Validating the International Classification for Patient Safety (ICPS): The Belgian Experience

Luc Van Looy

Medical Director

GZA Hospitals

Antwerpen, Belgium

THE PATIENT SAFETY PLAN

OF THE BELGIAN FEDERAL

GOVERNMENT

Patient safety

• Quality of care:

• Patient-centered

• Accessible

• Accurate

• In time

• Effective

• Efficient

• Affordable

• Safe

Patient safety

• Damage can have many faces and can hit all of

us

• Reports IOM:

• 1999 „To err is human‟

• 2001 „Crossing the quality chasm‟

• Targeting the system, not the individual

• “Events” (adverse events, near misses)

• Safety culture

Patient safety in BelgiumFederal Government project

• 5 year project

2007-2012

• Funding:

• National budget 7.216.214 € / year

• 104 € / hospital bed

• Hospitals with <100 beds: 10.000 €.

• Free participation, but with engagement

Engagement from the hopitals

• Installing:• A central steering patient-safety-committee

• An operational patient-safety-team

• Implementation of a safety-management-system:• Event notification

• Analysis

• Improvement actions

• Follow-up (indicators)

• Paving the way for future aggregation:

• Uniformity of data

• Classification taxonomy

2007 2008 2009 2010 2011 2012

}integrated

patient safety

management

system

2013-2016

strategy, vision, targets

Preparation

of project

define

In preparation

safety culture measurement actions for improvement measurement actions for improvement

eventnotification

installation of notification system use of notification system in all Belgian hospitals

analysis retrospective retrospective + proactive

improvement define intramural processes extramural processes

indicators pilot (only acute hospitals) cartographydevelopment new

indicatorsstandardized, integrated,

multidimensional set

5 year plan

Response of the field

0

10

20

30

40

50

60

70

80

90

100

% hospitals % beds

80

9190

9791

98

2007-2008

2008-2009

2009-2010

FOCUS ON TAXONOMY

Why taxonomy?

• Prime target: aggregation of data

• Study and analysis of data-collections:

• Detection of patterns and trends

• Sharing, structuring and communicating available knowledge

• Quality surveillance

• Different levels:

• Hospital

• Between hospitals:

Regional network

National

International

• Specialisms (Netherlands: Neosafe, Prima-RT)

Conditions for success

• Clear, understandable and reproducible

• Good balance between:• Sufficient detail – specificity

• Ease of use: limited training must suffice ( ICD9)

• On implementation:• Minimal negative impact on existing systems

• Comparative benefits buy-in• Efficient

• User-friendly

• Broad application:

Acute hospital, psychiatric institution, rehabilitation center…

In-hospital as well as ambulatory care

Taxonomy JCAHO

Taxonomy WHO

• ICPS

International

Classification

for Patient Safety

ICPS: a conceptual framework

• 10 high level

classes

• 48 key concepts

• ± 700 concepts

ICPS head classes

Incident typeIncident characteristics

Outcome patientOutcome organization

Patient characteristics

Detection

Contributing factorsMitigating factorsAmeliorating actions

Actions taken to reduce risk

Terrifying at first glance…

ICPS head classes

Incident typeIncident characteristics

Outcome patientOutcome organization

Patient characteristics

Detection

Contributing factorsMitigating factorsAmeliorating actions

Actions taken to reduce risk

Minimal dataset

Optional

Application of taxonomy

• The person reporting an event

• The patient-safety coordinator

• The patient-safety team

• The person reporting an event has no benefit in

taxonomy

• Even with a minimal dataset, there is always

ballast for someone somewhere

• Tailoring the notification system to the local

needs is crucial

Tailoring the notification system

Incorporation in event-notification

Fitting the taxonomy to the Belgian

situation

• Translation: Dutch, French, German

• Defining a code:

• E: Wrong patient

D: Verkeerde patiënt

F: Patient erroné

G: Falscher Patient

• Unique hierarchical code

Translations and codes

Basis for aggregation

Fitting the taxonomy to the Belgian

situation

• Federal Government provides a uniform XML-

model for data-export

Reporter

• Input incident (±taxonomy)

• Nominative or anonymous

Team PatSaf

• Supplementaryinfo?

• Analysis ifneeded

Team PatSaf

• Complete taxonomy(at least minimal data set)

• Anonimisation

Repository

• Reporting

• (Export)

Committee PatSafDecentral point of expertise

• Analysis if needed

xml

Problems to solve

• Clarification of some topics:

• i.e. ambulatory versus in-hospital care

• Consistency with and linking to existing

classifications:

• Some are obvious: ICD, ATC, ICF…

• But others are not and there is not always

consistency between countries

• WHO

Problems to solve

• Parallel registrations:• Mandatory:

• Transfusion-incidents

• Tissue donation (bone, tympano-ossicular, skin, veins, …)

• Infections

• …

• Others:• Psychiatry

• Fall incidents

• Radiotherapy

• Solitary initiatives…

• Avoid duplication

• Integration

Problems

• Legal protection for notification systems

• Patient safety act (Denmark)

• Netherlands

• …

• Safety culture:

• Health-workers

• Organizations

• Patient

• Society

are they all ready for open communication and

management?

Belgian patient safety project

• ICPS is not officially released by the WHO yet

• Whish for integration as a standard in Belgian

hospitals

• WHO:

• Request for a use-case in the Belgian hospital-

setting

Applying the minimal dataset to patient-safety

events

Coding

XML-export

Aggregation of data