Alison Cooper

A cross-sectional mixed methods study protocol to generate learning from patient safety incidents reported from general practice

Introduction Incident reports contain descriptions of errors and harms that occurred during clinical care delivery. Few observational studies have characterised incidents from general practice, and none of these have been from the England and Wales National Reporting and Learning System. This study aims to describe incidents reported from a general practice care setting. Methods and analysis A general practice patient safety incident classification will be developed to characterise patient safety incidents. A weighted-random sample of 12 500 incidents describing no harm, low harm and moderate harm of patients, and all incidents describing severe harm and death of patients will be classified. Insights from exploratory descriptive statistics and thematic analysis will be combined to identify priority areas for future interventions. Ethics and dissemination The need for ethical approval was waivered by the Aneurin Bevan University Health Board research risk review committee given the anonymised nature of data (ABHB R&D Ref number: SA/410/13). The authors will submit the results of the study to relevant journals and undertake national and international oral presentations to researchers, clinicians and policymakers.

Sources of unsafe primary care for older adults: a mixed-methods analysis of patient safety incident reports

Background older adults are frequent users of primary healthcare services, but are at increased risk of healthcare-related harm in this setting. Objectives to describe the factors associated with actual or potential harm to patients aged 65 years and older, treated in primary care, to identify action to produce safer care. Design and Setting a cross-sectional mixed-methods analysis of a national (England and Wales) database of patient safety incident reports from 2005 to 2013. Subjects 1,591 primary care patient safety incident reports regarding patients aged 65 years and older. Methods we developed a classification system for the analysis of patient safety incident reports to describe: the incident and preceding chain of incidents; other contributory factors; and patient harm outcome. We combined findings from exploratory descriptive and thematic analyses to identify key sources of unsafe care. Results the main sources of unsafe care in our weighted sample were due to: medication-related incidents e.g. prescribing, dispensing and administering (n = 486, 31%; 15% serious patient harm); communication-related incidents e.g. incomplete or non-transfer of information across care boundaries (n = 390, 25%; 12% serious patient harm); and clinical decision-making incidents which led to the most serious patient harm outcomes (n = 203, 13%; 41% serious patient harm). Conclusion priority areas for further research to determine the burden and preventability of unsafe primary care for older adults, include: the timely electronic tools for prescribing, dispensing and administering medication in the community; electronic transfer of information between healthcare settings; and, better clinical decision-making support and guidance.

Understanding the epidemiology of avoidable significant harm in primary care: protocol for a retrospective cross-sectional study

Introduction Most patient safety research has focused on specialist-care settings where there is an appreciation of the frequency and causes of medical errors, and the resulting burden of adverse events. There have, however, been few large-scale robust studies that have investigated the extent and severity of avoidable harm in primary care. To address this, we will conduct a 12-month retrospective cross-sectional study involving case note review of primary care patients. Methods and analysis We will conduct electronic searches of general practice (GP) clinical computer systems to identify patients with avoidable significant harm. Up to 16 general practices from 3 areas of England (East Midlands, London and the North West) will be recruited based on practice size, to obtain a sample of around 100 000 patients. Our investigations will include an ‘enhanced sample’ of patients with the highest risk of avoidable significant harm. We will estimate the incidence of avoidable significant harm and express this as ‘per 100 000 patients per year’. Univariate and multivariate analysis will be conducted to identify the factors associated with avoidable significant harm. Ethics/Dissemination The decision regarding participation by general practices in the study is entirely voluntary; the consent to participate may be withdrawn at any time. We will not seek individual patient consent for the retrospective case note review, but if patients respond to publicity about the project and say they do not wish their records to be included, we will follow these instructions. We will produce a report for the Department of Healths Policy Research Programme and several high-quality peer-reviewed publications in scientific journals. The study has been granted a favourable opinion by the East Midlands Nottingham 2 Research Ethics Committee (reference 15/EM/0411) and Confidentiality Advisory Group approval for access to medical records without consent under section 251 of the NHS Act 2006 (reference 15/CAG/0182).

Opportunities for incident reporting. Response to: ‘The problem with incident reporting’ by Macrae et al

Macrae highlights well-discussed challenges of using safety incident reporting systems as a source of learning and improvement in healthcare.1 Our research group has analysed over 50 000 free-text reports from primary care submitted to the England and Wales National Reporting and Learning System, and developed a mixed methods approach to identify learning from these reports.2 We agree that simply aiming for a greater number of reports to remedy problems arising from under-reporting is not desirable. There is, however, an opportunity to target specific discipline or professional …

Patient safety research in primary care: where are we now?

This issue of the BJGP reflects recent progress in patient safety research in primary care with the publication of three articles addressing safety culture and teamwork in community care; harms following transfer of care responsibilities between primary care, secondary care, and other sector services; and the approaches to clinical reasoning that are associated with diagnostic error.1–3 Traditionally, research in patient safety has focused on hospital-based, specialist care provision. The epidemiology of patient safety in these settings is established: around 1 in 10 patients experiences avoidable harm.4 Despite 90% of healthcare encounters occurring in the community setting in most developed nations, there has been an assumption that, due to the lower-risk nature of patient encounters in primary care, harms will be less significant.5 This claim is hard to disprove until robust population-level epidemiological studies are conducted to determine the frequency and burden of harms occurring in primary care. A patient safety incident is any unintended or unexpected incident that could have harmed or did harm a patient during healthcare delivery. This can be the result of a wrong or inappropriate action (‘error of commission’) or failing to do the right thing (‘error of omission’).4 Current estimates suggest that 1 in 50 patient encounters in primary care will result in a patient safety incident and, of these, substantial patient harm occurs in 1 in 20.4 As over 340 …

Improving the safety of vaccine delivery

ABSTRACT Vaccines save millions of lives per annum as an integral part of community primary care provision worldwide. Adverse events due to the vaccine delivery process outnumber those arising from the pharmacological properties of the vaccines themselves. Whilst one in three patients receiving a vaccine will encounter some form of error, little is known about their underlying causes and how to mitigate them in practice. Patient safety incident reporting systems and adverse drug event surveillance offer a rich opportunity for understanding the underlying causes of those errors. Reducing harm relies on the identification and implementation of changes to improve vaccine safety at multiple levels: from patient interventions through to organizational actions at local, national and international levels. Here we highlight the potential for maximizing learning from patient safety incident reports to improve the quality and safety of vaccine delivery.