INTRODUCTION: The number of injuries and expenses from unsafe delivery of health care has heeded the call for a greater patient safety advocacy. The development of an effective reporting system contributes towards this cause. The study aimed to explore the perceptions of nurses regarding critical incidents and investigate the factors affecting their decision to report a certain event. METHODS: Focus group discussions including 28 nurses working in the service wards of a tertiary hospital, and the data gathered were analyzed using descriptive qualitative approach. RESULTS: Three key themes emerged from the discussions: (1) perceptions of an incident, (2) attitudes, norms, and culture of incident reporting in the workplace, and (3) perceptions and suggestions for management actions and improving the reporting system. The study showed that various factors tend to interplay in the identification of an incident as well as the consideration to perform the behavior. DISCUSSION The primary practice and education implications focus on changing the workplace culture and proper orientation of the staff, while further research regarding the role of reporting, and appropriate analysis of error reporting among other health care professionals would be recommended.
hospital communication systems ; nursing education ; critical incidents ; patient safety

With the industrial development, vehicle, wars, and natural disasters, there are increasing chsnces of mass casuaities, it is very important to classify the injured patients by their severity, to give them immediate emergency care and to transfer them to the other medical facilities effectively. And it is more essential in the army. But in practice, there is no objective and comprehensive scale for injury severity yet. So we devised a method of comprehensive description for the injuredpatients. It is based on Abbreviated Injury Scale and Injury Severity Score and is composed of five parts of the body (General, Head & Neck, Chest, Abdomen, Extremities) and five degrees of severity (Grade I, Il, III, IV, V). For example, a description of a patient with multiple injuries such as generalized abrasion and cotusion, semicomatose mentality with skull fracture, hemoperitoneum, and fracture of right femoral shaft is very diffcult to understand quickly. But, with our method of description, the above is described as follows ; G(I)+(IV)+A (IV)+E(III), ISS =4+4+3 =41. And the high score is described as ISS makes it clear that the patient is very dangerous, even to death, so intensive care is immediately needed. Using this method, we reviewed 1,256 cases of passenger acidents of vehicles treated at our hospital during the last 2 years. The results were as follows ;1. The average ISS of 56 cases of dead is 33. 2. There are only 2 cases of death below 16 of ISS, and 84% mortality above 40 of ISS. 3. The average ISS of passengers in vehicles such as motocycles is 12, taxies 11, bongo 9, and buses 8. 4. We recommend our method of description for mass casualties, especially in the army. Because it is very useful to the injured patients by their severity, to give them immediate emergency care, to transfer them to the other medical facilities and to comprehend the whole condition of all patients.
Abbreviated Injury Scale ; Abdomen ; Critical Care ; Disasters ; Emergency Medical Services ; Head ; Hemoperitoneum ; Humans ; Industrial Development ; Injury Severity Score ; Mass Casualty Incidents ; Methods ; Mortality ; Motor Vehicles ; Multiple Trauma ; Neck ; Skull Fractures ; Thorax