Elsevier

Clinical Chiropractic

Volume 9, Issue 3, September 2006, Pages 139-149
Clinical Chiropractic

Original paper
The reporting of patient safety incidents—first experiences with the chiropractic reporting and learning system (CRLS): A pilot study

https://doi.org/10.1016/j.clch.2006.04.002Get rights and content

Summary

Objective

To design and test a reporting format for patient safety incidents (PSIs) related to chiropractic practice.

Design

A pilot study of adverse event monitoring.

Setting

Field chiropractic practice and the teaching clinic of the Anglo-European College of Chiropractic.

Subjects

Members of the British Chiropractic Association and final year clinical students.

Methods

Following design of a reporting format, chiropractors and/or final year clinical students responded by completing a form and submitting this to a central collection point for analysis.

Results

Forms were received from seven field practitioners and from 63 students providing information on a number of PSIs. The low number of field practitioners responding prevented any summative analysis and the results are therefore presented individually. With reference to the final year clinical students, the majority of PSIs were associated with misuse of therapeutic equipment (32%) and the treatment intervention itself (31%).

Conclusions

Gathering information on PSIs using this format was shown to be both feasible and fit for purpose. Further work is planned to widen access and to facilitate and promote the attributes for an informed safety culture for the chiropractic profession.

Section snippets

Background

In general terms, clinical risk management can be seen as a mechanism for managing exposure to risk that enables us to recognise the events that may result in unfortunate or damaging consequences in the future, their severity, and how they can be controlled.1 Clinical risk management is also at the heart of clinical governance, whose principles demand that lessons have to be learned from failure and clinical incidents involving harm or errors, and that these lessons will inform future clinical

Relevance of a clinical incident reporting and learning system to the chiropractic profession

Most of what is known about the risks and adverse events linked to chiropractic practice is based on retrospective case reviews and the analysis of medico-legal claims data. There have been only a limited number of prospective reporting and observational studies so far, and the patient sample sizes have usually been relatively small, making a wide generalisation of their results difficult. Clinical audits into risk factors for chiropractic treatment are few,10 and it has been found that

Basic design of an incident reporting system

The purpose of any patient safety incident reporting and learning system can be summarised as follows: the occurrence of an incident should trigger the completion of a report; incident report data should then be collected and analysed centrally to determine whether there are any trends that could represent potential problems in the delivery of care; the results of the analysis must then be distributed and shared with the individuals and organisations involved.13 These phases have been

Objective for the pilot study

Owing to the increasing move towards documenting patient safety incidents that may arise from treatment, we had felt for some time that there was a need for the chiropractic profession to be part of this safety culture developing within health care. With this in mind, a relatively simple and straightforward reporting format was designed, reflecting the basic principles of other incident reporting systems and especially as outlined in detail within the NPSA's Seven Steps to Patient Safety

Field chiropractors

In August 2005, each member of the BCA (approximately 1100 members at the time) was sent a CRLS Starter Pack containing several copies of the CRLS form (Fig. 1) and an accompanying explanation sheet together with an introductory letter by the BCA President. All chiropractors were instructed to use the self-addressed and stamped envelope for private and confidential return of any completed form(s). At the time of initial distribution, explanatory articles about the CRLS were released in the In

Field chiropractors

The rate of return of incidents reports by chiropractors was disappointing. During the 4-month data collection period, only eight reporting forms were received from seven individual chiropractors. This low number of reported incidents does not allow for any meaningful statistical analysis nor does it indicate any specific trends regarding risks or complications in association with chiropractic treatment. Table 3 shows a summary of the reported incidents.

Demographics

All of the 63 final year clinical

Discussion

To our best knowledge, the CRLS is the first system that has been specifically designed to capture data in a proactive and structured fashion on PSIs associated with chiropractic treatment. As the primary purpose of incident reporting is to reduce harm to patients and practitioners, it would be difficult to accept how the introduction of a specific reporting and learning system designed for chiropractors could not be interpreted as something of benefit. Chiropractic treatment is generally

Conclusions

This pilot study constitutes an initial report on the first experiences gained from the introduction of a voluntary or anonymous incident reporting system within the chiropractic profession in the UK. In itself, it does not provide many helpful answers regarding the frequency and types of PSIs associated with chiropractic care; it rather poses further questions and emphasises the need for ongoing enquiry or study in this area. For example, we plan to embark on a qualitative study to elucidate

Author contribution statement

HT conceived the idea for the pilot study. HT and JB contributed to the design and planning of the research and were responsible for the data collection. HT analysed the data. HT and JB wrote the first draft of the manuscript.
Conflict of interest

HT is Head of Clinic of the AECC and is a member of the BCA. No funding was received for this study.

Acknowledgements

We thank the British Chiropractic Association for their help and support with the graphical design and distribution of the CRLS amongst its members. We are especially grateful to those chiropractors who submitted PSI related reports and to the Class of 2006 who pioneered the use of the CRLS in the AECC teaching clinic.

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