BMJ Quality & Safety

Caruso, Rosario; Di Muzio, Marco; Di Simone, Emanuele; Dionisi, Sara; Magon, Arianna; Conte, Gianluca; Stievano, Alessandro; Girani, Emanuele; Boveri, Sara; Perrone, Pier Mario; Castaldi, Silvana; Menicanti, Lorenzo; Dolansky, Mary

doi: 10.1136/bmjqs-2025-019077pmid: 40784756

BackgroundHealthcare-related procedural misadventures remain underreported despite decades of investment in patient safety. International Classification of Diseases, 10th Revision (ICD-10) codes Y62–Y69 capture defined preventable adverse events during medical and surgical care. This study aimed to examine temporal patterns in Y62–Y69-coded events using aggregated, precomputed data from the TriNetX Global Collaborative Network.MethodsWe conducted a retrospective observational study using deidentified electronic health records from the TriNetX platform, encompassing over 135 million patients aged 0–89 (years: 2016–2024). Incidence rates for Y62–Y69–coded events were analysed globally and across four regional networks, USA, Europe–Middle East–Africa (EMEA), Asia-Pacific (APAC) and Latin America (LATAM), with additional sensitivity analyses in cardiovascular (ICD-10: I00–I99) and oncological (ICD-10: C00–D49) cohorts. Temporal trends were explored descriptively using polynomial regression (for visual pattern illustration) and the Mann-Kendall trend test.FindingsGlobally, Y62–Y69 incidence rates increased from 0.04 to 0.09 per 100 000 patients between 2016 and 2024 (125% increase), with inflection in the early postpandemic phase. EMEA exhibited the steepest rise (414%), followed by APAC (225%). The USA showed a non-linear pattern detectable only through polynomial modelling. LATAM and APAC trends lacked statistical significance, likely due to high year-to-year variability. Sensitivity analyses in the disease-specific cohorts reflected similar patterns, reinforcing the consistency of findings.InterpretationThis is the first global, real-world analysis of ICD-10 Y62–Y69–coded adverse events. The findings reveal a notable postpandemic escalation in procedural harm, underscoring the fragility of safety systems under operational stress. Regional heterogeneity and non-linear trajectories highlight the importance of locally tailored interventions and the need to reinvigorate global patient safety efforts.Data availability statementAll data were extracted from the TriNetX Global Collaborative Network. Aggregated incidence rates and the R code used for statistical analysis are provided in online supplemental file 2.

Chen, Teng-Chou; Trafford, Alex M; Carr, Matthew J; Bansal, Neetu; Kontopantelis, Evangelos; Avery, Anthony; Chen, Li-Chia; Ashcroft, Darren M

doi: 10.1136/bmjqs-2025-018794pmid: 40764033

BackgroundPrescribed opioids are potent analgesics associated with high safety risks due to their adverse effects, drug-drug and drug-disease interactions and potential for dependency. To support the implementation of prescribing indicators for further interventions, this study examined the prevalence of different types of potentially hazardous opioid prescribing (PHOP) in general practices across England and investigated underlying factors and variation between practices.MethodsWe conducted a cross-sectional study focusing on adults (aged ≥18 years) at risk of triggering 17 PHOP indicators on 1 April 2021, involving 1358 general practices contributing to the Clinical Practice Research Datalink Aurum. PHOP prevalence was calculated by dividing the number of patients triggering an indicator by the total number at risk. Variation was assessed with intraclass correlation coefficients (ICCs), and multilevel mixed-effects logistic regression models identified associated factors, presented as adjusted ORs (aORs) with 95% CIs.ResultsAmong 3 121 852 patients observed, 361 505 (11.58%, 95% CI 11.54, 11.62) triggered at least one PHOP indicator, yielding an ICC of 0.07 (95% CI 0.06, 0.07). The prevalence of the 17 PHOP indicators ranged from 1.97% to 32.02%. Significant variability was noted across the 17 indicators, especially for persistent opioid prescriptions in patients with alcohol use issues (ICC 0.08, 95% CI 0.07, 0.09), chronic obstructive pulmonary disease or asthma (ICC 0.08, 95% CI 0.07, 0.09) and hypothyroidism (ICC 0.07, 95% CI 0.06, 0.07). Patients from the most deprived regions (aOR 1.28, 95% CI 1.22, 1.34) and the Northwest of England (aOR 1.73, 95% CI 1.66, 1.81) had a higher risk of PHOP.Conclusions and relevanceThe high prevalence of PHOP, particularly among the most socioeconomically disadvantaged populations, emphasises existing prescribing risks and the need for their appropriate consideration within primary care. The high variation between practices indicates potential for improvement through targeted practice-level intervention.

Prideaux, Jonelle; Britto, Maria T; Vaughn, Lisa M; Auger, Katherine A; Fetters, Cassandra Dodds; Hoffman, James M; Kim, Julia M; Walsh, Kathleen E

doi: 10.1136/bmjqs-2025-018799pmid: 40866296

Background and objectivesPaediatric medication use is at high risk for errors due to factors such as weight-based dosing and liquid medications. In the outpatient setting, where most children take their medicines, errors are common and can be dangerous. However, errors are not widely measured in this setting. Continuous measurement is the first step towards quality improvement. Our aim was to collaborate with a variety of professional and patient/family key partners to identify types of measures needed to assess paediatric outpatient medication errors, including those that occur in the home.MethodsWe conducted qualitative interviews and concept mapping with parents, pharmacists, paediatricians, nurses, health system leaders and healthcare organisational leaders. Using concept mapping, a multiple-step structured process of surveys, sorting and analysis using multidimensional scaling and hierarchical cluster analysis, participants generated measures and prioritised those they considered most important and feasible to measure in future medication error instruments. At the same time, interviews identified gaps in current measurement approaches and top priorities to fill these gaps. Results were compared during analysis.ResultsConcept mapping participants (n=71) contributed ideas which key partner panel (n=9) mapped into seven clusters: prescribing errors, giving medication/administration, pharmacy dispensing, dosing tools and education, monitoring for problems, error surveillance and family partnership in understanding errors. Interview participants (n=24) highlighted the need for health system measures of safe outpatient medication used for quality improvement, including feasible measures related to home administration, dispensing errors and measures of harm. The ability to segment data by high-risk populations (eg, preferred language) was a priority.ConclusionsMeasures of safe administration at home were the highest priority for parents and healthcare professionals. Development of these measures is critical as no scalable measures for this element of care are available. These and other prioritised measures will likely need to include caregiver report.