Treatment Injury

Case study – sharing information to enhance patient safety

This is an overview of ACC’s treatment injury claims, with a focus on the patterns of accepted injuries. As always, our intention is to inform as well as promote learning and discussion.

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EVENT: ACC treatment injury data patterns and learning

Did you know?

Between July 2005 and December 2013 ACC made almost 65,000 treatment injury decisions and provided cover for almost 41,000 clients whose injuries had been caused by treatment.

Who is lodging these claims?

In relation to lodging provider practice, between July 2005 and December 2013 43% of all claims were lodged from GP practices, 34% by staff working within district health boards (DHBs), 13% by practitioners at private hospitals or clinics and 10% from other types of practice.

Where did the treatment injury events occur?

48% of all the treatment injury claims lodged occurred at public facilities (DHBs), 45% at private facilities and 7% at individual private practices (where the facilities could not be identified).

What was the volume trend of these claims?

Treatment injury claims grew rapidly in comparison with medical misadventure claims in the first four years of the scheme, after July 2005. Much of this growth was in high-volume, low-cost injuries, such as allergic reactions. There was some growth in more serious treatment injury claims from 2005, but these were lodged under the previous medical misadventure legislation.

In the following three years (July 2009 – June 2012) claim growth levelled at between 8,000 and 8,500 claims, with growth from July 2012 to June 2013 reaching almost 10,000 claims.

What were the most commonly accepted treatment injuries nationally?

Although the top 10 treatment injuries were generally high-volume, low-cost injuries, each injury category contained a small number of high-cost and serious injury claims.

National top-10 accepted treatment injuries 2013 vs 2012

injuries

Learning from treatment injuries and what’s happening regarding the prevention of these injuries:

Infection:

These claims were most commonly associated with the orthopaedic context, with 26% of all accepted wound infection claims arising from orthopaedic treatment. The most common event categories resulting in infection were removal of skin lesion and knee and hip surgery/replacement.

Surgical site infections (SSIs) are a significant problem worldwide, and although some of these infections are minor, they can still cause emotional and financial stress, long hospital stays, long-term disabilities etc. The consequences for health services, and more importantly patients, mean that preventing SSIs is extremely important. To address this, in 2012 the Health Quality and Safety Commission launched the Surgical Site Infection Improvement Programme – New Zealand’s first national quality improvement programme to reduce the incidence of SSIs. For further information, please follow the link: www.hqsc.govt.nz/our-programmes/infection-prevention-and-control/projects/surgical-site-infection-improvement.

Adverse reaction:

These claims commonly related to the more routinely prescribed antibiotics, such as amoxicillin, Augmentin and flucloxacillin. The number of these claims decreased in 2013 compared with 2012. There were some major adverse drug reaction claims (e.g. involving warfarin and trimethoprim) that were accepted.
ACC has published interesting case studies on alerted major drug reactions; the latest case study on medication adverse reaction can be found at the following link: www.acc.co.nz/for-providers/clinical-best-practice/case-studies/index.htmw.

Pressure injury:

There has been a general pattern of increased pressure injury claims over the years. These claims have mostly related to nursing care. Pressure injuries are usually preventable when certain steps are taken. Accepted claims for pressure injuries normally relate to inadequate pressure area prevention or management, for example no risk assessment, no prevention plan or a lack of pressure area care.

The Clinical Practice Guideline for the Prevention and Management of Pressure Injury presents a comprehensive review of the assessment, diagnosis, management and prevention of pressure injuries within the Australian, New Zealand, Hong Kong and Singapore health care contexts, based on the best evidence available up to August 2011. The Guideline is designed to provide information to assist in decision-making and is based on the best information available at the date of compilation.

The Guideline was developed by the Australian Wound Management Association and its subcommittee the Australian Pressure Injury Advisory Panel, in partnership with independent, multidisciplinary experts throughout Australia and the New Zealand Wound Care Society, the New Zealand Nursing Service, the Singapore Ministry of Health and the Hong Kong Enterostomal Therapists Association.

Other treatment injuries:

The following are the other treatment injuries in our top-10 list by volume. If you are aware of any useful information or learning, please send your feedback to Ti.info@acc.co.nz.

Haematoma – bruising:

These claims were most often lodged in relation to vascular access failure (with IV cannulation and venous puncture the most common). There was a smaller proportion of claims relating to major surgical haematomas, and a very small group of serious injuries to the spinal cord secondary to haematomas.

Nerve injury:

These claims most commonly related to vascular access, spinal surgery, hip/knee surgery/replacement and dental treatment.

Skin injury:

These claims were most commonly associated with nursing events, with 27% of all accepted skin injury claims associated with nursing treatment. The most common event categories resulting in skin injury were wound care and more specifically removal of dressings. Patient transfer was the next most common, shared with vascular access failure and strapping, tape or bandage.

Strain or sprain:

These claims most commonly related to positioning, manual therapy involving spinal and neck manipulation, dental treatment and interventional delivery leading with ventouse. Strain or sprain was most commonly associated with the maternity, radiology, dental, orthopaedics and physiotherapy contexts.

Dental injury:

These claims related most commonly to general anaesthetic, endotracheal intubation and intubation – other, and to dental treatment including tooth extraction and root canal treatment.

Perineal injury:

These claims related most commonly to interventional delivery with forceps delivery leading. The next most common event category was vaginal repair relating to the gynaecology and urology treatment contexts.

Gastrointestinal injury:

These injuries related most commonly to gastrointestinal injury scoping procedures and bowel surgery. Perforations of bowel and oesophagus were the most commonly accepted injuries.

The ACC website contains further information on treatment injury, along with all previously published treatment injury case studies (www.acc.co.nz/for-providers/clinical-best-practice/case-studies/index.htm).

Key messages:

  • Consent from the client is always required to lodge a treatment injury claim
  • It is important to send the treatment injury claim form (ACC2152) and all the relevant medical information at the time of lodgement to ensure timely rehabilitation support and assistance to the client
  • ACC covers only injuries, not underlying health conditions; hence if there is no injury as a result of treatment there is no need to lodge a claim
  • ACC provided cover for rehabilitation and assistance for almost 41,000 treatment injury claims between July 2005 and December 2013
  • Treatment injury claims relating to infections, nerve injuries and pressure injuries have increased over the years and some of these are preventable.

Claims information:

Between July 2005 and December 2013, 65,230 treatment injury claims were lodged, of which 64,812 were decided.
Of the 64,812 decided treatment injury claims, 40,762 (63%) were accepted and 24,050 (37%) were declined.
The most common reasons for declining claims were that no physical injury could be identified (45%), there was no causal link between treatment and the injury (31%), the injury was an ordinary consequence of treatment (12%) and the injury was wholly or substantially caused by an underlying health condition (7%).

**Only claims attributed to the Treatment Injury Fund are included.

Downloads

May 2014 treatment injury case study – Sharing information to enhance patient safety

June 2014 Newsletter

Published 06/06/2014

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