Validating the International Classification for Patient Safety (ICPS): The Belgian Experience
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Transcript of Validating the International Classification for Patient Safety (ICPS): The Belgian Experience
Luc Van Looy
Medical Director
GZA Hospitals
Antwerpen, Belgium
THE PATIENT SAFETY PLAN
OF THE BELGIAN FEDERAL
GOVERNMENT
Patient safety
• Quality of care:
• Patient-centered
• Accessible
• Accurate
• In time
• Effective
• Efficient
• Affordable
• Safe
Patient safety
• Damage can have many faces and can hit all of
us
• Reports IOM:
• 1999 „To err is human‟
• 2001 „Crossing the quality chasm‟
• Targeting the system, not the individual
• “Events” (adverse events, near misses)
• Safety culture
Patient safety in BelgiumFederal Government project
• 5 year project
2007-2012
• Funding:
• National budget 7.216.214 € / year
• 104 € / hospital bed
• Hospitals with <100 beds: 10.000 €.
• Free participation, but with engagement
Engagement from the hopitals
• Installing:• A central steering patient-safety-committee
• An operational patient-safety-team
• Implementation of a safety-management-system:• Event notification
• Analysis
• Improvement actions
• Follow-up (indicators)
• Paving the way for future aggregation:
• Uniformity of data
• Classification taxonomy
2007 2008 2009 2010 2011 2012
}integrated
patient safety
management
system
2013-2016
strategy, vision, targets
Preparation
of project
define
In preparation
safety culture measurement actions for improvement measurement actions for improvement
eventnotification
installation of notification system use of notification system in all Belgian hospitals
analysis retrospective retrospective + proactive
improvement define intramural processes extramural processes
indicators pilot (only acute hospitals) cartographydevelopment new
indicatorsstandardized, integrated,
multidimensional set
5 year plan
Response of the field
0
10
20
30
40
50
60
70
80
90
100
% hospitals % beds
80
9190
9791
98
2007-2008
2008-2009
2009-2010
FOCUS ON TAXONOMY
Why taxonomy?
• Prime target: aggregation of data
• Study and analysis of data-collections:
• Detection of patterns and trends
• Sharing, structuring and communicating available knowledge
• Quality surveillance
• Different levels:
• Hospital
• Between hospitals:
Regional network
National
International
• Specialisms (Netherlands: Neosafe, Prima-RT)
Conditions for success
• Clear, understandable and reproducible
• Good balance between:• Sufficient detail – specificity
• Ease of use: limited training must suffice ( ICD9)
• On implementation:• Minimal negative impact on existing systems
• Comparative benefits buy-in• Efficient
• User-friendly
• Broad application:
Acute hospital, psychiatric institution, rehabilitation center…
In-hospital as well as ambulatory care
Taxonomy JCAHO
Taxonomy WHO
• ICPS
International
Classification
for Patient Safety
ICPS: a conceptual framework
• 10 high level
classes
• 48 key concepts
• ± 700 concepts
ICPS head classes
Incident typeIncident characteristics
Outcome patientOutcome organization
Patient characteristics
Detection
Contributing factorsMitigating factorsAmeliorating actions
Actions taken to reduce risk
Terrifying at first glance…
ICPS head classes
Incident typeIncident characteristics
Outcome patientOutcome organization
Patient characteristics
Detection
Contributing factorsMitigating factorsAmeliorating actions
Actions taken to reduce risk
Minimal dataset
Optional
Application of taxonomy
• The person reporting an event
• The patient-safety coordinator
• The patient-safety team
• The person reporting an event has no benefit in
taxonomy
• Even with a minimal dataset, there is always
ballast for someone somewhere
• Tailoring the notification system to the local
needs is crucial
Tailoring the notification system
Incorporation in event-notification
Fitting the taxonomy to the Belgian
situation
• Translation: Dutch, French, German
• Defining a code:
• E: Wrong patient
D: Verkeerde patiënt
F: Patient erroné
G: Falscher Patient
• Unique hierarchical code
Translations and codes
Basis for aggregation
Fitting the taxonomy to the Belgian
situation
• Federal Government provides a uniform XML-
model for data-export
Reporter
• Input incident (±taxonomy)
• Nominative or anonymous
Team PatSaf
• Supplementaryinfo?
• Analysis ifneeded
Team PatSaf
• Complete taxonomy(at least minimal data set)
• Anonimisation
Repository
• Reporting
• (Export)
Committee PatSafDecentral point of expertise
• Analysis if needed
xml
Problems to solve
• Clarification of some topics:
• i.e. ambulatory versus in-hospital care
• Consistency with and linking to existing
classifications:
• Some are obvious: ICD, ATC, ICF…
• But others are not and there is not always
consistency between countries
• WHO
Problems to solve
• Parallel registrations:• Mandatory:
• Transfusion-incidents
• Tissue donation (bone, tympano-ossicular, skin, veins, …)
• Infections
• …
• Others:• Psychiatry
• Fall incidents
• Radiotherapy
• Solitary initiatives…
• Avoid duplication
• Integration
Problems
• Legal protection for notification systems
• Patient safety act (Denmark)
• Netherlands
• …
• Safety culture:
• Health-workers
• Organizations
• Patient
• Society
are they all ready for open communication and
management?
Belgian patient safety project
• ICPS is not officially released by the WHO yet
• Whish for integration as a standard in Belgian
hospitals
• WHO:
• Request for a use-case in the Belgian hospital-
setting
Applying the minimal dataset to patient-safety
events
Coding
XML-export
Aggregation of data