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Patient safety incidents in advance care planning for serious illness: a mixed-methods analysis

Dinnen, Toby ORCID:, Williams, Huw, Yardley, Sarah, Noble, Simon ORCID:, Edwards, Adrian ORCID:, Hibbert, Peter, Kenkre, Joyce and Carson-Stevens, Andrew ORCID: 2022. Patient safety incidents in advance care planning for serious illness: a mixed-methods analysis. BMJ Supportive and Palliative Care 12 (e3) , e403-e410. 10.1136/bmjspcare-2019-001824

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Objectives Advance care planning (ACP) is essential for patient-centred care in the last phase of life. There is little evidence available on the safety of ACP. This study characterises and explores patient safety incidents arising from ACP processes in the last phase of life. Methods The National Reporting and Learning System collates patient safety incident reports across England and Wales. We performed a keyword search and manual review to identify relevant reports, April 2005–December 2015. Mixed-methods, combining structured data coding, exploratory and thematic analyses were undertaken to describe incidents, underlying causes and outcomes, and identify areas for improvement. Results We identified 70 reports in which ACP caused a patient safety incident across three error categories: (1) ACP not completed despite being appropriate (23%, n=16). (2) ACP completed but not accessible or miscommunicated between professionals (40%, n=28). (3) ACP completed and accessible but not followed (37%, n=26). Themes included staff lacking the knowledge, confidence, competence or belief in trustworthiness of prior documentation to create or enact ACP. Adverse outcomes included cardiopulmonary resuscitation attempts contrary to ACP, other inappropriate treatment and/or transfer or admission. Conclusion This national analysis identifies priority concerns and questions whether it is possible to develop strong system interventions to ensure safety and quality in ACP without significant improvement in human-dependent issues in social programmes such as ACP. Human-dependent issues (ie, varying patient, carer and professional understanding, and confidence in enacting prior ACP when required) should be explored in local contexts alongside systems development for ACP documentation.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Publisher: BMJ Publishing Group
ISSN: 2045-435X
Funders: Marie Curie, Scientific Foundation Board, RCGP
Date of First Compliant Deposit: 15 August 2019
Date of Acceptance: 31 July 2019
Last Modified: 11 Oct 2023 23:55

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