1. CONTACT
Autumn 2010 Volume 24 Number 3
A helping hand for members of the British Chiropractic Association
NEWS • REPORTS • BUSINESS • FEATURES • DIARY • CLASSIFIEDS
CPiRLS:
Towards a
reporting
culture
Planning
for the
unexpected
Recruiting
right

2. 26 Contact Autumn 2010
• How often have you encountered this type
of incident in the past?
• What is the likelihood that your actions/
inactions were responsible?
• Further information (voluntary)*
When you open a reporting form, it remains
active for one hour; it would not be good
practice for it to remain open indefinitely on
a secure site.This means you must submit
the form within that time to avoid your entry
being lost.With this in mind, it may be a good
idea to plan or draft a particularly detailed
case before starting to enter it. A draft on your
computer can be cut and pasted into the
relevant fields.
Learning from incident
reporting
The principle of CPiRLS is that it provides
an opportunity for all chiropractors to learn
from collective experiences. Regular visits to
the site enable you to keep abreast of recent
CPiRLS: Towards a
reporting culture
The UK’s national online Chiropractic Patient Incident Reporting and Learning System
(CPiRLS) was launched in May 2009. In the 15 months since its launch, submission rates
have been low - around two incidents per month. Here, Rob Finch, Chief Executive of
the College of Chiropractors, writes on why the full benefits of this system can only be
realised with more use and participation.
T
he College of Chiropractors
administers CPiRLS on behalf of
the pan-professional team that
developed it.The system is based on
the pioneering work of HaymoThiel and the
two former paper-based incident reporting
systems: CRLS (Thiel et al, 2006) and PiRLS
(Cunliffe et al, 2009). An Implementation
Group comprising clinicians, academics and
educationalists, monitors the use of CPiRLS
and adds relevant resources to the site.
What you can report
Any occurrence that has made you think
about an actual, probable or potential impact
on patient safety can be reported. If this
occurrence led you to discuss the case with
colleagues, to consider changes to your
practice and/or to personally reflect in a
non-routine manner, then it is probably worth
reporting. If in doubt, report!
The use of the word‘safety’, in the context
of chiropractic incident reporting, is possibly
misleading.There is no suggestion that
chiropractic is unsafe.The term should be
taken in its widest sense, to encompass the
concepts of risk and injury and CPiRLS should
be viewed as a means of minimising these
components of safety.
The CPiRLS website provides a trigger list
(available once you log in) which helps you
to identify the types of incidents that may be
worth reporting. It is true that some of the
incidents listed may appear insignificant and,
to some extent, fairly routine, for example,
post-treatment soreness.There is, of course,
no expectation that you would report every
case of post-treatment soreness however,
if a patient had an unusually acute reaction
(i.e. something out of the ordinary that
prompted you to mention it to a colleague in
conversation), then why not mention it to the
national chiropractic community, particularly
if you felt you learned something from what
happened?
Producing an incident report
First and foremost it must be emphasized that
CPiRLS is a completely anonymised process.
The system only actually requires basic
information, with an emphasis on what
happened. The main reporting form has
the following fields, most of which require
a simple choice from a pull-down menu.
Only those five fields marked with an asterix
below require text input from the reporter:
• Patient’s age and gender
• Where the incident happened
• Category of incident
• What happened?*
• Why and how did it happen?*
• Describe the actions taken*
• Key words to describe the incident*
• Was the patient harmed?
• Could the incident have been avoided?
Special Interest

3. Contact Autumn 2010 27
Is there a time limit for reporting an
incident?
The learning value of any incident that
had an impact on you and your practice
does not deplete over time.You should not
underestimate the potential importance of
sharing incidents months, or even years, after
they occur.
reports and to share comments with other
visitors. Some clinics are now basing regular
clinic meetings on a review of the incidents
reported on CPiRLS. For example, one clinic
Principal commented:
“Withinourpractice,thechiropractorsmeet
everysixweekstoreviewchallengingcases
andanyincidentsthathaveoccurredor
beenavoidedbygoodpracticeanddecide
ifanyrequirereporting.Aspartofour
reflectivepractice,wealsolookattheCPiRLS
reportsthathavebeensubmittedtosee
whetherwecanlearnfromtheseincidents.
IamfindingthatCPiRLSisanexcellenttool
forpromotingreflectivepracticeatmyclinic.
Althoughithastakenalongtimetowork
outhowbesttogetallpractitionersaware
ofincidentreportingandbeingpro-activein
thisrespect,Ithinkwearefinallythere.
In a recent study of the culture of safety
among UK chiropractors (Finch et al, 2010),
there was a strong indication that awareness
of the importance and value of incident
reporting is growing and that lessons are
being learned locally, through clinic initiatives
of the type outlined above. However, it is
clear that this growing awareness has not yet
been fully translated into widespread national
reporting via CPiRLS although, hopefully, this
is now changing.
The CPiRLS Implementation Group has
published two Safer Practice Notices in
response to minor trends identified among
the reports submitted to date.These serve to
provide guidance in the management of the
type of incidents in question should they be
encountered again. Additional notices will be
produced as further trends arise.
Frequently asked questions
What is an incident?
CPiRLS defines a reportable incident as any
type of patient safety event, error, accident
or deviation from the norm that actually
happened, nearly happened (near miss) or
has the potential to happen.This is regardless
of whether it is considered minor or major,
results in significant patient harm or leads to a
patient complaint.
How do I access CPiRLS?
The full features of www.cpirls.org are only
available to registered chiropractors through
the use of a generic username and password.
These can be obtained from the professional
associations and the College of Chiropractors.
References
Cunliffe C, Johnson IJ, Selby J (2009) Safety
incidents, treatment complications and
reactions recorded in a student teaqching
clinic: a retrospective analysis. Proceedingsof
theAssociationofChiropracticCollegesResearch
AgendaConference(ACC-RAC).
Finch RP, Heale GS, JayTC (2010) Culture of safety
among UK chiropractors before and after
the launch of online patient safety incident
reporting and learning. ClinicalChiropractic 13,
172-173.
Thiel HW, Bolton JE (2006)The reporting of
patient safety incidents – first experiences with
the chiropractic reporting and learning system
(CRLS): a pilot study. ClinicalChiropractic 9,
139-149.
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Special Interest