International Taxonomy of Medical Errors in Primary Care - Version 2
Summary
Download the Taxonomy
Custom Taxonomy Editions
Previous Versions
Studies that Used the Taxonomy
Summary
The International Taxonomy of Medical Errors in Primary Care - Version 2
was created to code and classify the medical errors reported by family physicians
and general practitioners in research undertaken by the American
Academy of Family Physicians.[1]
[2] These studies used the definition
of medical error adopted by the U.S. Institute of Medicine.[3] That is, "safety is defined as
freedom from accidental injury" and "error is defined as the failure of a planned
action to be completed as intended or the use of a wrong plan to achieve an
aim." We made this definition functional for study participants by explaining:
"For this study, please report anything that happened in your own practice
that should not have happened, that was not anticipated and that makes you
say "that should not happen in my practice, and I don't want it to happen
again". It can be small or large, administrative or clinical - anything
that you identify as something to be avoided in the future."
Reported events did not require an adverse outcome of care or actual or potential
harm to patients. The definition deliberately relates to true errors, or mistakes,
without regard to actual or potential consequences. It therefore differs from
most other definitions, which tend to focus on "preventable adverse events"
(actual harm) or "sentinel events" (potential harm). Our definition risks
attracting reports of trivial events, thereby distracting from the central purpose
patient safety research - to find ways to protect patients from harm. However,
we have found that an event that is trivial on one occasion may be non-trivial
on another. Our definition is congruent with the aim to improve both health
care quality and safety.
The taxonomy was created from the actual words used in the free text portions
of reports. As well as defining types of errors, these free text responses were
used to create categories of "Contributing Factors,""Consequences,"
and "Suggestions for Prevention." While "contributing factors"
are sometimes errors in their own right, more often they are simply circumstances
that made the reported error more likely - such things as heavy workload and
language mismatches between patients and providers. The "consequences" categories
reports only the consequences reported by providers. They therefore probably
underestimate the consequences experienced by patients. Often however, the reported
error was discovered and resolved before its effects reached any patient. "Suggestions
for prevention" is a classification of providers' ideas on how the reported
error might be avoided in the future.
The taxonomy best describes events that are the concern of family physicians
and general practitioners and is weaker in describing areas of the healthcare
system that are more comprehensively understood and experienced by patients
(e.g. errors relating to access), nurses (e.g. screening errors), or administrators
(e.g. errors relating to payment).
The taxonomy is an evolving tool and is currently being tested and expanded
by research involving primary care practice staff and patients. Through further
use its categories will become better defined. Given the breadth of scope of
the practice of family physicians, it may take some time and repeated use of
this tool to develop it to the stage where it truly describes all or most medical
errors in primary care. We look forward to seeing that time approach.
The development of this taxonomy has been supported by grants from the Commonwealth
Fund, the Agency for Healthcare Research and Quality, the American Academy of
Family Physicians, the World Health Network Foundation, and institutions supporting
Linnaeus Collaboration members in Australia, Canada, England, Germany, the Netherlands,
New Zealand, and the United States.
References
[1]Dovey SM, Meyers DS, Phillips RL,
Green LA, Fryer GE, Galliher J, Kappus J. A preliminary taxonomy of medical
errors in family practice. Quality and Safety in Health Care 2002;
11: 233-8. Full
text. PubMed
abstract.
[2] Makeham M, Dovey S, Country M,
Kidd M. An international taxonomy for errors in general practice: a pilot
study. Med J Aust 2002; 177: 68-72. Full
Text. PubMed
abstract.
Custom Taxonomy Editions
None available.
Previous Versions
None available.
Studies that Used the Taxonomy
Dovey SM, Meyers DS, Phillips RL, Green LA,
Fryer GE, Galliher J, Kappus J. A preliminary taxonomy of medical errors
in family practice. Quality and Safety in Health Care 2002; 11: 233-8.
Full
text. PubMed
abstract.
Makeham M, Dovey S, Country M, Kidd M. An international taxonomy for errors
in general practice: a pilot study. Med J Aust 2002; 177: 68-72.
Full
Text. PubMed
abstract.
Woolf SH, Kuzel AJ, Dovey SM, Phillips RL. A string of mistakes: The importance
of cascade analysis in describing, counting, and preventing medical errors.
Ann Fam Med. 2004 Jul 1; 2(4):317-326. Full
Text. PubMed
abstract.