4.2 Article

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

期刊

BMJ SUPPORTIVE & PALLIATIVE CARE
卷 12, 期 E3, 页码 E403-E410

出版社

BMJ PUBLISHING GROUP
DOI: 10.1136/bmjspcare-2019-001824

关键词

Clinical decisions; Communication

资金

  1. Marie Curie
  2. Scientific Foundation Board of the Royal College of General Practitioners [MC 2016-06]

向作者/读者索取更多资源

This study characterizes and explores patient safety incidents arising from Advance Care Planning (ACP) processes in the last phase of life. The study identifies three categories of incidents related to ACP: ACP not completed, ACP completed but not accessible or miscommunicated between professionals, and ACP completed and accessible but not followed. The incidents may result in adverse outcomes such as inappropriate treatment and/or transfer or admission.
Objectives Advance 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. Methods The 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. Results We 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. Conclusion This 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.

作者

我是这篇论文的作者
点击您的名字以认领此论文并将其添加到您的个人资料中。

评论

主要评分

4.2
评分不足

次要评分

新颖性
-
重要性
-
科学严谨性
-
评价这篇论文

推荐

暂无数据
暂无数据