Making the most of safety data

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Making the most of safety data: do not throw the baby out with the bathwater! Katherine Cheema and Samantha Riley Abstract In the National Health Service in England there are many sources of information pertaining to patient safety. This paper sets out to describe the challenge of measuring patient safety and describes the key data sources that underpin the national understanding of the area. The paper will describe how utilizing all of the available patient safety data, irrespective of the variability inherent, can ensure that practising clinicians have a better understanding of the current picture of patient safety and can fully evidence the efficacy of their improvement actions. Examples of effective triangulation of these data sources are given with acknowledgement of the challenges this can present in terms of engagement and understanding, particularly in the clinical context. Recommendations for the effective use of information in the assessment of patient safety are also provided.

Introduction Patient safety is a foundation principle of the National Health Service (NHS) and indeed of the caring professions, being a core part of delivering quality services. In a world of dwindling resources that requires us to do more for less, an unrelenting focus on ensuring that our patients remain safe while in our care is crucial to guarantee that we deliver the best care possible. In order to achieve this, rigorous measurement of harm events and other patient safety information is crucial, not only in identifying where we may have gone wrong, but also to help us understand where improvement work has been successful and point to possible next steps in our journey towards harmfree care. So, what data are there to interrogate to shed light on the state of patient safety in the NHS? We are certainly not short of data. In fact, we are positively swimming in it, with a range of datasets and tools that are regularly in use to collect patient safety data and fully accessible to clinical teams across the country. The Institute for Healthcare Improvement’s (IHI) global trigger tool is widely used as a deep but rapid approach to assess the cause and avoidability of harm, primarily in hospital-based care. We have extensive risk and root cause reporting to the National Reporting and Learning System (NRLS) hosted by the National Patient Safety Agency (NPSA) as well as a centralized database of serious incidents via the Strategic Executive Information System system, healthcare-associated infections via the Health Protection Agency (HPA) data

Katherine Cheema MSc Research Methods, NHS South of England Quality Observatory, UK; Samantha Riley BSc (Hons) Computer Science, NHS South of England Quality Observatory, UK Email: samantha.riley@southeastcoast.nhs.uk

Clinical Risk 2012; 18: 124 –130

collection system and a host of standard datasets that record administrative data that can be interrogated to assess patient safety events. This year, incentivized through a national clinical quality incentive payment (CQUIN), another tool has been added to the mix, the NHS Safety Thermometer, a point prevalence tool that identifies patients with specific harms, covering pressure ulcers, harm from falls, catheterized patients with urinary tract infections and venous thromboembolism and from which can be derived a composite ‘harm free care’ indicator. This is of course not to mention information collected under the auspices of local programmes, audits and projects such as that used within as well as less frequent national surveys, such as the HPA’s catheter-associated infection audit, which collects additional data often outside the regular datasets. Given the wealth of data that are available to clinicians working within the NHS, we might expect our measurement of harm to be integral to all our regular reporting and readily available at all levels and in all areas where care is delivered. Our progress in reducing avoidable harm should be second to none; after all, we have all these data to help us identify what is working and what is not. In reality, each individual data source is slightly different, either using differing measurement methodologies, alternative definitions or designed to operate in specific care settings. Accordingly, many users of patient safety data are ‘wedded’ to preferred measurement methods, based on the premise that a different definition or methodology could not provide them with the specific answer they require. There is some truth in the suggestion that different data sources will yield differing ‘answers’. This paper aims to show how utilizing all of the patient safety data, irrespective of the variability inherent within it, can ensure that you have a better understanding of the current picture of patient safety and can fully evidence the efficacy of your improvement actions. We provide examples of where DOI: 10.1258/cr.2012.012021


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