Incident Reporting and Analysis in Pediatrics

Each incident report underwent data coding using multi-axial frameworks to describe incident types (primary and contributory), potential contributory factors, incident outcomes, and harm severity (S2–S4 Texts) [23 ,25 (link),28 (link)]. Primary incidents included those proximal (chronologically) to the patient outcome, whereas contributory incidents included those that contributed to the occurrence of another incident. Multiple codes for incident type, contributory factor, and incident outcome were applied to each report where necessary. The codes were applied systematically and chronologically according to nine recursive incident analysis rules developed by the Australian Patient Safety Foundation (S1 Table) [29 ]. This permitted modeling of the steps preceding and leading to primary incidents, e.g., contributory incidents and factors, which, in turn, resulted in patient outcomes (S1 Fig). The incident type, contributory factor, and incident outcome frameworks were developed in house [28 (link)]. Each incident report in the NRLS comes with a reporter-allocated harm severity; however, where the free-text descriptions conflicted with the reporter-allocated harm severity, harm severity was reclassified using WHO International Classification for Patient Safety definitions (see Table 1 for WHO definitions of harm severity) [3 ,23 ,25 (link),30 ]. The medications involved in medication incidents were recorded and classified using the British National Formulary for Children, and the types of conditions affecting these children were recorded and classified using the International Classification of Diseases (ICD-10) (S2 Table) [31 ,32 ]. A random 20% sample of reports was independently double-coded by P. R. and H. W.