Patient safety incidents in advance care planning for serious illness: a mixed-methods analysis

Abstract

ObjectivesAdvance care planning (ACP) is essential for patient-centred care in the last phase of life. There is little evidence available on the safety of ACP. This study characterises and explores patient safety incidents arising from ACP processes in the last phase of life.MethodsThe National Reporting and Learning System collates patient safety incident reports across England and Wales. We performed a keyword search and manual review to identify relevant reports, April 2005–December 2015. Mixed-methods, combining structured data coding, exploratory and thematic analyses were undertaken to describe incidents, underlying causes and outcomes, and identify areas for improvement.ResultsWe identified 70 reports in which ACP caused a patient safety incident across three error categories: (1) ACP not completed despite being appropriate (23%, n=16). (2) ACP completed but not accessible or miscommunicated between professionals (40%, n=28). (3) ACP completed and accessible but not followed (37%, n=26). Themes included staff lacking the knowledge, confidence, competence or belief in trustworthiness of prior documentation to create or enact ACP. Adverse outcomes included cardiopulmonary resuscitation attempts contrary to ACP, other inappropriate treatment and/or transfer or admission.ConclusionThis national analysis identifies priority concerns and questions whether it is possible to develop strong system interventions to ensure safety and quality in ACP without significant improvement in human-dependent issues in social programmes such as ACP. Human-dependent issues (ie, varying patient, carer and professional understanding, and confidence in enacting prior ACP when required) should be explored in local contexts alongside systems development for ACP documentation.

Nature and type of patient-reported safety incidents in primary care: cross-sectional survey of patients from Australia and England

“…14 15 However, most of the evidence describing the nature of patient-reported safety incidents has originated from the hospital setting, 16 with primary care considered an emerging research area. [17][18][19][20][21][22][23][24][25][26] A small number of studies have described the frequency of patient-reported safety incidents or errors, and harm in primary…”

Which human factors design issues are influencing system performance in out-of-hours community palliative care? Integration of realist approaches with an established systems analysis framework to develop mid-range programme theory

“…We have already applied this mid-range programme theory to our later analysis of incidents arising from advance care planning. 31 This identified structure-based solutions to ensure patients receive timely and robust advance care planning would not be enough; in 37% (26 of 70) of advance care planning incidents, the plan was not followed due to person-level issues such as poor higher-level meta-cognitive skills or emotional intelligence often in the context of lack of confidence or experience.…”

Analysis of applying a patient safety taxonomy to patient and clinician-reported incident reports during the COVID-19 pandemic: a mixed methods study

“…The PatIent SAfety (PISA) Research Group at Cardiff University has led an extensive characterisation of patient safety incidents reported by healthcare professionals from primary and secondary care settings. This includes studies to identify priority areas for patient safety across the health and social care continuum, including unsafe discharge from secondary to primary care settings [ 18 ], incidents experienced by children in primary care [ 19 ], older adults [ 20 ], patients receiving palliative care [ 21 ], advanced care planning [ 22 ] and adults receiving opiate replacement therapy [ 23 ]. The PISA classification system has also previously been used to characterise the nature of patient-reported safety incidents in primary care settings from the UK and Australia, enabling the data to be used for service learning and improvement [ 24 ].…”