Improving critical incident reporting in primary care through education and involvement

Abstract

BackgroundCritical incident reporting systems (CIRS) can be an important tool for the identification of organisational safety needs and thus to improve patient safety. In German primary care, CIRS use is obligatory but remains rare. Studies on CIRS implementation in primary care are lacking, but those from secondary care recommend involving management personnel.ObjectiveThis project aimed to increase CIRS use in 69 practices belonging to a local practice network.MethodsThe intervention consisted of the provision of a web-based CIRS, accompanying measures to train practice teams in error management and CIRS, and the involvement of the network’s management. Three measurements were used: (1) number of incident reports and user access rates to the web-based CIRS were recorded, (2) staff were given a questionnaire addressing incident reporting, error management and safety climate and (3) qualitative reflection conferences were held with network management.ResultsOver 20 months, 17 critical incidents were reported to the web-based CIRS. The number of staff intending to report the next incident online decreased from 42% to 20% of participants. In contrast, the number of practices using an offline CIRS (eg, incident book) increased from 23% to 49% of practices. Practices also began proactively approaching network management for help with incidents. After project completion, participants scored higher in the patient safety climate factor ‘perception of causes of errors’. For many practices, the project provided the first contact with structured error management.ConclusionSpecific measures to improve the use of CIRS in primary care should focus on network management and practice owners. Practices need basic training on safety culture and error management. Continuing, practices should implement an offline CIRS, before they can profit from the exchange of reports via web-based CIRS. It is crucial that practices receive feedback on incidents, and trained network management personnel can provide such support.

Second Victims in Intensive Care—Emotional Stress and Traumatization of Intensive Care Nurses in Western Austria after Adverse Events during the Treatment of Patients

“…Regarding the three-step model of supporting second victims according to Scott et al [ 2 ], if the collegial help within the department is not sufficiently effective, then crisis intervention by a special team or even a network of professional support should be considered. To improve the CIRS application and thereby create a better safety culture, an increased need for training is necessary at all levels of hospital management [ 31 ]. Additional reactive measures to avoid the second victim phenomenon are: short breaks, offering collegial discussions, debriefing of stressful situations and technical support, carrying out an error analysis, and avoiding blame and bullying in the team [ 5 ].…”

Providing an interactive undergraduate elective on safety culture online – concept and evaluation

“…We based the development of this online elective on our own preparatory work on the topic of safety culture, as well as our teaching experience, including our medical-didactic knowledge of online formats [ 17 – 19 ]. The formal requirement for the undergraduate elective was the approval of the curriculum by the study commission.…”

Vapaaehtoisen vaaratapahtumajärjestelmän kehittäminen korkean kehitysasteen potilastietojärjestelmissä

“…Vaaratapahtumien raportointijärjestelmät ovat olleet käytössä jo yli vuosikymmenen ajan useissa maissa, mutta näiden järjestelmien käytön kattavuus maiden välillä vaihtelee suuresti. [1] Raportoinnilla pyritään havaitsemaan ongelmia ja tutkimaan taustalla olevia syitä, minkä seurauksena organisaation on mahdollista oppia estämään tällaisten tapahtumien uusiutumista [1][2][3].…”