Categories of Harm

Patient Safety Systems-Based Morning Report

Tuesday, Feb. 23rd, 7:30am

6th floor conference room (Masonic)

Definition of Harm

Healthcare-associated harm is impairment of the body or any deleterious effect arising from plans or actions taken during healthcare, rather than an underlying disease or injury[i]. Harm can include disease, injury, suffering (including increased length of stay or readmission), disability and/or death[ii].

Most common Cause of Harm in Pediatrics

A significant proportion of harm in children occurs from errors in prescribing, dispensing and administration of medications[iii]. A 2014 pediatric review article stated medication errors occurred in 5-27% of all pediatric medication orders[iv]. These medication errors were partly due to the need for weight-based dosing.

Type of Harm to Document in iCare

Step 1 in initiating an iCare report asks what happened to the affected party in terms of category/severity of harm. Our iCare system bases their categories of harm on the National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP) Index for Categorizing Medication Errors[V]. As shown below, these are the 6 different categories of harm to choose from in iCare:

  • Event resulted in no apparent injury or harm but required monitoring or intervention to preclude harm (vital signs, neuro checks, lab tests, or imaging)
  • Injury resulted in minor or superficial wound or temporary harm (dressing, ice, cleaning, topical medication or a minor adverse drug event such as rash, nausea or constipation)
  • Injury resulted in moderate or temporary harm, requiring continuation of care (suturing, steri-strips, splinting, transfer to a higher level of care or sent for further follow-up (ER, CT, etc.)
  • Injury resulted in major or permanent harm (surgery, casting, dialysis, sensory loss or pressure ulcers of stage 3, 4 or unstageable)
  • Injury resulted in intervention to sustain life (rapid response, EMS activated, CPR initiated, code blue, ventilation or transport called)
  • Injury resulted in unanticipated death

Conclusion

The goal of patient safety is to prevent every form of harm. Errors might be inevitable in healthcare, but avoidable harm can be averted through a combination of human, process and structural interventions. Therefore it is important all categories of harm should be reported in iCare to prevent future harm in our patients.

For more Information:

  • Wachter, Robert M. "Patient safety at ten: unmistakable progress, troubling gaps." Health affairs 29.1 (2010): 165-173.
  • Brennan, Troyen A., et al. "Incidence of adverse events and negligence in hospitalized patients: results of the Harvard Medical Practice Study I." New England journal of medicine 324.6 (1991): 370-376.
  • Leape, Lucian L., et al. "The nature of adverse events in hospitalized patients: results of the Harvard Medical Practice Study II." New England journal of medicine 324.6 (1991): 377-384.
  • Wilson R M, Michel P, Olsen S, Gibberd R W, Vincent C, El-Assady R et al. Patient safety in developing countries: retrospective estimation of scale and nature of harm to patients in hospital BMJ 2012; 344:e832

Advanced Material:

  • Parry, Gareth, Amelia Cline, and Don Goldmann. "Deciphering harm measurement." JAMA 307.20 (2012): 2155-2156.

References

[i] Runciman, William, et al. "Towards an International Classification for Patient Safety: key concepts and terms." International Journal for Quality in Health Care 21.1 (2009): 18-26.

[ii] Wilson R M, Michel P, Olsen S, Gibberd R W, Vincent C, El-Assady R et al. Patient safety in developing countries: retrospective estimation of scale and nature of harm to patients in hospital BMJ 2012; 344:e832

[iii] Miller, Marlene R., et al. "Medication errors in paediatric care: a systematic review of epidemiology and an evaluation of evidence supporting reduction strategy recommendations." Quality and Safety in Health Care 16.2 (2007): 116-126.

[iv] Rinke, Michael L., et al. "Interventions to reduce pediatric medication errors: a systematic review." Pediatrics (2014): peds-2013.

[v] http://www.nccmerp.org/sites/default/files/indexBW2001-06-12.pdf. NCC MERP Index for Categorizing Medication Errors