VULNERABLE CHILDREN AND THEIR CARE QUALITY ISSUES: A DESCRIPTIVE ANALYSIS OF A NATIONAL DATABASE

• Published in: BMJ quality & safety Vol. 24; no. 11; pp. 732 - 733
• Main Authors: Omar, Adhnan, Rees, Philippa, Evans, Huw Prosser, Williams, Huw, Cooper, Alison, Bannerjee, Sophie, Hibbert, Peter, Makeham, Meredith, Parry, Gareth, Donaldson, Liam, Edwards, Adrian, Carson-Stevens, Andrew
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group LTD 01.11.2015
• ISSN: 2044-5415; 2044-5423
• DOI: 10.1136/bmjqs-2015-IHIabstracts.18

BackgroundGlobally, two in five children are deemed vulnerable by virtue of their physical, psychological and social characteristics. These children are at increased risk of sub-optimal care and disproportionate levels of iatrogenic harm. There remains a paucity of literature describing initiatives for practice improvement for these children.ObjectivesIdentify safety reports describing vulnerable children in the England and Wales National Reporting and Learning System (NRLS). Characterise reports in terms of what happened and reported causative issues, in order to identify key change concepts (drivers) and related interventions (change ideas) for improvement.MethodsAn operational definition of ‘vulnerability in children’, including key domains and related keywords (Appendix 1, 2), was empirically informed by a scoping review of the published and grey literature. Relevant reports were descriptively analysed. The free text of the four most frequent incident types (Pareto principle) was discussed by a multi-disciplinary team to identify key concepts for improvement.Results2,015 reports were identified involving vulnerable children. The problem areas identified primarily resulted from a fragmentation of care services. This included inefficient transfer of information between primary care services; failure to operationalise care plans in practice; and inconsistent access to healthcare services. Reported causes are outlined in an Ishikawa diagram (figure 1) and summarized in the related driver diagram (figure 2) to mitigate problem areas.ConclusionsAnalysis of patient safety incident reports assisted in the pragmatic identification of key concepts for healthcare professionals to begin more informed discussions about improving the care delivered to vulnerable children.Figure 1Ishikawa diagram illustrating causative factors contributing to patient safety incidents.Figure 2Driver diagram for improved safety and quality of healthcare of vulnerable children in primary care.Appendix 1Process of generating key terms.Appendix 2 Process of generating key terms (continued).