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Original article
Paediatric enteral feeding at home: an analysis of patient safety incidents
  1. Bethan Page1,
  2. Rasanat Nawaz1,2,
  3. Sarah Haden3,
  4. Charles Vincent1,
  5. Alex C H Lee2,3
  1. 1 Department of Experimental Psychology, University of Oxford, Oxford, UK
  2. 2 Oxford Academic Health Science Network, Oxford, UK
  3. 3 John Radcliffe Hospital, Oxford, Oxfordshire, UK
  1. Correspondence to Miss Bethan Page, Experimental Psychology, University of Oxford, Oxford, OX2 6AE, UK; bethan.page{at}psy.ox.ac.uk

Abstract

Aims To describe the nature and causes of patient safety incidents relating to care at home for children with enteral feeding devices.

Methods We analysed incident data relating to paediatric nasogastric, gastrostomy or jejunostomy feeding at home from England and Wales’ National Reporting and Learning System between August 2012 and July 2017. Manual screening by two authors identified 274 incidents which met the inclusion criteria. Each report was descriptively analysed to identify the problems in the delivery of care, the contributory factors and the patient outcome.

Results The most common problems in care related to equipment and devices (n=98, 28%), procedures and treatments (n=86, 24%), information, training and support needs of families (n=54, 15%), feeds (n=52, 15%) and discharge from hospital (n=31, 9%). There was a clearly stated harm to the child in 52 incidents (19%). Contributory factors included staff/service availability, communication between services and the circumstances of the family carer.

Conclusions There are increasing numbers of children who require specialist medical care at home, yet little is known about safety in this context. This study identifies a range of safety concerns relating to enteral feeding which need further investigation and action. Priorities for improvement are handovers between hospital and community services, the training of family carers, the provision and expertise of services in the community, and the availability and reliability of equipment. Incident reports capture a tiny subset of the total number of adverse events occurring, meaning the scale of problems will be greater than the numbers suggest.

  • gastroenterology
  • comm child health
  • health services research

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

https://doi.org/10.1136/archdischild-2019-317090

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    Footnotes

    • Contributors BP, RN and CV conceived and designed the study. BP and RN analysed the data with support from paediatric surgeon AL and community paediatrician SH. BP drafted the manuscript with support from RN, AL and CV. All authors provided critical feedback on the manuscript and analysis. All authors approved the final manuscript.

    • Funding This work was supported by the Economic and Social Research Council [grant number ES/J500112/1]; and the Health Foundation.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement There is no additional unpublished data from this study.

    • Patient consent for publication Not required.