A Thousand Words
Incident reports are commonplace in healthcare, meant to record the facts. But do they?
I've written about write-ups, including their presentation as conclusions and use as political bats. If you've worked in healthcare any length of time, you're well aware of the pejorative tone of "written up." It's often an excuse, a threat, and an action at once.
I have written you up.
That doesn't sound good.
It can be difficult to separate facts from conclusions and players from politics. If a housekeeper finds sharps mixed with regular trash in a patient room and suspects a doctor, for instance, she may perceive a status gap not worth crossing and say nothing.
This exact issue came up in a conversation I had the other day. And it's just plausible. How often do we all let something slide because the person involved is our boss, an administrator, or a doctor? How often because the person is arrogant, dismissive, difficult, or just a bully? More than any of us will admit, I suspect.
Suppose a unit of blood is returned in a transport container to your laboratory per your suspected transfusion reaction protocol, but the unit wasn't properly sealed. The container is full of blood, and the unit is useless to culture. You can write this up as a process deviation and safety hazard. But is your perception "full of blood" credible?
One solution is worth a thousand word write-up: take a picture of it.
The bland truth of a photograph is hard to argue with and has none of the nuance of tone associated with the written word. It can't be explained away as just your opinion. A photograph can be attached to an incident report that lists the date, time, and bare facts of the event. It says, this is what I saw.
A photograph is, in short, a factual record. Which is what an incident report should be.