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Parental involvement in patient safety events in paediatric emergency care: a multi-method analysis
Isobel Joy McFadzean1,2, Lauren Donovan3, Thomas Purchase3,2
1Division of Population Medicine, Cardiff University School of Medicine, Cardiff, UK mcfadzeanj@cardiff.ac.uk.
Insights
Parents significantly mitigate harm in pediatric emergency care by advocating for their children and prompting reassessments. However, communication gaps regarding medical history can inadvertently contribute to patient safety incidents.
Area of Science:
- Pediatric patient safety
- Healthcare quality improvement
- Family-centered care
Background:
- National focus on child safety failures led to Martha's Rule, empowering families to request urgent reviews.
- Rising pediatric emergency department (ED) attendances highlight risks of healthcare-associated harm.
- Understanding parental roles in mitigating and contributing to unsafe care in EDs is crucial.
Purpose of the Study:
- To examine how parents contribute to and mitigate unsafe care in pediatric emergency departments.
- To analyze parental involvement in patient safety incidents within EDs.
Main Methods:
- Exploratory multi-method analysis of anonymized pediatric safety incidents from EDs (2014-2020).
- Reviewed 4000 reports to identify patient safety incidents with parental involvement.
- Categorized reports by incident type, contributory and mitigatory factors, outcome, and harm severity.
Main Results:
- Of 658 relevant reports, 90.0% involved parents mitigating harm, while 10.0% showed parental contribution to incidents.
- Parents primarily mitigated harm through advocacy, prompting reassessments, and supporting care.
- Poor communication of clinical information (e.g., allergies, history) contributed to incidents, including medication errors.
Conclusions:
- Parents are vital partners in pediatric safety within EDs, actively preventing harm.
- Healthcare systems need to enhance partnership working with families.
- Addressing pediatric vulnerabilities and improving communication are essential for patient safety.
Introduction:
Parents are central to keeping children safe when receiving healthcare. National scrutiny of failures to recognise and respond to clinical deterioration in children led to the introduction of Martha's Rule by National Health Service (NHS) England, which formalises families' rights to request an urgent clinical review for children. Given rising paediatric emergency department (ED) attendances and evidence of healthcare-associated harm within EDs, we examined how parents contribute to and mitigate unsafe care in this care context.
Methods:
This was an exploratory multi-method analysis of anonymised paediatric safety incidents from EDs. We sought reports reported by EDs between 2014 and 2020. 4000 reports were reviewed to identify whether a patient safety incident had occurred and whether there was parental involvement to mitigate or contribute to the harm. Reports were categorised by incident type (what happened), contributory (why it happened), mitigatory factors (actions taken to reduce or prevent harm), outcome (patient impact) and harm severity.
Results:
Of 658 reports that met the definition of a patient safety incident and included parental involvement, 591 (90.0%) described parents mitigating harm and 67 (10.0%) described inadvertent contribution to incidents. Parents most commonly mitigated harms by advocating for their children, prompting reassessments where necessary and supporting care. However, poor communication involving clinical information, particularly allergies or pertinent medical history, contributed to harm, leading to multiple safety incidents, including the administration of contraindicated medication within EDs.
Conclusion:
Parents are important participants in paediatric safety within EDs, and we have identified diverse ways in which they prevent harm. As policy initiatives formalise escalation pathways, healthcare systems must strengthen mechanisms to support partnership working with families across healthcare settings, while addressing paediatric vulnerabilities that contribute to harm.
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