Credits and acknowledgments

BACRA is a tool designed to help middle managers improve management of risks inherent in healthcare activities. It helps to create a safer environment for patients, and it also helps professionals to demonstrate that they effectively assume their responsibility of handling safety events in a proactive manner that is in accordance with Spanish Law 16/2003 on Quality and Cohesion in the National Health System. BACRA has been designed to be used at both hospitals and primary care.

BACRA offers:

• Analysis that is realistic and close to the incident.
• Calm and participatory reflection that offers greater assurances for professionals and safety for patients.
• Realistic solutions to safety incidents.
• Confidence when informing patients about an adverse event.
• Confidence for the professionals who must inform a patient who suffered an adverse event (see Recommendations Guide pages 24 and 35).
• Tips for helping professionals affected by the occurrence of an adverse event (see Recommendations Guide pages 18 and 37).
• Responsible performance of management tasks by middle managers in the healthcare organization.

How to use BACRA:

• Before using BACRA, acquiring information about the incident in a non-interrogatory manner from the professionals nearest it (see Recommendations Guide) is recommended, reviewing the clinical history and other relevant documentation. During this analysis, avoid an interrogatory attitude, do not exhibit mistrust towards them, or draw premature conclusions.
• Sharing this analysis and possible solutions between 2-3 people from the unit is advised.

Terms of use acceptance:

Hide the form so that nobody else can access it

You can hide the form so that nobody else may access the data concerning the incident you are analyzing. Choose a key that contains four numbers to protect the form, write it down, and place it in a secure location. Without this key, you will not be able to access your data.

Enter your key to show the form

Please introduce the key you used to protect the form in order to continue with the incident analysis.

2-Reset your form (data from the current analysis will be lost):

If you do not remember the key and wish to use the tool, click the Reset button below in order to start over and conduct a new analysis.

WARNING: all data entered up to now will be erased.

Indicate the type of center you are at:

Type of harm

Note that, for unavoidable damage, you do not need to fill in the fields of BACRA tool. However, if you wish, you can perform the analysis.

We recommend you report the incident with the system used at your health center.

Reporting system

We recommend you report the incident with the system used at your health center.

Indicate the nature of the harm (more than one option may be selected):

Indicate the nature of the near miss:

Measures adopted with the patient in relation to the harm suffered

Impact

Specify when it occurred and when it became known

Please chronologically narrate the events

Describe what happened in an orderly manner and without value judgments. To complete this table, reconstruct what occurred, beginning with who reported the event first and how the incident became known.

Event 1

Event 2

Event 3

Event 4

Event 5

1. The Five Whys technique

We must ask ourselves as many as five times why events occur. "Safety is like peeling an onion; the more you look, the more you find, and each layer makes you cry.”

2. Immediate and latent causes

When filling in data, keep in mind:

• Immediate causes or active errors: These terms refer to errors committed by professionals in direct contact with patients. These are generally easy to identify (pushing an incorrect button, injecting the wrong product...) and almost always involve someone in the front line of care.

This category includes forgetfulness, distractions, lapses, assessment errors, and failures of compliance with established norms.

• Latent causes or system errors: These refer to circumstances and errors that are less clear, present in the organization and the design of devices, activities, etc., that can facilitate the occurrence of errors and contribute to harming patients.

Use of resources and equipment

Organization and culture of safety

Factors attributable to professional activity

3. Intrinsic risk factors for the patient

RPN (RISK PRIORITY NUMBER)

Legends of letters used:

S: Severity    O: Probability de occurrence    D: Probability of detection     RPN: Risk probability number

Root cause                                               S         O        D        RPN             Proposed solutions                 Person responsible and date                Verification

Date of analysis

Print results

This report may be useful for patient safety managers at your center who analyze incidents and assess whether issuing an alert to improve safety for all patients is advisable.

Assess whether this report should be sent to the unit of reference in patient safety.

Erase report

Once the report is printed, erasing all fields for reasons of confidentiality is recommended.