Patient Safety Within Chiropractic: The Role of CPiRLS

In this article, BCA Member and RCC CPiRLS Development Group Chair, Mark Thomas, talks to us about the importance of incident reporting for patient safety and the development of the profession, and how the Chiropractic Patient Incident Reporting and Learning System (CPiRLS) can help with this. 

Patient Safety

No one would disagree that patient safety is paramount within healthcare. All healthcare providers have a professional and ethical responsibility to reduce the risk of harm to patients. Of course, the risks associated with manual therapy are low, however, adverse events of various severity can occur [1]. In addition, other types of safety incidents can occur within chiropractic practice e.g. patient trip or fall [2].

The national and international chiropractic professional associations and bodies are focused on improving patient safety. The principles of patient safety are clearly demonstrated within the BCA Patient Charter [3], putting the patient’s interests first and demonstrating duty of candor if something does not go as expected. As part of the new GCC Code consultation, registrant respondents placed quality and safety within the top four values, highlighting its importance to the profession. Last year, the World Federation of Chiropractic (WFC) launched a Global Patient Safety Task Force to support a patient safety culture within the profession. The Task Force has recently published a ‘call to action’ for the profession, mapped to the WHO Global Patient Safety Framework [3].

Incident Reporting and Learning

Within the UK, the Royal College of Chiropractors’ (RCC) mission includes assuring safety within chiropractic practice and recommends a number of ways to demonstrate this, such as effective communication, risk management, as well as reporting and learning from safety incidents. Safety incidents comprise any deviation from normal clinical care that may occur and that has the potential to cause patient harm [4]. Safety incident reporting (and learning) systems can be used to record and review safety incidents, aiming to identify safety needs.

The Chiropractic Patient Incident Reporting and Learning System (CPiRLS)

CPiRLS is a safety incident reporting and learning system available to all chiropractors within the UK via www.cpirls.org. As it is a secure and anonymous system, you will require a username and password, which can easily be provided by the BCA or RCC.

CPiRLS was developed and launched in the UK by the RCC in 2009 [5]. The first 10 years of safety incident reporting data has been analysed and published [2]. Please note, this is open access via the Journal of Chiropractic & Manual Therapies if you would like to learn more about the findings. Based on the 10-year analysis, the RCC CPiRLS Development Group published a number of ‘Safer Practice Notices’ to highlight identified areas of risk and recommendations to reduce patient harm. These are openly available to all chiropractors, chiropractic students and patients.

Previous research has identified a positive attitude towards patient safety within the chiropractic profession, however, safety incident reporting was demonstrated as an unlikely course of action [6]. Although the rates of incident reporting appear to be increasing, there is significant under-reporting on CPiRLS [2]. To address some potential barriers to incident reporting, the RCC CPiRLS Development Group re-developed the system to make it more contemporary and easier to use. CPiRLS 2.0 was officially launched at the RCC AGM earlier this year and is accessible via www.cpirls.org.

CPiRLS 2.0 contains a number of modifications to improve usability and reduce the time taken to report a safety incident. These include reducing the number of (sub)categories, reducing the word count requirement, shifting the focus toward learning (not just reporting) and defining the level of patient harm. In addition, all new safety incidents reported on CPiRLS 2.0 now receive a comment from the CPiRLS Development Group.

Why should I use CPiRLS?

As well as reporting safety incidents, UK chiropractors can view incidents that have previously been reported, including comments from the CPiRLS Development Group. This can be useful to discuss at team meetings and identify potential learning needs. Remember, all safety incidents are completely anonymous, so chiropractors cannot be identified.

A common question from the profession is around when to use CPiRLS to report a safety incident. Our advice is to report any situation that prompted you to reflect and/or discuss with others. If in doubt, please share it with the profession; by doing so you are supporting the profession and helping to protect patients.

 

 

References:

[1] Carnes, D., Mars, T.S., Mullinger, B., Froud, R. and Underwood, M., 2010. Adverse events and manual therapy: a systematic review. Manual therapy, 15(4), pp.355-363.

[2] Thomas, M., Swait, G. and Finch, R., 2023. Ten years of online incident reporting and learning using CPiRLS: implications for improved patient safety. Chiropractic & Manual Therapies, 31(1), p.9.

[3] Coleman, B.C., Rubinstein, S.M., Salsbury, S.A., Swain, M., Brown, R. and Pohlman, K.A., 2024. The World Federation of Chiropractic Global Patient Safety Task Force: a call to action. Chiropractic & Manual Therapies, 32(1), p.15.

[4] World Health Organization, 2020. Patient safety incident reporting and learning systems: technical report and guidance. Available at https://www.who.int/publications/i/item/9789240010338.

[5] Finch RP, Bolton J, Jay TC, Thiel HW, Webster M, Connor C, (2009). Development of CPiRLS: the future of patient safety incident reporting and learning in the UK [abstract]. Proceedings of the World Federation of Chiropractic Congress.

[6] Wangler, M., Peterson, C., Zaugg, B., Thiel, H. and Finch, R., 2013. How do chiropractors manage clinical risk? A questionnaire study. Chiropractic & Manual Therapies, 21, pp.1-11.