6637 How do families mitigate paediatric safety incidents in emergency departments? A multi-method national analysis of incident reports

Ball, Emily, McFadzean, Joy, Purchase, Thomas ORCID: https://orcid.org/0000-0002-4504-2111, Robb, Philippa, Gwyn, Sioned, Donovan, Lauren, Hellard, Stuart, Rees, Philippa and Carson-Stevens, Andrew ORCID: https://orcid.org/0000-0002-7580-7699 2024. 6637 How do families mitigate paediatric safety incidents in emergency departments? A multi-method national analysis of incident reports. Archives of Disease in Childhood 109 , A400-A401. 10.1136/archdischild-2024-rcpch.629

Preview

PDF (Abstract) - Published Version Download (347kB) | Preview

Abstract

Objectives Healthcare-associated harm is an international public health issue.1 Children are a particularly vulnerable group, with 15%–35% of hospitalised children experiencing harm whilst receiving medical care.2Whilst many factors increase the risk of adverse events, such as a child’s dependency on others to rec- ognise and respond to illness, children have a unique protective factor in the form of their parents (guardians and families), who are well placed to detect and prevent unsafe care. Mar- tha’s Rule highlights the need to more effectively enable parents to function as safety advocates.3 We aimed to characterise the role of parents in mitigating patient safety incidents involving children within Emergency Departments.4 Methods Free text of patient safety incident reports submitted from Emergency Departments in England and Wales between 2014–2020 to the National Reporting Learning System (now the Learning from Patient Safety Events Service) were searched for terms like *parent*, *dad*, and *mother*. We were provided with 12,300 reported and created a weighted sample of 4000 reports.4 Two trained paediatricians and a general practitioner reviewed reports which were included for analysis if there was clear evidence in the narrative of parental involvement directly related to the reported incident. Reports were systematically coded using the Patient Safety (PISA) classification system.5 An inductive thematic analysis in NVivo informed the development of a mitigatory factor framework. An exploratory descriptive analysis identified the most frequent semantic relationships between type of incident, mitigating factors, and harm outcomes. Results A total of 1065 (27%) reports were included for analy- sis. Parents were involved in mitigating incidents in over two thirds of reports (714, 67%). The most common mitigatory factors included: ‘family advocates for child’, ‘parent expresses concern about care given’, and ‘family chases healthcare appointment’. The most frequent incidents with parental mitiga- tory factors related to diagnosis and assessment (157, 22%), e. g., a missed diagnosis, medication (150, 21%), e.g., wrong medication prescribed, and treatment (89, 13%), e.g., insuffi- cient treatment given. In 229 (32%) of these reports, parents prevented harm or further harm. Conclusion Parents play a key role in preventing safety inci- dents and harms when their children receive healthcare in Emergency Departments. Identification of mitigation factors within incident report narratives will support health systems to identify where they should investigate further or intervene to improve safety. Our analysis has identified priority areas to enable the co-development of recommendations and strategies to deliver safer paediatric care and support parents as child safety advocates.

Item Type:	Article
Date Type:	Published Online
Status:	Published
Schools:	Medicine
Subjects:	R Medicine > R Medicine (General) R Medicine > RJ Pediatrics
Publisher:	BMJ Publishing Group
ISSN:	0003-9888
Date of First Compliant Deposit:	29 August 2024
Date of Acceptance:	30 July 2024
Last Modified:	01 Oct 2024 14:00
URI:	https://orca.cardiff.ac.uk/id/eprint/171639

Actions (repository staff only)

Edit Item