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Li L, Badgery-Parker T, Merchant A, Fitzpatrick E, Raban MZ, Mumford V, Metri NJ, Hibbert PD, Mccullagh C, Dickinson M, Westbrook JI. Paediatric medication incident reporting: a multicentre comparison study of medication errors identified at audit, detected by staff and reported to an incident system. BMJ Qual Saf 2024:bmjqs-2023-016711. [PMID: 38621921 DOI: 10.1136/bmjqs-2023-016711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 04/01/2024] [Indexed: 04/17/2024]
Abstract
OBJECTIVES To compare medication errors identified at audit and via direct observation with medication errors reported to an incident reporting system at paediatric hospitals and to investigate differences in types and severity of errors detected and reported by staff. METHODS This is a comparison study at two tertiary referral paediatric hospitals between 2016 and 2020 in Australia. Prescribing errors were identified from a medication chart audit of 7785 patient records. Medication administration errors were identified from a prospective direct observational study of 5137 medication administration doses to 1530 patients. Medication errors reported to the hospitals' incident reporting system were identified and matched with errors identified at audit and observation. RESULTS Of 11 302 clinical prescribing errors identified at audit, 3.2 per 1000 errors (95% CI 2.3 to 4.4, n=36) had an incident report. Of 2224 potentially serious prescribing errors from audit, 26.1% (95% CI 24.3 to 27.9, n=580) were detected by staff and 11.2 per 1000 errors (95% CI 7.6 to 16.5, n=25) were reported to the incident system. Although the prescribing error detection rates varied between the two hospitals, there was no difference in incident reporting rates regardless of error severity. Of 40 errors associated with actual patient harm, only 7 (17.5%; 95% CI 8.7% to 31.9%) were detected by staff and 4 (10.0%; 95% CI 4.0% to 23.1%) had an incident report. None of the 2883 clinical medication administration errors observed, including 903 potentially serious errors and 144 errors associated with actual patient harm, had incident reports. CONCLUSION Incident reporting data do not provide an accurate reflection of medication errors and related harm to children in hospitals. Failure to detect medication errors is likely to be a significant contributor to low error reporting rates. In an era of electronic health records, new automated approaches to monitor medication safety should be pursued to provide real-time monitoring.
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Affiliation(s)
- Ling Li
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Tim Badgery-Parker
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Alison Merchant
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Erin Fitzpatrick
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Magdalena Z Raban
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Virginia Mumford
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Najwa-Joelle Metri
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Peter Damian Hibbert
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Cheryl Mccullagh
- Executive, Beamtree, Redfern, New South Wales, Australia
- The Sydney Children's Hospitals Network Randwick and Westmead, Sydney, New South Wales, Australia
| | - Michael Dickinson
- The Sydney Children's Hospitals Network Randwick and Westmead, Sydney, New South Wales, Australia
| | - Johanna I Westbrook
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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Zurynski Y, Churruca K, Arnolda G, Dalton S, Ting HP, Hibbert PD, Molloy C, Wiles LK, de Wet C, Braithwaite J. Quality of care for acute abdominal pain in children. BMJ Qual Saf 2019; 29:509-516. [PMID: 31776200 PMCID: PMC7286043 DOI: 10.1136/bmjqs-2019-010088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 11/04/2019] [Accepted: 11/10/2019] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To assess quality of care for children presenting with acute abdominal pain using validated indicators. DESIGN Audit of care quality for acute abdominal pain according to 21 care quality indicators developed and validated in four stages. SETTING AND PARTICIPANTS Medical records of children aged 1-15 years receiving care in 2012-2013 were sampled from 57 general practitioners, 34 emergency departments (ED) and 28 hospitals across three Australian states; 6689 medical records were screened for visits for acute abdominal pain and audited by trained paediatric nurses. OUTCOME MEASURES Adherence to 21 care quality indicators and three bundles of indicators: bundle A-History; bundle B-Examination; bundle C-Imaging. RESULTS Five hundred and fourteen children had 696 visits for acute abdominal pain and adherence was assessed for 9785 individual indicators. The overall adherence was 69.9% (95% CI 64.8% to 74.6%). Adherence to individual indicators ranged from 21.6% for assessment of dehydration to 91.4% for appropriate ordering of imaging. Adherence was low for bundle A-History (29.4%) and bundle B-Examination (10.2%), and high for bundle C-Imaging (91.4%). Adherence to the 21 indicators overall was significantly lower in general practice (62.7%, 95% CI 57.0% to 68.1%) compared with ED (86.0%, 95% CI 83.4% to 88.4%; p<0.0001) and hospital inpatient settings (87.9%, 95% CI 83.1% to 91.8%; p<0.0001). CONCLUSIONS There was considerable variation in care quality for indicator bundles and care settings. Future work should explore how validated care quality indicator assessments can be embedded into clinical workflows to support continuous care quality improvement.
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Affiliation(s)
- Yvonne Zurynski
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia.,NHMRC Partnership Centre in Health System Sustainability, Macquarie University, Sydney, New South Wales, Australia
| | - Kate Churruca
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Gaston Arnolda
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Sarah Dalton
- Agency for Clinical Innovation, NSW Health, Sydney, New South Wales, Australia
| | - Hsuen P Ting
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Peter Damian Hibbert
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia.,Division of Health Sciences, Australian Centre for Precision Health, University of South Australia Cancer Research Institute (UniSA CRI), Adelaide, South Australia, Australia
| | - Charlotte Molloy
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia.,Division of Health Sciences, Australian Centre for Precision Health, University of South Australia Cancer Research Institute (UniSA CRI), Adelaide, South Australia, Australia
| | - Louise K Wiles
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia.,Division of Health Sciences, Australian Centre for Precision Health, University of South Australia Cancer Research Institute (UniSA CRI), Adelaide, South Australia, Australia
| | - Carl de Wet
- Healthcare Improvement Unit, Queensland Government Clinical Excellence Division, Brisbane, Queensland, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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Homaira N, Wiles LK, Gardner C, Molloy CJ, Arnolda G, Ting HP, Hibbert PD, Braithwaite J, Jaffe A. Assessing the quality of health care in the management of bronchiolitis in Australian children: a population-based sample survey. BMJ Qual Saf 2019; 28:817-825. [PMID: 30940731 PMCID: PMC6837255 DOI: 10.1136/bmjqs-2018-009028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 03/12/2019] [Accepted: 03/18/2019] [Indexed: 11/24/2022]
Abstract
Background Bronchiolitis is the most common cause of respiratory hospitalisation in children aged <2 years. Clinical practice guidelines (CPGs) suggest only supportive management of bronchiolitis. However, the availability of CPGs do not guarantee that they are used appropriately and marked variation in the clinical management exists. We conducted an assessment of guideline adherence in the management of bronchiolitis in children at a subnationally representative level including inpatient and ambulatory services in Australia. Methods We searched for national and international CPGs relating to management of bronchiolitis in children and identified 16 recommendations which were formatted into 40 medical record audit indicator questions. A retrospective medical record review assessing compliance with the CPGs was conducted across three types of healthcare setting: hospital inpatient admissions, emergency department (ED) presentations and general practice (GP) consultations in three Australian states for children aged <2 years receiving care in 2012 and 2013. Results Purpose-trained surveyors conducted 13 979 eligible indicator assessments across 796 visits for bronchiolitis at 119 sites. Guideline adherence for management of bronchiolitis was 77.3% (95% CI 72.6 to 81.5) for children attending EDs, 81.6% (95% CI 78.0 to 84.9) for inpatients and 52.3% (95% CI 44.8 to 59.7) for children attending GP consultations. While adherence to some individual indicators was high, overall adherence to documentation of 10 indicators relating to history taking and examination was poorest and estimated at 2.7% (95% CI 1.5 to 4.4). Conclusions The study is the first to assess guideline-adherence in both hospital (ED and inpatient) and GP settings. Our study demonstrated that while the quality of care for bronchiolitis was generally adherent to CPG indicators, specific aspects of management were deficient, especially documentation of history taking.
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Affiliation(s)
- Nusrat Homaira
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.,Respiratory Department, Sydney Children's Hospital Randwick, Randwick, New South Wales, Australia
| | - Louise K Wiles
- University of South Australia, Adelaide, South Australia, Australia.,Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Claire Gardner
- University of South Australia, Adelaide, South Australia, Australia
| | | | - Gaston Arnolda
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Hsuen P Ting
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Peter Damian Hibbert
- University of South Australia, Adelaide, South Australia, Australia.,Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Adam Jaffe
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.,Respiratory Department, Sydney Children's Hospital Randwick, Randwick, New South Wales, Australia
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Hooper TD, Hibbert PD, Hannaford NA, Jackson N, Hindmarsh DM, Gordon DL, Coiera EC, Runciman WB. Surgical site infection-a population-based study in Australian adults measuring the compliance with and correct timing of appropriate antibiotic prophylaxis. Anaesth Intensive Care 2015; 43:461-7. [PMID: 26099757 DOI: 10.1177/0310057x1504300407] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Prophylaxis for surgical site infection (SSI) is often at variance with guidelines, despite the prevalence of SSI and its associated cost, morbidity, and mortality. The CareTrack Australia study, undertaken by a number of the authors, demonstrated that appropriate care (in line with evidence- or consensus-based guidelines) was provided at 38% of eligible SSI healthcare encounters. Here, we report the indicator-level CareTrack Australia findings for SSI prophylaxis. Indicators were extracted from Australian and international clinical guidelines and ratified by clinical experts. A sample designed to be representative of the Australian population was recruited (n=1154). Participants' medical records were reviewed and analysed for compliance with the five SSI indicators. The main outcome measure was the percentage of eligible healthcare encounters with documented compliance with indicators for appropriate SSI prophylaxis. Of the 35,145 CareTrack Australia encounters, 702 (2%) were eligible for scoring against the SSI indicators. Where antibiotics were recommended, compliance was 49% for contaminated surgery, 57% for clean-contaminated surgery and 85% for surgery involving a prosthesis: these fell to 8%, 10% and 14%, respectively (an average of 11%), when currently recommended timing of antibiotic administration was included. Where antibiotics were not indicated, 72% of patients still received them. SSI prophylaxis in our sample was poor; over two-thirds of patients were given antibiotics, whether indicated or not, mainly at the wrong time. There is a need for national agreement on clinical standards, indicators and tools to guide, document and monitor SSI prophylaxis, with both local and national measures to increase and monitor their uptake.
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Affiliation(s)
- T D Hooper
- Project Manager, Centre for Sleep Research, University of South Australia, Adelaide, South Australia
| | - P D Hibbert
- Program Manager, Australian Institute of Health Innovation, University of New South Wales, Sydney, New South Wales
| | - N A Hannaford
- Senior Analyst, Clinical Research, Centre for Sleep Research, University of South Australia, Adelaide, South Australia
| | - N Jackson
- Research Assistant, Australian Institute of Health Innovation, University of New South Wales, Sydney, New South Wales
| | - D M Hindmarsh
- Biostatistician, Australian Institute of Health Innovation, University of New South Wales, Sydney, New South Wales
| | - D L Gordon
- Professor, Microbiology and Infectious Diseases, SA Pathology, Flinders Medical Centre, Bedford Park, South Australia
| | - E C Coiera
- Professor, Chief Investigator, Australian Institute of Health Innovation, University of New South Wales, Sydney, New South Wales
| | - W B Runciman
- Chief Investigator, Centre for Sleep Research, University of South Australia, Adelaide, South Australia
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Runciman WB, Hibbert PD. Spontaneous ventilation pneumothorax. Anaesth Intensive Care 2008; 36:455-456. [PMID: 18564811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Runciman WB, Williamson JAH, Deakin A, Benveniste KA, Bannon K, Hibbert PD. An integrated framework for safety, quality and risk management: an information and incident management system based on a universal patient safety classification. Qual Saf Health Care 2006; 15 Suppl 1:i82-90. [PMID: 17142615 PMCID: PMC2464872 DOI: 10.1136/qshc.2005.017467] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2006] [Indexed: 11/03/2022]
Abstract
More needs to be done to improve safety and quality and to manage risks in health care. Existing processes are fragmented and there is no single comprehensive source of information about what goes wrong. An integrated framework for the management of safety, quality and risk is needed, with an information and incident management system based on a universal patient safety classification. The World Alliance for Patient Safety provides a platform for the development of a coherent approach; 43 desirable attributes for such an approach are discussed. An example of an incident management and information system serving a patient safety classification is presented, with a brief account of how and where it is currently used. Any such system is valueless unless it improves safety and quality. Quadruple-loop learning (personal, local, national and international) is proposed with examples of how an exemplar system has been successfully used at the various levels. There is currently an opportunity to "get it right" by international cooperation via the World Health Organization to develop an integrated framework incorporating systems that can accommodate information from all sources, manage and monitor things that go wrong, and allow the worldwide sharing of information and the dissemination of tools for the implementation of strategies which have been shown to work.
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Affiliation(s)
- W B Runciman
- Department of Anaesthesia and Intensive Care, University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia.
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