Creating European guidelines for Chiropractic Incident Reporting and Learning Systems (CIRLS): relevance and structure

Abstract

BackgroundIn 2009, the heads of the Executive Council of the European Chiropractors' Union (ECU) and the European Academy of Chiropractic (EAC) involved in the European Committee for Standardization (CEN) process for the chiropractic profession, set out to establish European guidelines for the reporting of adverse reactions to chiropractic treatment. There were a number of reasons for this: first, to improve the overall quality of patient care by aiming to reduce the application of potentially harmful interventions and to facilitate the treatment of patients within the context of achieving maximum benefit with a minimum risk of harm; second, to inform the training objectives for the Graduate Education and Continuing Professional Development programmes of all 19 ECU member nations, regarding knowledge and skills to be acquired for maximising patient safety; and third, to develop a guideline on patient safety incident reporting as it is likely to be part of future CEN standards for ECU member nations.ObjectiveTo introduce patient safety incident reporting within the context of chiropractic practice in Europe and to help individual countries and their national professional associations to develop or improve reporting and learning systems.DiscussionProviding health care of any kind, including the provision of chiropractic treatment, can be a complex and, at times, a risky activity. Safety in healthcare cannot be guaranteed, it can only be improved. One of the most important aspects of any learning and reporting system lies in the appropriate use of the data and information it gathers. Reporting should not just be seen as a vehicle for obtaining information on patient safety issues, but also be utilised as a tool to facilitate learning, advance quality improvement and to ultimately minimise the rate of the occurrence of errors linked to patient care.ConclusionsBefore a reporting and learning system can be established it has to be clear what the objectives of the system are, what resources will be required and whether the implementing organisation has the capacity to operate the system to its full advantage. Responding to adverse event reports requires the availability of experts to analyse the incidents and to provide feedback in a timely fashion. A comprehensive strategy for national implementation must be in place including, but not limited to, presentations at national meetings, the provision of written information to all practitioners and the running of workshops, so that all stakeholders fully understand the purposes of adverse event reporting. Unless this is achieved, any system runs the risk of failure, or at the very least, limited usefulness.

A Literature Review of Pediatric Spinal Manipulation and Chiropractic Manipulative Therapy: Evaluation of Consistent Use of Safety Terminology

“…The use of one, both, or a combination of extensive or short templates could be evaluated for feasibility and possible integration into existing or developing incident reporting systems such as the Chiropractic Incident Reporting and Learning Systems. 14 Currently, safety incidents following pediatric manual procedures vary from 0.23% to 9%. [8][9][10][11] Four studies reporting primary data on pediatric safety incidents had retrospective designs and were subject to limitations including bias and external validity of results to the overall pediatric population.…”

“…14 The idea behind not identifying the operator is to promote trust and minimize the blame culture that may be associated with reporting safety incidents. 14 The identification or anonymity of the operator could be discussed and debated to promote reporting of safety incidents.…”

“…14 The idea behind not identifying the operator is to promote trust and minimize the blame culture that may be associated with reporting safety incidents. 14 The identification or anonymity of the operator could be discussed and debated to promote reporting of safety incidents. The proposed template adapted from the ICH or another to be designed chiropractic template could greatly benefit the quality of the information collected on chiropractic safety incidents.…”

“…Investigating and reporting safety incidents will ultimately improve the care provided to patients by allowing appropriate identification and management of known risks. 14 Therefore, understanding international standards in terminology, procedures, and requirements in medical patient safety such as those offered by the International Conference on Harmonisation of Technical Requirements for Registration of Pharmaceuticals for Human Use (ICH) may offer better consistency. The use of internationally agreed terminology and reporting procedures should allow better intra-and interprofessional understanding and sharing of information on the safety of chiropractic pediatric care.…”

Compensation claims for chiropractic in Denmark and Norway 2004–2012

“…Furthermore, we strongly support the implementation of incident reporting in chiropractic practice, and recently initiatives have been made in countries such as Switzerland and England. Although DPCA and NSCP are unique organizations in Europe, we suspect that more knowledge can be gained through more systematic collection of reported adverse events in chiropractic practice [ 52 ] as well as in medicine in general [ 3 ].…”