Categories of Harm
Patient Safety Systems-Based Morning Report
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
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
Parry, Gareth, Amelia Cline, and Don Goldmann. "Deciphering harm measurement." JAMA 307.20 (2012): 2155-2156.
[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