When it comes to reducing the number of patient-safety incidents and near misses, no-fault reporting is being used in Georgia with some success.

St. Joseph's/Candler of Savannah began using no-fault reporting five years ago. The Veterans Affairs medical centers in Atlanta, Augusta and Dublin followed suit in 1999.

"No-fault reporting isn't about placing blame," said Paul A. Gutting, CPHRM, ARM, director of risk management at St. Joseph's/Candler. "Our primary intention is to improve patient care by helping prevent errors in our processes."

Here's how no-fault reporting works: Employees are encouraged to report any patient injury or near miss through an anonymous system. Each incident is reviewed by the risk management department, not only to assure that the patient has not been adversely affected, but also to examine various health care delivery processes.

Sometimes the process may be redesigned to reduce the risk of further errors.

For example, a nurse may select a medication from storage and, as she's headed to the patient's room for the scheduled dose, she realizes that the dosage amount was incorrect or she had the wrong medication. She caught the mistake before it became critical, but she still reports that the incident occurred.

"In this case, the person would report the near miss herself, and it might indicate that there is something wrong with the processes we're using to dispense medication," Gutting said. "We're not looking at the nurse; we're looking at the systems and processes being used."

"We encourage employees to report all incidents and near misses," said Sonja Reid, RN, BSN, MHSA, and quality management risk manager at the Atlanta Veterans Affairs Medical Center.

"They're not tattling on someone. This is blame-free anonymous reporting."

Employees have various choices for reporting events - traditional paper forms, a telephone hotline or some type of online system, depending on the health care institution.

"Using the telephone reporting system is the fastest, and we can respond sooner," Reid said. "The paper reporting system takes time. Some people like the intranet because they know the information goes directly into our database; they get a printout confirmation."

Whatever the case, Reid said that the no-fault reporting system is catching the majority of incidents quickly.

"On average, the anonymous system picks up everything that we hear about through the grapevine," she said. "By the time regular reports are filed and an incident shows up there, we already have it in the system. It's a better method than plain old paper."

At St. Joseph's/Candler, the majority of incidents are reported by telephone using an automated dedicated four-digit telephone extension - called the S.O.S. line for Smart on Safety. The phone number is printed on a small lifesaver shape and is posted on every phone on all the unit floors.

"It gives us the ability to intervene in an event more quickly," Gutting said. "It's easier for people to report this way."

The hospital has a risk-analysis person on staff who regularly picks up the information from the line and forwards it to the appropriate unit or department.

"We've seen an improvement in the number of reports we're receiving since using the telephone system," Gutting said. "We're constantly preaching the gospel of risk management. Our primary goal is to improve patient care."