Table 1

Categories of Blame by Persons Reporting Safety Incidents

Blame Focus and DefinitionExample
Acknowledging personal responsibility
Blames self“Seen as temporary resident for an inguinal hernia awaiting operation. Was incarcerated (probably) and I acted on his history of this being reducible. I should have admitted him there and then and didn’t. No complaint by patient.”
 Blames himself/herself for the incident
Blamed by another“The patient was diagnosed as having a [rare type of cancer]. He had attended the surgery on and off since [date] with urinary symptoms which seemed to respond to antibiotics. He saw every clinical member of the practice and was examined but a thorough examination was impossible. He was referred for a possible hernia on [date] and to the urology department on [date]. He was seen by both specialties within a week and diagnosis was confirmed. There has been a comment made to the family by a consultant that we should have spotted it sooner.”
 Describes a third party blaming him/her for the incident
Directed blame
Blames anotherExample 1: “A terminally ill patient attended A&E in possible retention of urine. This patient has a syringe driver in situ with morphine and metoclopramide. The syringe driver was clearly labelled as per policy but despite this the doctor who saw the patient in A&E took the syringe driver down and left the patient without any analgesia or anti-sickness medication. As a result, the patient was in a lot of pain and was only given a small amount of oral analgesia after being in A&E for some hours. TOTALLY UNACCEPTABLE. Medication error/critical incident. Complete lack of knowledge demonstrated by the doctor. Inadequate assessment and lack of knowledge on behalf of the doctor, and failure to listen to the patient, as he did question why they were taking the syringe driver down.”
 Blames another individual for the incident
Others blaming others“Patient had an appointment with the doctor. Patient was in discomfort with problems swallowing and indigestion. This lady has complex co-morbidities. After a few days she felt very ill and thought it was the medication that had been prescribed on the day of her appointment. The patient contacted the practice but the practice would/could not provide an appointment that day or indeed the next day. The doctor eventually agreed to do another prescription without seeing her again (stemetil). When the patient went to collect the medication the pharmacist would not dispense the medication as it was not suitable for people with under active thyroid and it was for vertigo/nausea/vomiting. The patient could not raise this issue since the practice was then closed. The patient added that this is not the first time that something has happened like this.”
 Describes another individual being blamed for the incident
Unknown blame“Patient with rheumatoid arthritis on steroids was taken off bone protection medication for 1 year giving a ‘drug free holiday’ to reduce the incidence of atypical fracture (without a review date to re-start). She had been on this medication for 7 years. Stopping this medication was inappropriate.”
 Blame identified but source unclear
No blame“Computer system misinterpreted the directions for the dose of amiodarone and printed out 1/2 tablet daily instead of 1 1/2 stated on the prescription even though the patient’s computer record showed 1 1/2 daily as issued.”
 No attribution of blame to a person
  • A&E = accident and emergency; GP = general practitioner; INR = international normalized ratio.