Frey,
B, et.al. (2009) Involvement of parents in critical incidents in a neonatal-paediatric
intensive care unit. Qual Saf Health Care 18(6) pg. 446-9.
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(subscription required)BACKGROUND: With more liberal visiting hours in paediatric intensive care practice, parents' presence at the bedside has increased. Parents may thus become involved in critical incidents as contributors or detectors of critical incidents or they may be affected by critical incidents.
METHODS: Voluntary, anonymous, non-punitive critical incident reporting system. Parents' involvement in critical incidents has been evaluated retrospectively (January 2002 to August 2007). The reports were analysed regarding involvement of parents, age of child, unit (paediatric intensive care or intermediate neonatal nursery), critical incident severity, critical incident category, actual or potential harm to patient and/or parent (minor, moderate, major), delay between the critical incident and its detection, and implemented system changes.
RESULTS: Overall, 2494 critical incidents have been reported. There were 101 critical incidents with parental involvement: parents as contributors to critical incident (18; 0.7%), parents discovering a critical incident (11; 0.4%), parents affected by critical incident (72; 2.9%). The most vulnerable categories regarding contribution and detection were drugs, line/drain disconnection, trauma and hygiene. Ten critical incidents precipitated by parents were of moderate severity and seven of potential major severity (six line/drain disconnections). The majority of the events (six) detected by parents were of potential moderate severity and four were of major severity.
CONCLUSION: Because of their presence at the bedside, parents in the paediatric intensive care unit are inevitably involved in safety issues. It is not the parents' duty to guarantee the safety for their children, but parents should be encouraged to report anything that worries them. Only an established safety culture allows parents to articulate their concerns.
Comment: This study in one Swiss hospital raises the issue of the parent role in the safety of their infant. The findings of the authors' incident review are informative, but I find it more important that this issue is being studied and reported in the literature. It does not appear that parents were involved in the review, I think this would be a very helpful contribution. Are you involving parents in incident reviews like this? What do you think about this idea? One thing struck me was why so few incidents in which a parent discovered a critical incident (11 out of 2494)? Also, the category of incidents in which the parent was affected provides a further dimension that is important to understand and using critical incident reporting in this manner is interesting - are there units in NICQ who do this? If yes, what is your experience, please comment.
This recent editorial comment (pubmed | full text) raises the notion of connecting human factors engineering with parent engagement in safety for their hospitalized child. It is unclear how this would be executed, but parent knowledge of human factors principles would likely be beneficial. Some further thought provoking commentary on patient and family roles in safety is presented by Bob Wachter's in this blog post titled: Can Patients Help Ensure Their Own Safety? More Importantly, Why Should They Have To? Jim Handyside