Don’t you love it when something you’ve been planning for years finally comes to fruition?

BCPSLS has been looking forward to electronically submitting data to the Canadian Institute for Health Information (CIHI) for inclusion in Canada’s National System for Incident Reporting – Radiation Treatment (NSIR-RT) database since 2015.

Today we initiate the first data transfer—a fitting way to celebrate World Patient Safety Day!

Radiation treatment

Radiation treatment (RT), or radiotherapy, uses radiation to destroy or shrink cancer cells. It’s used to try to cure cancer, reduce the chance of cancer returning, or to help control symptoms. 

According to the Canadian Cancer Society, nearly one in two Canadians is expected to face cancer in their lifetime. About half of the people treated for cancer receive RT. This adds up to over 190,000 treatment courses prescribed annually across Canada.

RT is most often provided via external beam from a machine called a linear accelerator. It can also be delivered internally, which is known as brachytherapy.

Linear accelerator, BC Cancer

In BC, RT is provided at six BC Cancer regional care centres. The RT program is guided by policies and procedures that focus on quality assurance and safe care delivery.

A key element of RT safety is learning from patient safety incidents.

National System for Incident Reporting – Radiation Treatment (NSIR-RT)

Most health care providers in BC are aware that BCPSLS is the provincial patient safety incident reporting system. But did you know there was a national incident reporting system?

Since 2010, the National System for Incident Reporting (NSIR) has been collecting medication safety incident data from participating Canadian health care facilities. Authorized individuals within these facilities can then access the national database to inform local and system improvements in health care delivery.

NSIR was developed by the Canadian Institute for Health Information (CIHI), an independent, not-for-profit corporation that produces health information to help decision makers improve the health care system.

BCPSLS has been submitting de-identified data about medication incidents to NSIR since 2015 and is the only province to do so electronically.

In 2017, CIHI launched the NSIR-RT module after pilot testing it in cancer treatment centres across Canada.

To develop the RT module, CIHI joined forces with the Canadian Partnership for Quality Radiotherapy (CPQR).

CPQR works closely with cancer system partners to improve cancer care for Canadians by establishing best practices and setting benchmarks in radiation treatment quality and safety.  Funded by the Canadian Partnership Against Cancer, CPQR tools are used by all radiation treatment programs in Canada, as well as around the world.

According to CIHI program leads Annie Walker and Spencer Ross, CPQR was the ideal partner for this initiative.

“CIHI provided the incident reporting infrastructure and CPQR provided the subject matter experts,” says Annie. “They also had a well-established means to communicate with the RT community across Canada.”

CPQR’s strong network led to the RT module’s adoption in almost every province in Canada. It is also newly available in French as well as English.

Another key contribution of CPQR was the development of a taxonomy that clarified which incidents should be reported and allowed data to be classified in a logical and consistent format. CPQR continues to review and evolve the taxonomy with input from users in cancer treatment centres across the country to effectively support learning and improvement.

RT incident reporting in BC

In 2016, working with CIHI in tandem with the development of NSIR-RT, BCPSLS partnered with BC’s Provincial Radiation Therapy Program to launch an RT-specific incident report form at BC Cancer.

“The RT form has improved the way that BC Cancer handles incidents,” says Alison Giddings, Clinical Educator, BC Cancer.

Alison helped pilot the BCPSLS RT form back in 2016. She now chairs a Regional RT Quality Committee and participates on the national NSIR-RT Advisory Committee.

To track and trend incidents, Alison creates quarterly summary reports and shares them with staff. In addition, safety incidents and potential improvements are discussed during weekly meetings with other RT leaders within her region. Incidents are routinely addressed by revising a procedure or educating staff. Working groups may be formed to implement larger or systemic improvements.

“Because the form has RT-specific fields, incident reports are completed more consistently and we are able to track, trend, and analyze incidents more effectively,” adds Alison.

Collaborating for success

The strong relationship BCPSLS Central Office and the CIHI-NSIR team established over years of working on medication data transfer provided a solid foundation for collaboration. Lessons learned from the earlier work informed the way forward, and the BCPSLS RT report form and taxonomy were specifically designed to align with and enable electronic data sharing with NSIR-RT.

Why electronic data sharing?

In addition to saving precious time and resources by eliminating the need for duplicate data entry, electronic transfer reduces the risk of human error that is inherent in any manual data entry process.

Currently, every other facility in Canada that submits incident data to NSIR-RT does so by manually inputting each incident one at a time.

“BC’s provincial incident reporting system, supportive Central Office team, and partnership with BC Cancer was a huge advantage in making electronic data transfer possible,” notes Spencer. “Our long-term plan is to expand this process to other facilities within Canada.”

As part of the data transfer process, BC Cancer is supporting expert review of RT incident reports in BCPSLS before the data is shared with CIHI to ensure the information is reliable and valid and meets confidentiality standards. Feedback from the review process can also be shared with managers and leaders at BC Cancer to improve reporting and follow-up practices and with BCPSLS Central Office to inform changes to forms and fields.

Sharing is caring

Contributing to NSIR-RT will allow BC Cancer to share its experiences and best practices, to learn from other provincial agencies, and to gain insight into similarities in the sources of risks and underlying system failures.

Use of the national data set can help in the creation of prevention strategies that can reduce or eliminate future incidents and improve patient safety, particularly where rare incidents are concerned.

“NSIR-RT users can analyze data locally and also look to learnings from other RT centres in Canada,” notes Erika Brown, Executive Director, CPQR. “Our NSIR-RT bulletins highlight case studies from across the country and provide quality improvement recommendations based on mined system data.”

BCPSLS extends its gratitude to the many organizations and individuals involved in making this project a success and wishes everyone a happy World Patient Safety Day!

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