The Datix Common Classification System

1 A. Introduction:The Datix Common Classification System , Version 2 (CCS2) has been designed for use by the entire spectrum of Datix clients worldwide and thus encompasses concepts that have been broadly adopted in a variety of countries. As a starting point, the Datix CCS2 builds on the logic that underpins the World Health Organization Conceptual Framework for the International Classification for Patient Safety (WHO-ICPS; January 2009). The CCS2 is structured to be simple and easy to use, in order to enhance consistency and reliability by users, with the ultimate goal being to collect actionable data and facilitate learning through the identification of causality, and important contributing factors resulting in causality, that may be subject to modulation and/or even elimination.

2 Use of the CCS2 will facilitate benchmarking and continuous improvement CCS2 has been developed with input from many Datix users including clinical staff. The Classification System is comprehensive, and specific elements (domains, subdomains and subordinate categories) may be switched off by local Datix administrators in order to meet unique requirements. Our corporate advice is that local Datix System administrators always coordinate their efforts with front-line clinical and other professional staff before making decisions regarding the format for reporting interfaces forms or decisions regarding which Classification elements to utilize or inactivate.

3 The utilization and utility of the Datix software for learning requires strong engagement with front-line clinical staff, and this will be greatly enhanced by seeking their input before decisions are CCS2 is continuously evolving to comply with changing industry requirements and to incorporate suggestions from clients that have broad applicability in many settings. Thus, we encourage our clients to send us their suggestions for enhancements. In some countries, specific elements of Classification are required by regulators and government agencies, and the CCS2 can incorporate modifications of this sort if necessary.

4 Once changes are put into CCS2 by the Datix corporate program manager they are available for use across our worldwide client base, and as specific data fields can be turned of by local Datix administrators individual clients are not required The Datix Common Classification System Version 2 Datix , Melbury House, 51 Wimbledon Hill Road, London, SW19 7 QWT 020 8971 1971 E W utilize the entire CCS2. Each client can, by deletion of fields, customize the CCS2 to meet their individual needs. Additional fields cannot be added however as our CCS2 is a proprietary product and only our Datix corporate program manager can add new elements of , we strongly encourage our clients to submit suggestions for enhancements to the CCS2, which we will then consider through our change management processes for all clients.

5 Any changes incorporated are thus available for all Datix Understanding Safety Incidents and Adverse Events:There is a natural tension in the healthcare safety community regarding the definitions of safety incidents and adverse events . Aligning with the logic of the WHO Conceptual Framework, Datix has defined a safety incident as an insufficient or failed process that has resulted in, or at least has the potential to result in, harm to patients, staff, visitors or organizations. An adverse event is the consequence (harm/injury) resulting from the safety , for example, if a patient has an allergic reaction to a medication for which he or she has a known history of allergy, the allergic reaction (urticaria, anaphylaxis, death) is the adverse event resulting from the safety incident the administration of an incorrect medication.

6 To prevent this kind of adverse event in the future one must investigate and identify the reasons that the incorrect medication was administered and thus correct the contributing factors resulting in causality. Improvements in safety and healthcare result from correcting insufficiencies or failed processes resulting in harmful incidents, not by simply counting adverse safety incidents affecting patients there are a couple of exceptions to the safety incident definition of insufficient or failed processes, as we have included some discrete adverse events, such as pressure ulcers and healthcare associated infections, as incident types.

7 We did this because the WHO conceptual framework was structured this way, and also because many current users have encouraged us to do so also. However, most safety professionals will agree that pressure ulcers and healthcare associated infections are outcomes (harms/injuries) that have resulted from incidents; , insufficient or failed processes for providing healthcare , staff and visitor safety incidents may reach individuals, in which case these individuals may be harmed or not harmed, or may not reach individuals and thus be categorized as near-miss or close-call incidents.

8 These incidents also merit Classification and analysis because the insufficient or failed processes that cause or contribute to near-misses or close-calls, and the interventions by staff or System processes resulting in the avoidance of harm and injury provide useful opportunities for learning and , Melbury House, 51 Wimbledon Hill Road, London, SW19 7 QWT 020 8971 1971 E W Structure of the Datix Common Classification SystemThe Datix CCS2 is designed to permit Classification of incidents that affect patients, staff, visitors and organizations.

9 Incident Classification consists of three tiers: Tier 1: Broad domains of incidents that may result in adverse events. These are listed on the computer interface form dropdown menus, and the order of these can be modified by the local Datix System administrators. Users should familiarize themselves with these domains before attempting to classify incidents. Tier 2: Subdomains of process insufficiencies or failures within each Tier 1 domain. These are listed on the computer interface form dropdown menus (subject to local decisions) after selection of the appropriate Tier 1 domain.

10 Users should review these Tier 2 sudomains before continuing with 3: Further, more detailed, subordinate categories of process insufficiencies or failures representing the finest level of granularity in Classification . D. Tier 1 Domains and Tier 2 Sub-domains - Schematic Representation: For brevity s sake I have portrayed some representative Tier 1 domain and Tier 2 subdomain headings below. The Tier 3 subordinate categorical headings are too numerous to include but can be provided separately in Excel format on request.