Analysis of paediatric long-term ventilation incidents in the community

Abstract

AimTo describe the nature and causes of reported patient safety incidents relating to care in the community for children dependent on long-term ventilation with the further aim of improving safety.MethodsWe undertook an analysis of patient safety incident data relating to long-term ventilation in the community using incident reports from England and Wales’ National Reporting and Learning System occurring between January 2013 and December 2017. Manual screening by two authors identified 220 incidents which met the inclusion criteria. The free text for each report was descriptively analysed to identify the problems in the delivery of care, the contributory factors and the patient outcome.ResultsCommon problems in the delivery of care included issues with faulty equipment and the availability of equipment, and concerns around staff competency. There was a clearly stated harm to the child in 89 incidents (40%). Contributory factors included staff shortages, out of hours care, and issues with packaging and instructions for equipment.ConclusionsThis study identifies a range of problems relating to long-term ventilation in the community, some of which raise serious safety concerns. The provision of services to support children on long-term ventilation and their families needs to improve. Priorities include training of staff, maintenance and availability of equipment, support for families and coordination of care.

Tracheostomy and long‐term mechanical ventilation in children after veno‐venous extracorporeal membrane oxygenation

“…When compared to the overall rate of all PICU patients receiving a tracheostomy (about 6%), 13 our data would suggest that ECMO for respiratory failure is associated with an increased requirement for tracheostomy during the PICU stay. Additionally, a new requirement for long‐term mechanical ventilation was not rare (6% of all patients, 9% of patients surviving to ICU discharge), particularly given the challenges, burdens, and risks that can be associated with discharge on long‐term mechanical ventilation 23–27 …”

“…Additionally, a new requirement for long-term mechanical ventilation was not rare (6% of all patients, 9% of patients surviving to ICU discharge), particularly given the challenges, burdens, and risks that can be associated with discharge on long-term mechanical ventilation. [23][24][25][26][27] Patients receiving a tracheostomy were older and weighed more than those who did not receive a tracheostomy. They also required Several studies have sought to identify factors associated with worse long-term outcomes and functional status in pediatric patients supported on ECMO.…”

Problems and Possibilities of Technology-Dependent Children with Long-term Home Ventilation: 10 Years of Implementation of Home Medical Care in Japan

“…In addition, in other medical procedures, except for suction, the care burden remained at the same level irrespective of TDC's motor function level. Particularly notable was that as they become mobile, TDC remove devices by themselves, and similar problems were described in the process of care [19]. Therefore, overall, the improvement of motor function does not ease caregivers' burden as had been previously thought.…”

‘It gives me more freedom’: Family perspectives on travelling with children on nocturnal ventilation

“…Several studies have recognised the challenges associated with facilitating care at home, from the perspectives of parents and children (Carnevale et al, 2006;Ergenekon et al, 2021;Seear et al, 2016;Toly et al, 2012Toly et al, , 2019. In addition, recognition of the need to provide access to other key cultural markers of childhood such as attending school is also documented (Brookes, 2019;Nawaz et al, 2020). To date, limited attention has been given to other aspects of family life such as holidays and travel.…”