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Using the WHO international classification of patient safety framework to identify incident characteristics and contributing factors for medical or surgical complication deaths

Mitchell, Rebecca, Faris, Mona, Lystad, Reidar, Pulido, Diana Fajardo, Norton, Grace, Baysari, Melissa, Clay-Williams, Robyn, Hibbert, Peter, Carson-Stevens, Andrew and Hughes, Cliff 2020. Using the WHO international classification of patient safety framework to identify incident characteristics and contributing factors for medical or surgical complication deaths. Applied Ergonomics 82 , 102920. 10.1016/j.apergo.2019.102920
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Abstract

This study aimed to operationalise and use the World Health Organisation's International Classification for Patient Safety (ICPS) to identify incident characteristics and contributing factors of deaths involving complications of medical or surgical care in Australia. A sample of 500 coronial findings related to patient deaths following complications of surgical or medical care in Australia were reviewed using a modified-ICPS (mICPS). Over two-thirds (69.0%) of incidents occurred during treatment and 27.4% occurred in the operating theatre. Clinical process and procedures (55.9%), medication/IV fluids (11.2%) and healthcare-associated infection/complications (10.4%) were the most common incident types. Coroners made recommendations in 44.0% of deaths and organisations undertook preventive actions in 40.0% of deaths. This study demonstrated that the ICPS was able to be modified for practical use as a human factors taxonomy to identify sequences of incident types and contributing factors for patient deaths. Further testing of the mICPS is warranted.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Publisher: Elsevier
ISSN: 0003-6870
Date of First Compliant Deposit: 16 August 2019
Date of Acceptance: 12 August 2019
Last Modified: 24 Oct 2019 14:21
URI: http://orca-mwe.cf.ac.uk/id/eprint/124976

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