored ‘Very good’ in the pretest and post-test, respectively. Similarly, 8 participants (9.30%) and 33 participants (38.37%) scored ‘Excellent’ in the pre-test and post-test, respectively, indicating a significant improvement in knowledge following the training. Laboratory staff consistently achieved good scores throughout the process. Prior to the training, only the postgraduate students and signatory authorities demonstrated comparatively good knowledge. However, the post-test results showed a notable shift, with participants who initially scored below average achieving average or higher scores after the training. This improvement is likely attributed to the better understanding of the incident reporting protocol during the training sessions.
Overall, the P value for the knowledge assessment was less than 0.001, indicating that the improvement observed was significant. Clerical staff demonstrated minimal knowledge, likely due to limited exposure to laboratory protocols and related terminology. However, their attitude towards incident reporting showed a positive sign in the post-test.
With regard to practice, more than 80% of the staff, postgraduates, clerical staff, and signatory authorities reported practicing incident reporting in their daily routines. However, 19.33% participants were not involved in routine incident reporting, highlighting the need for improvement. The most common cited barriers included lack of knowledge regarding how and where to report, a weak institutional culture of reporting, and to a lesser extent, the perceived lack of time. These factors are consistent with findings reported by other researchers.2 Improper practices may also stem from fear related to incident handling, as well as issues in documenting incidents manually. Clear and effective communication is also vital for patient satisfaction.16 To address these issues, implementation of structured communication tools alongside an efficient incident reporting system is essential to streamline the process.17 Qualitative studies are necessary to gain deeper insight into how these risk factors contribute to the occurrence of exposure incidents.18
This study had several limitations. It did not assess the intermediate outcomes of the training, and short term results may not fully reflect its effectiveness. Determination of effectiveness of training in improving attitude and practice of incident reporting would have enhanced the validity of the study. Additionally, an audit conducted six months post-training could provide a more accurate measure of its long-term effectiveness. Implementing continuous training program is also recommended.
Conclusion
The training led to improved knowledge and a more positive attitude among laboratory staff and postgraduate students toward incident reporting. However, further studies are needed to assess intermediate and long- term impact of the training on knowledge, attitudes, and practices related to incident reporting.
Conflict of interest
Nil
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