Patient and caregiver factors in ambulatory incident reports: a mixed-methods analysis

BMJ Open Quality

article

Anjana E Sharma¹  Beatrice Huang³  Jan Bing Del Rosario⁴  Janine Yang⁵  W John Boscardin⁶  Urmimala Sarkar² 

[1]Family & Community Medicine, Center for Excellence in Primary Care, Department of Medicine , University of California San Francisco

[2]UCSF Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital , University of California San Francisco

[3]1 Family & Community Medicine, Center for Excellence in Primary Care, Department of Medicine , University of California San Francisco , San Francisco , California , USA 2 UCSF Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital , University of California San Francisco , San Francisco , California , USA 3 Division of HIV, ID and Global Medicine, Department of Medicine , University of California San Francisco , San Francisco , California , USA 4 Drexel University College of Medicine , Bakersfield , California , USA 5 Department of Epidemiology and Biostatistics , University of California San Francisco , San Francisco , California , USA 6 Division of General Internal Medicine, Department of Medicine , University of California San Francisco

[4]Division of HIV, ID and Global Medicine, Department of Medicine , University of California San Francisco

[5]Drexel University College of Medicine

[6]Department of Epidemiology and Biostatistics , University of California San Francisco

[7]Division of General Internal Medicine, Department of Medicine , University of California San Francisco

关键词: patient safety;    ambulatory care;    safety management;    patient participation;    medical error;    measurement/epidemiology;   

DOI  :  10.1136/bmjoq-2021-001421

学科分类：药学

来源: BMJ Publishing Group

【 摘 要 】

Objectives Patients and caregivers are the primary stakeholders in ambulatory safety, given they perform daily chronic disease self-management, medication administration and outpatient follow-up. However, little attention has been given to their role in adverse events. We identified themes related to patient and caregiver factors and challenges in ambulatory safety incident reports from a Patient Safety Organization.Methods We conducted a mixed-methods analysis of ambulatory incident reports submitted to the Collaborative Healthcare Patient Safety Organization, including 450 hospitals or clinic members in 13 US states. We included events that had patient and/or caregiver behavioural, socioeconomic and clinical factors that may have contributed to the event. Two members of the team independently coded patient/caregiver factors, with dual coding of 20% of events. We then conducted a ‘frequent item set’ analysis to identify which factors most frequently co-occurred. We applied inductive analysis to the most frequent sets to interpret themes. Our team included a diverse stakeholder advisory council of patients, caregivers and healthcare staff.Results We analysed 522 incident reports and excluded 73 for a final sample of 449 events. Our co-occurrence analysis found the following three themes: (1) clinical advice may conflict with patient priorities; (2) breakdowns in communication and patient education cause medication adverse events and (3) patients with disabilities are vulnerable to the external environment.Conclusions Ambulatory safety reports capture both structural and behavioural factors contributing to adverse events. Actionable takeaways include the following: improving clinician counselling of patients to convey medical advice to elicit priorities, enhanced education regarding medication adverse events and expanding safety precautions for patients with disabilities at home. Ambulatory safety reporting must include patients in reporting and event review for better mitigation of future harm.

【 授权许可】

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