Routinely recorded patient safety events in primary care: a literature review (original) (raw)
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Prevalence of Adverse Drug Events in Ambulatory Care: A Systematic Review
Annals of Pharmacotherapy, 2011
M edication-related adverse events represent an important cause of morbidity, and more recent attention has been placed on medication safety in ambulatory care settings, the most frequently used components of the formal healthcare system. 1,2 In the ambulatory care setting, adverse drug events (ADEs) have been reported to occur at a rate of 25%. Approximately 39% of these ADEs were preventable. 3 Since many ADEs are associated with medication errors, and thus potentially preventable, understanding the nature of medication errors in ambulatory care settings can direct attention toward improvement of medication safety in ambulatory care. 2 Ambulatory care is any medical care delivered on an outpatient basis and includes both primary and specialty care. In many countries, primary care settings account for the majority of drug prescriptions. For example, in 2008, primary care accounted for 69.9% of medication-related costs for the British National Health Service (NHS) versus only 30.1% for drugs supplied in the hospital setting. 4 In addition, 80-90% of all prescriptions for antibiotics in Europe are issued in primary care settings. 5 Further-OBJECTIVE: Most medications are prescribed, dispensed, and administered in ambulatory care settings, yet little information exists on the adverse effects of drugs in this setting. This review was conducted to estimate the prevalence of adverse drug events (ADEs) and the proportion of preventable ADEs in ambulatory care settings; compare data for different age groups including children, adults, and elderly patients; and review drug classes most commonly associated with ADEs. )-were systematically searched for published data. Bibliographies of retrieved articles were searched individually for additional relevant studies.
The Journal of family practice, 2002
To describe and classify process errors and preventable adverse events that occur from medical care in outpatient primary care settings. Systematic review and synthesis of the medical literature. We searched MEDLINE and the Cochrane Library from 1965 through March 2001 with the MESH term medical errors, modified by adding family practice, primary health care, physicians/family, or ambulatory care and limited the search to English-language publications. Published bibliographies and Web sites from patient safety and primary care organizations were also reviewed for unpublished reports, presentations, and leads to other sites, journals, or investigators with relevant work. Additional papers were identified from the references of the papers reviewed and from seminal papers in the field. Process errors and preventable adverse events. Four original research studies directly studied and described medical errors and adverse events in primary care, and 3 other studies peripherally addressed ...
BMJ open, 2017
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. 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 ...
The Journal of family practice
To describe and classify process errors and preventable adverse events that occur from medical care in outpatient primary care settings. Systematic review and synthesis of the medical literature. We searched MEDLINE and the Cochrane Library from 1965 through March 2001 with the MESH term medical errors, modified by adding family practice, primary health care, physicians/family, or ambulatory care and limited the search to English-language publications. Published bibliographies and Web sites from patient safety and primary care organizations were also reviewed for unpublished reports, presentations, and leads to other sites, journals, or investigators with relevant work. Additional papers were identified from the references of the papers reviewed and from seminal papers in the field. Process errors and preventable adverse events. Four original research studies directly studied and described medical errors and adverse events in primary care, and 3 other studies peripherally addressed ...
BMC Family Practice
Background: Patient safety research is conducted predominantly in hospital settings, with a dearth of insight from primary care, despite suggestions that 2.2% of primary care consultations result in a patient safety incident. This study aimed to assess the feasibility of an intervention intended to improve patient safety in general practice. Methods: A randomised controlled feasibility study was conducted with general practices in the Republic of Ireland (N = 9) and Northern Ireland (N = 2), randomly assigned to the intervention (N = 5) or control (N = 6) group. The nine-month intervention consisted of: 1) repeated safety climate (SC) measurement (using GP-SafeQuest questionnaire) and feedback (comparative anonymised practice-level SC data), and 2) patient record reviews using a specialised trigger tool to identify instances of undetected patient harm. For control practices, SC was measured at baseline and study end only. The intervention's perceived usefulness and feasibility were explored via an end-ofstudy questionnaire and semi-structured interviews. Results: Thirteen practices were invited; 11 participated; 10 completed the study. At baseline, 84.8% of intervention practice staff (39/46) and 77.8% (42/54) of control practice staff completed the SC questionnaire; at the study terminus, 78.3% (36/46) of intervention practice staff and 68.5% (37/54) of control practice staff did so. Changes in SC scores, indicating improvement, were observed among the intervention practices but not in the control group. The trigger tool was applied to 188 patient records; patient safety incidents of varying severity were detected in 19. 1% (36/188). Overall, 59% of intervention practice team members completed the end-of-study questionnaire, with the majority in both healthcare systems responding positively about the intervention. Interviews (N = 9) identified the intervention's usefulness in informing practice management and patient safety issues, time as a barrier to its use, and the value of group discussion of feedback. Conclusion: This feasibility study suggests that a definitive randomised controlled trial of the intervention is warranted. Our findings suggest that the intervention is feasible, useful, and sustainable. Practices were willing to be recruited into the study, response and retention rates were acceptable, and there is possible evidence of a positive effect of the intervention. Trial registration: The trial registration number is: ISRCTN11426121 (retrospectively registered 12th June 2018).
South African Medical Journal, 2016
The incidence of medical adverse events (AEs) in hospitalised patients was estimated at 9.2% (interquartile range 4.6-12.4) by de Vries et al. [1] in 2008. An event was defined as an incident resulting in death, a prolonged hospital stay or disability but not attributable to the underlying medical condition. The Canadian AEs study [2] found a rate of 7.5% from review of 3 745 medical records in four hospitals. Public hospitals in a multicentre study conducted in Africa and the Middle East had a range of 2.5-18.4%. [3] Other methods used to assess AEs include incident reports, interviewing of healthcare providers, direct observation, external audits, confidential inquiries and complaints. Use of a hybrid electronic medical record system has demonstrated some benefit in combining prospective and retrospective approaches to uncover surgical AEs. Laing et al. [4] identified 71.4% errors prospectively and 28.6% retrospectively. They found that a tick-box system improved the quality of documentation, which could help solve the disadvantage inherent in retrospective reviews. [5] Prospective approaches involve voluntary written documentation or reporting of incidents, with concerns of underreporting when a culture of quality monitoring is not entrenched. [6] Objective The practice of AE reporting has not gained ground in many institutions in low-income countries. This may be due to inadequate awareness of its importance in informing service quality improvement to minimise harm to patients. This study was carried out with the objective of comparing the prevalence and patterns of AEs in hospitalised patients, using review of medical records and incident reporting. Methods The study was carried out in a 254-bed tertiary hospital in Nairobi, Kenya. The hospital has ~20 000 admissions per annum, comprising medical, surgical, paediatric and obstetric patients. A retrospective review of randomly selected medical records of patients admitted in 2010 was undertaken to identify the presence or absence of AEs documented in the index year. All inpatient medical records and reported clinical incidents for the index year were eligible for inclusion. When more than one incident occurred in a patient in the index year, all were included as separate occurrences provided they were not related. Using an estimated AE prevalence of 14.5%, [3] power of 80% and 5% precision, a sample size estimate of about 200 medical records was determined adequate. We assumed that 20% of the records would be incomplete and therefore added an extra 40 medical charts, giving a total sample size of 245 records. However, in order to obtain a larger number to enable meaningful comparison, we This open access article is distributed under Creative Commons licence CC-BY-NC 4.0.
Contributory factors to patient safety incidents in primary care: protocol for a systematic review
Systematic Reviews, 2015
Background: Organisations need to systematically identify contributory factors (or causes) which impact on patient safety in order to effectively learn from error. Investigations of error have tended to focus on taking a reactive approach to learning from error, mainly relying on incident-reporting systems. Existing frameworks which aim to identify latent causes of error rely almost exclusively on evidence from non-healthcare settings. In view of this, the Yorkshire Contributory Factors Framework (YCFF) was developed in the hospital setting. Eighty-five percent of healthcare contacts occur in primary care. As a result, this review will build on the work that produced the YCFF, by examining the empirical evidence that relates to the contributory factors of error within a primary care setting. Methods/design: Four electronic bibliographic databases will be searched: MEDLINE, Embase, PsycInfo and CINAHL. The database search will be supplemented by additional search methodologies including citation searching and snowballing strategies which include reviewing reference lists and reviewing relevant journal table of contents, that is, BMJ Quality and Safety. Our search strategy will include search combinations of three key blocks of terms. Studies will not be excluded based on design. Included studies will be empirical studies conducted in a primary care setting. They will include some description of the factors that contribute to patient safety. One reviewer (SG) will screen all the titles and abstracts, whilst a second reviewer will screen 50% of the abstracts. Two reviewers (SG and AH) will perform study selection, quality assessment and data extraction using standard forms. Disagreements will be resolved through discussion or third party adjudication. Data to be collected include study characteristics (year, objective, research method, setting, country), participant characteristics (number, age, gender, diagnoses), patient safety incident type and characteristics, practice characteristics and study outcomes. Discussion: The review will summarise the literature relating to contributory factors to patient safety incidents in primary care. The findings from this review will provide an evidence-based contributory factors framework for use in the primary care setting. It will increase understanding of factors that contribute to patient safety incidents and ultimately improve quality of health care.