CONTACTAutumn 2010 Volume 24 Number 3

A helping hand for members of the British Chiropractic Association

NEWS • REPORTS • BUSINESS • FEATURES • DIARY • CLASSIFIEDS

CPiRLS: Towards a reporting culture

Planningfor the unexpected

Recruiting right

26 Contact Autumn 2010

• How often have you encountered this type

of incident in the past?

• What is the likelihood that your actions/

inactions were responsible?

• Further information (voluntary)*

When you open a reporting form, it remains

active for one hour; it would not be good

practice for it to remain open indefi nitely on

a secure site. This means you must submit

the form within that time to avoid your entry

being lost. With this in mind, it may be a good

idea to plan or draft a particularly detailed

case before starting to enter it. A draft on your

computer can be cut and pasted into the

relevant fi elds.

Learning from incident

reportingThe principle of CPiRLS is that it provides

an opportunity for all chiropractors to learn

from collective experiences. Regular visits to

the site enable you to keep abreast of recent

CPiRLS: Towards a reporting culture

The UK’s national online Chiropractic Patient Incident Reporting and Learning System

(CPiRLS) was launched in May 2009. In the 15 months since its launch, submission rates

have been low - around two incidents per month. Here, Rob Finch, Chief Executive of

the College of Chiropractors, writes on why the full benefi ts of this system can only be

realised with more use and participation.

The College of Chiropractors

administers CPiRLS on behalf of

the pan-professional team that

developed it. The system is based on

the pioneering work of Haymo Thiel and the

two former paper-based incident reporting

systems: CRLS (Thiel et al, 2006) and PiRLS

(Cunliff e et al, 2009). An Implementation

Group comprising clinicians, academics and

educationalists, monitors the use of CPiRLS

and adds relevant resources to the site.

What you can reportAny occurrence that has made you think

about an actual, probable or potential impact

on patient safety can be reported. If this

occurrence led you to discuss the case with

colleagues, to consider changes to your

practice and/or to personally refl ect in a

non-routine manner, then it is probably worth

reporting. If in doubt, report!

The use of the word ‘safety’, in the context

of chiropractic incident reporting, is possibly

misleading. There is no suggestion that

chiropractic is unsafe. The term should be

taken in its widest sense, to encompass the

concepts of risk and injury and CPiRLS should

be viewed as a means of minimising these

components of safety.

The CPiRLS website provides a trigger list

(available once you log in) which helps you

to identify the types of incidents that may be

worth reporting. It is true that some of the

incidents listed may appear insignifi cant and,

to some extent, fairly routine, for example,

post-treatment soreness. There is, of course,

no expectation that you would report every

case of post-treatment soreness however,

if a patient had an unusually acute reaction

(i.e. something out of the ordinary that

prompted you to mention it to a colleague in

conversation), then why not mention it to the

national chiropractic community, particularly

if you felt you learned something from what

happened?

Producing an incident report

First and foremost it must be emphasized that

CPiRLS is a completely anonymised process.

The system only actually requires basic

information, with an emphasis on what

happened. The main reporting form has

the following fi elds, most of which require

a simple choice from a pull-down menu.

Only those fi ve fi elds marked with an asterix

below require text input from the reporter:

• Patient’s age and gender

• Where the incident happened

• Category of incident

• What happened?*

• Why and how did it happen?*

• Describe the actions taken*

• Key words to describe the incident*

• Was the patient harmed?

• Could the incident have been avoided?

Special Interest

Contact Autumn 2010 27

Is there a time limit for reporting an

incident?

The learning value of any incident that

had an impact on you and your practice

does not deplete over time. You should not

underestimate the potential importance of

sharing incidents months, or even years, after

they occur.

reports and to share comments with other

visitors. Some clinics are now basing regular

clinic meetings on a review of the incidents

reported on CPiRLS. For example, one clinic

Principal commented:

“Within our practice, the chiropractors meet

every six weeks to review challenging cases

and any incidents that have occurred or

been avoided by good practice and decide

if any require reporting. As part of our

refl ective practice, we also look at the CPiRLS

reports that have been submitted to see

whether we can learn from these incidents.

I am fi nding that CPiRLS is an excellent tool

for promoting refl ective practice at my clinic.

Although it has taken a long time to work

out how best to get all practitioners aware

of incident reporting and being pro-active in

this respect, I think we are fi nally there.

In a recent study of the culture of safety

among UK chiropractors (Finch et al, 2010),

there was a strong indication that awareness

of the importance and value of incident

reporting is growing and that lessons are

being learned locally, through clinic initiatives

of the type outlined above. However, it is

clear that this growing awareness has not yet

been fully translated into widespread national

reporting via CPiRLS although, hopefully, this

is now changing.

The CPiRLS Implementation Group has

published two Safer Practice Notices in

response to minor trends identifi ed among

the reports submitted to date. These serve to

provide guidance in the management of the

type of incidents in question should they be

encountered again. Additional notices will be

produced as further trends arise.

Frequently asked questionsWhat is an incident?

CPiRLS defi nes a reportable incident as any

type of patient safety event, error, accident

or deviation from the norm that actually

happened, nearly happened (near miss) or

has the potential to happen. This is regardless

of whether it is considered minor or major,

results in signifi cant patient harm or leads to a

patient complaint.

How do I access CPiRLS?

The full features of www.cpirls.org are only

available to registered chiropractors through

the use of a generic username and password.

These can be obtained from the professional

associations and the College of Chiropractors.

ReferencesCunliff e C, Johnson IJ, Selby J (2009) Safety

incidents, treatment complications and

reactions recorded in a student teaqching

clinic: a retrospective analysis. Proceedings of

the Association of Chiropractic Colleges Research

Agenda Conference (ACC-RAC).

Finch RP, Heale GS, Jay TC (2010) Culture of safety

among UK chiropractors before and after

the launch of online patient safety incident

reporting and learning. Clinical Chiropractic 13,

172-173.

Thiel HW, Bolton JE (2006) The reporting of

patient safety incidents – fi rst experiences with

the chiropractic reporting and learning system

(CRLS): a pilot study. Clinical Chiropractic 9,

139-149.

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