Patient Safety Education Research Articles

Assessment of Knowledge About Patient Safety Concepts Among Medical and Pharmacy Students.

Patient safety is a central principle of healthcare professional practice that requires a significant consideration within the teaching curricula; however, there is a lack of special courses that focus on patient safety concepts in an integrated way in many countries. This study aims to assess the knowledge of medical and pharmacy students regarding patient safety concepts. A cross-sectional study was conducted at Alfaisal University during the 2018-2019 school year. A survey consisting of 15 questions was designed with the help of the quality and patient safety department at King Faisal Specialist Hospital and Research Centre, Riyadh (KFSHRC). The survey was validated and then electronically distributed to all students enrolled in the College of Medicine and College of Pharmacy. A total of 304 (22%) of 1368 students completed the survey. The survey revealed that 51% of students had an acceptable understanding of the types of human error; however, 53% of students had little knowledge about the factors that lead to these errors and 61% did not know how to report an error. Many students (41%) reported being directly involved in an unsafe situation that may cause patient harm, such as a healthcare-related error, adverse event, or inconsistent care. Most students (90%) agreed that hiding errors to avoid further implications is unethical and reporting errors is the responsibility of every healthcare provider. Most Alfaisal University students understand the significance of patient safety education and understand the types of human errors, yet the causes of errors and the protocols for reporting them were not well understood by most students.

Impact of an internal medicine nocturnist service on care of patients with cancer at a large Canadian teaching hospital: a quality-improvement study.

Background:Nocturnists (overnight hospitalists) are commonly implemented in US teaching hospitals to adhere to per-resident patient caps and improve care but are rare in Canada, where patient caps and duty hours are comparatively flexible. Our objective was to assess the impact of a newly implemented nocturnist program on perceived quality of care, code status documentation and patient outcomes.Methods:Nocturnists were phased in between June 2018 and December 2019 at Toronto General Hospital, a large academic teaching hospital in Toronto, Ontario. We performed a quality-improvement study comparing rates of code status entry into the electronic health record at admission, in-hospital mortality, the 30-day readmission rate and hospital length of stay for patients with cancer admitted by nocturnists and by residents. Surveys were administered in June 2019 to general internal medicine faculty and residents to assess their perceptions of the impact of the nocturnist program.Results:From July 2018 to June 2019, 30 nocturnists were on duty for 241/364 nights (66.5%), reducing the mean maximum overnight per-resident patient census from 40 (standard deviation [SD] 4) to 25 (SD 5) (p < 0.001). The rate of admission code status entry was 35.3% among patients admitted by residents (n = 133) and 54.9% among those admitted by nocturnists (n = 339) (p < 0.001). The mortality rate was 10.5% among patients admitted by residents and 5.6% among those admitted by nocturnists (p = 0.06), the 30-day readmission rate was 8.3% and 5.9%, respectively (p = 0.4), and the mean acute length of stay was 7.2 (SD 7.0) days and 6.4 (SD 7.8) days, respectively (p = 0.3). Surveys were completed by 15/24 faculty (response rate 62%), who perceived improvements in patient safety, efficiency and trainee education; however, only 30/102 residents (response rate 29.4%) completed the survey.Interpretation:Although implementation of a nocturnist program did not affect patient outcomes, it reduced residents’ overnight patient census, and improved faculty perceptions of quality of care and education, as well as documentation of code status. Our results support nocturnist implementation in Canadian teaching hospitals.

Development and Effectiveness of a Patient Safety Education Program for Inpatients.

Background: Patient safety is considered an important issue in the field of healthcare, and most advanced countries. Purpose: This study was designed to evaluate a patient safety education program among hospitalized patients. Of the 69 participants, 33 completed the patient safety education program while the 36 remaining participants were given educational booklets. The program was used to measure knowledge about patient safety, patient safety perception, and willingness to participate in patient safety. Methods: Patient safety education was developed by the analysis–design–development–implementation–evaluation model considering expert advice, patient needs, and an extensive literature review. Data were collected from 20 July to 13 November 2020. Data were analyzed using SPSS statistical program. The effectiveness of the experimental and control groups before and after education was analyzed using paired t-tests, and the difference in the amount of increase in the measured variables for each group was analyzed using independent t-tests. Results: The experimental group had significantly higher patient safety scores (t = 2.52, p = 0.014) and patient safety perception (t = 2.09, p = 0.040) than those of the control group. However, there was no significant difference between the two groups regarding the willingness to participate in patient safety. Conclusion: The patient safety education program developed using mobile tablet PCs could be an effective tool to enhance patient involvement in preventing events that may threaten the safety of patients. Further studies are recommended to develop a variety of educational interventions to increase patient safety knowledge and perceptions of patients and caregivers.

Learning the lessons from patient safety incidents.

John Tingle, Lecturer in Law, Birmingham Law School, University of Birmingham, discusses some key reports and sources of information that can help inform patient safety teaching and learning.

Patient Safety Education in Entry to Practice Pharmacy Programs: A Systematic Review.

The aim of this systematic review was to synthesize, summarize, and evaluate the quality of extant quantitative and qualitative literature related to patient safety in pharmacy education. This systematic review included literature that targeted the content, delivery, and outcomes of patient safety in addition to literature that explored the perspectives of pharmacy students and faculty on how patient safety is integrated within their curricula. A systematic review was conducted. Four electronic databases were searched for articles published between 2000 and 2019: PubMed, MEDLINE, EMBASE, and ScienceDirect. Selection was based on prespecified criteria and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Two independent reviewers selected articles, extracted data, and assessed articles' qualities using the Crowe Critical Appraisal Tool. Discrepancies were resolved by consensus or by consulting a third reviewer. Descriptive synthesis of data was performed. Twenty-five eligible articles were included. The majority of studies originated from United States (n = 15). Educational content involved principles of patient safety, and identification, disclosure, and management of medication errors. There was a lack of standardization on how patient safety is incorporated into the pharmacy curricula. Eleven articles (64%) were interprofessional in nature, delivered as a patient safety course (n = 6), through simulation (n = 3), as seminars (n = 1), or as part of student experiential learning (n = 1). Of the 7 articles discussing delivery of patient safety through courses or modules, 4 (57%) were offered as elective courses. Students' perceptions and attitudes significantly improved after all patient safety interventions, reflecting the importance of addressing patient safety in education to ensure optimum future practice. This systematic review demonstrated how patient safety education was incorporated into pharmacy programs in terms of the content and methods of delivery. It was promising to see patient safety content being delivered interprofessionally and in experiential education. Students and faculty regarded implementing patient safety in education as an essential act to meet future work demands. Longitudinal studies to assess the long-term impact of incorporating patient safety on student behaviors upon graduation and health outcomes are needed.

ATTITUDE AND PREFERENCE OF REHAB SCIENCES STUDENTS ON PATIENT SAFETY AND QUALITY IMPROVEMENT EDUCATION

BACKGROUND AND AIMS Patient safety has been neglected in the rehabilitation as per many of the studies, there is a surge demand to get acquainted with the knowledge of patient safety for quality and reliable care. This study aimed to explore the attitude and preferences of rehab sciences students about patient safety and quality improvement education to overcome the gaps in practice regarding patient safety. METHODOLOGY A cross-sectional survey was conducted on undergraduate medical students of physical and occupational therapy, on convenience sampling technique. Data was collected through WhatsApp and e-mail on self-administered questionnaire formulated on google document, based on attitude and preferences of patient safety and quality improvement education. RESULTS A total number of 134 responses received out of which 56.7% were occupational therapy (OT) and rest physical therapy (PT) student. 67.9% OT and 79.9% PT have rated their current knowledge of patient safety and quality improvement as an average. Moreover, students believe that 97.8% good communication, 98.5% patient participation and motivation and 96.3%multidisciplinary teamwork plays a vital role in reducing risk of error. Consecutively, 95.5% of students encourage the safety measurement and quality practice should be an objective of undergraduate curriculum. CONCLUSION The curriculum must include objectives that introduce clinical guidelines to devise a standardized protocol for safety and quality work concepts in order to reduce the risk of errors in practicing and promote patient safety. Patient, Rehab Sciences, Healthcare, Safety, Quality, Education, risk

Generating a Future Vision of Patient Safety: A Pilot Program to Test the Integration of Certified Professional in Patient Safety™ Curriculum into Undergraduate Medical Education.

Preventable healthcare-associated harm results in significant morbidity and mortality in the United States, costing nearly 400 000 patient lives annually. The Institute for Healthcare Improvement provides high-quality educational resources tailored for working healthcare professionals. One such resource is the Certified Professional in Patient Safety (CPPS™) review course, which equips professionals with advanced proficiency in 5 core patient safety domains. The CPPS™ certification is the only interprofessional, patient safety science credential recognized worldwide. In 2010, the Lucian Leape Institute at the National Patient Safety Foundation described the critical need for medical students to participate in patient safety solutions as well. However, equivalent patient safety credentialing remains challenging for students in the preclinical and clinical stages of training to obtain. To address this growing dilemma, the Texas College of Osteopathic Medicine (TCOM) piloted the first-of-its-kind CPPS™ course with 10 medical students to test a novel, academic-level approach to patient safety curriculum. Medical students showed large gains in performance on the post-test (83.18% ± 26.12%) compared to the pre-test (46.46% ± 27.18%) (P < .001, η2 p = .368), representing increased knowledge across all learning domains. On the national certification examination, students had a 90% first-time pass rate, exceeding the current national average of 70% for first-time examinees. In satisfaction surveys, students expressed the value of pilot curriculum for their medical training, the importance of similar Patient Safety Education and CPPS certification for all medical students, their confidence as future healthcare change agents. Content analysis of open response questions revealed 3 key areas of strength and opportunity for guiding future iterations of the course. This pilot generates a future vision of patient safety, equipping students with critical knowledge to systematically improve healthcare quality.

Implementation of a Quality and Patient Safety Curriculum for Pathology Residency Training

Quality and Patient Safety education for resident physicians is necessary to prepare them for independent practice and to meet accreditation requirements. Integrating such education into the residents’ routine work can provide them with valuable practical experience, while advancing the institution’s quality priorities. We committed to Quality and Patient Safety education for our pathology residents but found no published program that met their specific needs. To fill this gap in pathology residency education, we designed and implemented a new curriculum that spans the 4-year duration of residency training. Curriculum content was drawn from the pathology milestones, and educational strategies were based on the principles of adult learning. The curriculum was implemented in the 2018 to 19 academic year, and residents were assessed before and after their participation. The residents engaged in several Quality and Patient Safety activities and projects under faculty supervision, and improved their scores on objective assessments (Quality and Patient Safety quiz and in-service examination). Implementation was facilitated by a Quality and Patient Safety chief resident, and the recruitment of faculty with demonstrated Quality and Patient Safety interest. Our comprehensive Quality and Patient Safety curriculum is feasible to implement and can help pathology residents develop the knowledge and skills needed to lead quality initiatives. We believe that the curriculum framework is readily adaptable to other residency programs.

Focus Group Study on Health Care Professionals’ Experience of Patient Safety Education

Focus Group Study on Health Care Professionals’ Experience of Patient Safety Education

Major educational factors associated with nursing adverse events by nursing students undergoing clinical practice: A descriptive study

BackgroundAs the main group of healthcare providers in hospitals, nurses have more frequent contacts than any other clinician and thus are in a better position to improve patient safety. With the purpose of cultivating competent nurses, nursing educators have the responsibility to promote patient safety. A better understanding of educational factors affecting nursing adverse events by nursing students undergoing clinical practice can help nursing educators find appropriate ways to fulfil their duty. ObjectiveTo examine the status quo of nursing adverse events and to discuss the major educational factors concerned in different regions of China. DesignA descriptive study design was undertaken in 2018. Participants and settingA convenience sample of 1173 nursing students undergoing clinical practice was recruited from 22 hospitals in different regions of China. MethodsThe Chinese version of the Medical Student Safety Attitudes and Professionalism Survey (MSSAPS) was administered to and demographic and professional data were collected from clinical nursing students after obtaining informed consent. ResultsThe incidence of nursing adverse events in clinical student nurses was 17.8%. Approximately 87.01% of nursing adverse events were near miss. The positive response rate of safety attitudes and professionalism by clinical nursing students ranged from 57.5% to 96.9%. Logistic analysis indicated that gender, educational level, hospital regions, safety culture and professional behavior experience dimensions were the major factors influencing nursing adverse events. ConclusionAttention should be paid to the situation in which clinical nursing students are prone to nursing adverse events. Cooperation between nursing colleges and hospitals should be strengthened to promote patient safety in clinical nursing students. We suggest that nursing educators implement patient safety education in both theoretical and practical teaching and use multiple forms, especially simulation-based training, to strengthen safe nursing behavior to reduce the incidence of nursing adverse events.

The Effect of Patient Safety Education on Undergraduate Nursing Students' Patient Safety Competencies.

Patient safety is influenced by a set of factors in various levels of the healthcare system. One of the factors affecting patient safety is safety competencies of the nursing students. The current study aimed to evaluate the effect of patient safety education on patient safety competencies of the nursing students. This quasi-experimental study was conducted with a pretest-posttest deign. The levels of patient safety competencies of 50 nursing students were investigated in a nursing school affiliated to large university of medical sciences in the south of Iran in 2019. Data were collected using Health Professional Education in Patient Safety Survey (H-PEPSS). The data were analyzed in SPSS 21 using descriptive statistics and repeated measures ANOVA. The three investigated intervals were significantly different in terms of the total H-PEPSS dimensions, while the lowest was attributed to the dimension "managing safety". Mean scores of "how broader patient safety issues are addressed in health professional education" and "comfort speaking up about patient safety" significantly increased during the follow-up periods. The educational intervention was partially effective in improving patient safety competencies of the nursing students over long term.

A Multicentered Academic Medical Center Experience of a Simulated Root Cause Analysis (RCA) for Hematology/Oncology Fellows.

Quality improvement and patient safety education is an Accreditation Council for Graduate Medical Education (ACGME) common program requirement for hematology/oncology fellowships. Interprofessional clinical patient safety activities, such as root cause analyses (RCA), can be challenging to incorporate into busy schedules. We report on a multicentered experience utilizing a simulated RCA educational module in an attempt to provide fellows with the tools needed to participate in a live RCA and to increase awareness of the need to analyze patient safety events. The 2-h module included a didactic session explaining the basics of an RCA including common terminology, effective chart review, and personal interviews. The fellows assessed a patient safety event of a missed coagulopathy and created an event flow map and fishbone analysis. They then formed root cause/contributing factor statements and proposed a solution. Twenty-three fellows from two institutions completed the experience. There was a significant difference in fellow reported comfort with participating in a live RCA (p = 0.03), and in utilizing the tools of an RCA following the mock RCA experience (p = 0.005). About 70% of respondents felt that as a result of the mock RCA, they were more likely to report a near miss or adverse event and were more likely to be thorough in their documentation. Mock RCAs are a feasible method of incorporating ACGME-required patient safety activities into hematology/oncology fellow education and are effective in increasing their comfort and understanding of important quality improvement skills.

A multicentered academic medical center experience of a simulated root cause analysis (RCA) for hematology/oncology fellows.

188 Background: Quality improvement and patient safety education is an Accreditation Council for Graduate Medical Education (ACGME) common program requirement for hematology/oncology fellowships. Specifically, the ACGME requires trainee participation in interprofessional clinical patient safety activities, such as root cause analyses. These can be challenging to incorporate into busy schedules and are intimidating to some trainees, but simulated RCAs are a novel way to assure trainees gain important patient safety skills. We report on a multicentered experience utilizing a simulated RCA educational module in an attempt to provide fellows with the tools needed to participate in a live RCA and to increase awareness of the need to analyze patient safety events. Methods: The two-hour module included a didactic session explaining the basics of an RCA including common terminology, effective chart review, and personal interviews. The fellows assessed a patient safety event of a missed coagulopathy and created an event flow map and fishbone analysis. They then formed root cause/contributing factor statements and proposed a solution. Seventeen fellows from two institutions completed pre- and post-session surveys regarding the experience. Results: There was a 47% increase in both the percentage of fellows who felt comfortable participating in live RCAs in the future, and in the number of fellows who felt comfortable with using the tools typically utilized in an RCA. 70.59% of respondents felt that as a result of the mock RCA, they were more likely to report a near miss or adverse event. Conclusions: Mock RCAs are a feasible method of incorporating ACGME-required patient safety activities into hematology/oncology fellow education and are effective in increasing their comfort and understanding of important quality improvement skills

The Timing of Simulation-Based Scenario Implementation in Patient Safety Education: The Example of the Operating Room

BackgroundSimulation-based experiences (SBEs) are accepted as an effective strategy for learning about patient safety in operating rooms, which are known as high-risk working environments. In implementing SBEs, there is a need to investigate when students prefer simulation and when it is effective for students' success. MethodsA total of 56 students were included in the study, which was designed as a quasiexperimental study. The data were collected through the Theoretical Knowledge Test, Skills Assessment Form, Student Satisfaction and Self-Confidence in Learning Scale, Simulation Design Scale, and Educational Applications Questionnaire forms. ResultsAlthough there were no differences found between students' satisfaction, self-confidence, and education practices, there was a remarkable decrease in the Simulation Design Scale responses of the students in the group who applied the SBE after clinical practice compared with those of the group who applied the SBE before clinical practice, and there was a statistically significant difference in the support subdimension. ConclusionThe results of this study show that scenario implementation during education about patient safety in the operating room is more effective if performed before clinical application.

Patient safety education in pre-registration nursing programmes in South Korea.

This study investigated how patient safety is currently taught in pre-registration nursing programmes across South Korea and explored nurse educators' perspectives on curriculum change. Pre-graduate education plays a critical role in preparing nurses with the requisite patient safety competencies. However, little is known about how patient safety education is addressed in South Korean nursing schools or the perspectives of nurse educators regarding patient safety education and a need for change. This descriptive study used data collected during a 2019 accreditation workshop provided by the Korean Accreditation Board of Nursing Education. A paper-and-pencil survey was completed by 80 nurse educators working in 16 regions throughout Korea. A little consistency was found in approaches to teaching patient safety. Patient safety topics are addressed throughout various nursing courses, and patient safety education is limited in hours of instruction and breadth of content. A majority of respondents indicated that additional supports are needed, including a national standardized curriculum for patient safety education. A new approach to teaching patient safety is needed in Korean pre-registration nursing education. Overall, patient safety education is limited and provided through a fragmented approach with little attention to systems, workplace design or human issues that are necessary for developing the critical reasoning and skills to support patient safety. The accrediting and regulatory bodies in South Korea should work together to develop and implement explicit standards of patient safety education and patient safety competencies for nursing students. Development of a standardized national curriculum is essential for providing a consistent, systematic and comprehensive approach to patient safety education in nursing programmes.

Implementing and Evaluating a Patient Safety Curriculum for Undergraduate Medical Students using Blackboard

Background: One of the important components of the medical school curricula is patient safety education. Aim: To introduce a WHO patient safety course in medical undergraduate curriculum College of Medicine Jouf University (COM JU) using blackboard, measuring students’ attitudes and knowledge to patient safety course pre-post intervention. Methods: A quasi-experimental Pre-program/Post-program single group design was applied in this study. A Comprehensive sample of 5th-year undergraduate medical students (COM JU) (n=56) participated in the study. The first two levels of Kirkpatrick’s evaluation of educational intervention were measured; the first level (learner satisfaction) measured using The Attitudes to Patient Safety Questionnaire (APSQ) and the second level (knowledge) where students completed locally designed multiple-choice items targeting patient safety basic information. To increase student's awareness of the course author conducted a World Health Organization (WHO) learning from errors workshop before the implementation of the course. The course was uploaded on the learning management system (Blackboard). Students' satisfaction with blackboard as a learning tool for patient safety course was measured. Results: We matched student pretest with posttest and used paired t-tests to identify mean differences.Response rate was 86.15% (n=56) of students. There was a statistically significant difference between genders regarding the importance of patient safety (p =0.004). Results of (APSQ) showed that there was a minor improvement of attitude towards patient safety after the intervention. There was a statistically significant difference between students' knowledge test pre-post intervention (pre_42.86±12.17-post_54.83 ±14.9) p 0.000. Seventy-three percent 73% (n=41) of students agreed that Blackboard provided them with a positive learning experience. Conclusion: implementing a patient safety course into undergraduate medical education improved students’ knowledge of patient safety, blackboard is an effective learning management system to teach a course online from a students' perspective.

University of California, San Francisco School of Medicine

University of California, San Francisco School of Medicine

107. GETTING TO THE ROOT CAUSE: RESIDENT ENGAGEMENT IN A MORBIDITY, MORTALITY, &amp; IMPROVEMENT CURRICULUM WITHIN A LARGE PEDIATRIC TRAINING PROGRAM

Residents are exposed to medical errors during their training. The ACGME emphasizes the importance of patient safety and medical error analysis in a residency curriculum. Understanding root cause analysis (RCA) is an important component of a morbidity, mortality, and improvement (MMI) curriculum, enriching patient safety education. The objectives are to (1) engage residents in a mock RCA, (2) increase resident comfort in reporting medical errors, and (3) increase resident awareness of patient safety opportunities. Our MMI curriculum incorporated a mock-RCA workshop which highlighted a medical error that occurred due to poor patient hand-off. Residents assumed multiple roles (including that of chief quality officer) and were guided through an RCA. They identified the safety event, deviations from standard of care, and corrective actions to mitigate recurrence. Using a 5-point Likert scale survey, we assessed residents on their understanding of the RCA process, confidence in identifying safety events and deviations in care, willingness to report a medical error, and perceived ability to identify QI opportunities in the workplace. 100% strongly agreed or agreed that they had a better understanding of the RCA process (n = 20). 95% either strongly agreed or agreed that they felt confident in identifying safety events and deviations in care. Regarding likelihood to self-report a medical error or one made by a colleague, 95% strongly agreed or agreed with both statements. All residents strongly agreed or agreed with their ability to identify QI opportunities in day-to-day patient care. Lastly, 85% either strongly agreed or agreed that they had become more actively interested in participating in a QI project involving patient safety. Medical errors provide opportunities for residents to learn and take corrective actions. An MMI curriculum, focused through the lens of an RCA, is an opportunity for residents to gain a better understanding of how medical errors are identified and engage residents in QI science on a hospital-wide level.

Rate of anastomotic leak following right hemicolectomy by general surgical trainees.

Performing a right hemicolectomy (RH) is a core technical competency for general surgical trainees. There is a concern that anastomotic leaks occur more frequently when patients are operated on by trainees rather than by surgeons. This study aims to analyse the quality of care outcomes after RH, stratified by the experience level of the operator. Patients were retrospectively recruited from the Bi-National Colorectal Cancer Audit (BCCA) Registry, from 2007 to 2018. All patients who underwent a RH for colorectal cancer were eligible. The primary outcome measure was anastomotic leak rate. A total of 6548 eligible right hemicolectomies were identified, with 74% being performed by consultants, 12% by fellows, and 14% by surgical trainees. The overall incidence of an anastomotic leak was 2.1%, with the highest rate of 3.7% noted among supervised registrars. Positive resection margin rate was the highest among unsupervised trainees at 10.5%, as compared with 4.3% among consultants. Anastomotic leak, anastomotic bleeding, prolonged ileus, and pneumonia occurred significantly less frequently with consultant surgeons, as compared with trainees. Independent risk factors for anastomotic leak were urgent surgery, extended right hemicolectomy, conversion to open surgery, and a lower level of operator seniority. Two independent risk factors were identified for inpatient mortality-a high ASA score (III and above) and urgent surgery. RH is a common operative procedure in general surgical training. Data from this study may assist with the structuring of surgical training programmes, aimed at maximising both patient safety and trainee professional development and education.

Assessing Adverse Events After Chiropractic Care at a Chiropractic Teaching Clinic: An Active-Surveillance Pilot Study

ObjectiveThis study aimed to assess the feasibility of implementing an active-surveillance reporting system within a chiropractic teaching clinic and subsequently determining the frequency of adverse events (AEs) after treatment administered by chiropractic interns. MethodsInterns were invited to collect data from patients using 3 questionnaires that recorded patient symptom change: 2 completed by the patient (before and 7 days after treatment) and 1 completed by the intern (immediately after treatment). Worsened and new symptoms were considered AEs. Qualitative interviews were conducted with clinicians and interns to assess the feasibility of implementing the reporting system, with resulting data categorized under 4 domains: acceptability, implementation, practicality, and integration. ResultsOf the 174 eligible interns, 80 (46.0%) collected data from 364 patient encounters, with 119 (32.7%) returning their posttreatment form. Of the 89 unique patients (mean age = 39.5 years; 58.4% female, 41.6% male), 40.1% presented with low back pain and 31.1% with neck pain. After treatment, 25 symptoms (8.9%) were identified as AEs, mostly reported by patients as worsening discomfort or pain. Data from qualitative interviews suggest that the AE reporting system was well accepted; however, proposed specific modifications include use of longitudinal electronic surveys. ConclusionOur findings suggest that it is feasible to conduct an active-surveillance reporting system at a chiropractic teaching clinic. Important barriers and facilitators were identified and will be used to inform future work regarding patient safety education and research.