How do parents help to keep children safe in general practice? An exploratory descriptive analysis of safety incident reports from England and Wales

Problem

Children are vulnerable to unsafe healthcare. They are dependent on others to recognise illness and to advocate on their behalf. Martha’s Rule highlights the importance of enabling parents (families, guardians, carers) to act as safety advocates for their children. Parents can play a key role in identifying and preventing patient safety incidents, which could lead to harm, whilst their child receives care.

Our aim was to characterise the role of parents in mitigating patient safety incidents involving children, within a general practice setting.

Approach

Search terms, for example, *parent*, *dad*, *mother*, were applied to the National Reporting and Learning System (NRLS) database to identify safety reports involving children submitted between September 2014 and February 2023 (n=183,700 were available). Only reports captured from the ‘General Practice’ care setting in the NRLS were included. Two trained general practitioners reviewed and included reports for further analysis if parental involvement was directly related to a safety incident reported within general practice. Reports were coded using the Patient Safety (PISA) classification, in which the incident type, contributory factors, outcomes for the patient and harm severity were identified.

An exploratory descriptive analysis summarised the relationships between coded variables and the parental role in identifying and mitigating safety incidents.

Findings

A total of 1521 reports from general practice with a parental search term were identified, and 397 (26%) reports met the inclusion criteria for analysis. There was good inter-rater reliability between the coders for inclusion/exclusion of reports (Cohen’s kappa coefficient 0.72).

Parents helped mitigate safety incidents in 72% (287) of reports. Reports can contain more than one incident type, and 358 incident types were identified in total. The most frequent incident types with parental mitigatory involvement related to medications (164, 46%), specifically prescribing (81, 49%), dispensing (41, 25%), and vaccinations (16, 10%). The next top incident types involved diagnosis and assessment (15%, 55), administrative processes (11%, 38) and communication issues (11%, 38).

The top mitigating factors (total 304) included parents identifying issues relating to medications (153, 50%), such as querying doses, spotting an incorrect medication, or chasing prescriptions. Parents frequently chased appointments and referrals (50, 16%) and made complaints or provided feedback (29, 9.5%) for organisations to learn from their concerns. Parents successfully prevented harm or further harm (e.g., disease progression) from occurring in 54% (154) of reports.

Consequences

Parents play a key role in preventing a breadth of safety incidents and harms when their children receive healthcare in general practice. Our analysis has identified priority areas which will be discussed at workshops with parents and the public, to co-develop recommendations and strategies to deliver safer paediatric care, and support parents to act as safety advocates for their children.