Towards an International Classification for Patient Safety: the conceptual framework
1 Department of Health Services Research, Division of Quality Measurement and Research, The Joint Commission, Oakbrook Terrace, IL 60181, USA
2 Office of Patient Safety, The Joint Commission, USA
3 National Patient Safety Agency, UK
4 Partnership for Patient Safety, USA
5 Australian Patient Safety Foundation
6 Measurements and Health Information Systems Department, Information, Evidence and Research Cluster, World Health Organization, Geneva, Switzerland
7 Division of Clinical Epidemiology, Geneva University Hospitals, Switzerland
8 Joanna Briggs Institute and Royal Adelaide Hospital, University of South Australia, Australia
9 Institute of Health and Society, Newcastle University Medical School, UK
10 Economic Aspects of Patient Safety, Hasselt University, Belgium
11 STAKES (Nordic Center for Classifications in Health Care), Department of Public Health and Caring Services, Sweden
Global advances in patient safety have been hampered by the lack of a uniform classification of patient safety concepts. This is a significant barrier to developing strategies to reduce risk, performing evidence-based research and evaluating existing healthcare policies relevant to patient safety. Since 2005, the World Health Organization's World Alliance for Patient Safety has undertaken the Project to Develop an International Classification for Patient Safety (ICPS) to devise a classification which transforms patient safety information collected from disparate systems into a common format to facilitate aggregation, analysis and learning across disciplines, borders and time. A drafting group, comprised of experts from the fields of patient safety, classification theory, health informatics, consumer/patient advocacy, law and medicine, identified and defined key patient safety concepts and developed an internationally agreed conceptual framework for the ICPS based upon existing patient safety classifications. The conceptual framework was iteratively improved through technical expert meetings and a two-stage web-based modified Delphi survey of over 250 international experts. This work culminated in a conceptual framework consisting of ten high level classes: incident type, patient outcomes, patient characteristics, incident characteristics, contributing factors/hazards, organizational outcomes, detection, mitigating factors, ameliorating actions and actions taken to reduce risk. While the framework for the ICPS is in place, several challenges remain. Concepts need to be defined, guidance for using the classification needs to be provided, and further real-world testing needs to occur to progressively refine the ICPS to ensure it is fit for purpose.
Keywords: classification, patient safety, incident, conceptual framework
* Address reprint requests to: Heather Sherman, Department of Health Services Research, Division of Quality Measurement and Research, The Joint Commission, One Rennaisance Blvd, Oakbrook Terrace, IL 60181 USA; E-mail: hsherman{at}jointcommission.org
Accepted for publication October 31, 2008.
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