Centre for Primary Care, University of Manchester, Manchester, UK.
NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, UK.
BMJ Open. 2019 Jul 23;9(7):e028927. doi: 10.1136/bmjopen-2019-028927.
To examine general practitioner (GP) understanding of the never event (NE) concept in general practice, and to identify potential enablers and barriers to implementation in UK general practice.
Qualitative study using focus groups. The data were analysed thematically and were informed by the normalisation process theory.
General practice in Northwest England and Southwest Scotland.
25 GPs took part in five focus groups. 13 GPs were female and 12 male with an age range of 28-60.
The NE approach of avoiding serious preventable adverse outcomes from healthcare fitted with participants expectations of the delivery of care but the implementation of strategies to prevent the specific NE was considered complex and variable. The main themes identified participants' understandings and perceived limitations of the NE concept; the embedded layers of responsibility to implement NE within practices and the work required for implementation within general practices. Participants' accounts highlighted the differential nature of work in general practice and that the implementation of initiatives to address specific NE should be situated within a learning and systems approach to implementation. Some NEs were considered more relevant and amenable to simple solutions than others which could influence implementation.
The NE concept was considered overall an important approach to help address key primary care patient safety issues. The utility of individual NEs may vary depending on the complexity of the initiatives that would be needed to manage related risks to as low as reasonably practicable.
调查全科医生（GP）对一般实践中“永远事件”（NE）概念的理解，并确定在英国普通实践中实施的潜在促成因素和障碍。
使用焦点小组的定性研究。数据通过主题分析进行分析，并受规范化进程理论的启发。
英格兰西北部和苏格兰西南部的普通实践。
25 名全科医生参加了五个焦点小组。其中 13 名全科医生为女性，12 名男性，年龄在 28-60 岁之间。
避免医疗保健中严重可预防不良后果的 NE 方法符合参与者对护理提供的期望，但实施预防特定 NE 的策略被认为是复杂且可变的。确定的主要主题包括参与者对 NE 概念的理解和感知限制；在实践中实施 NE 的隐含责任层次结构以及在普通实践中实施所需的工作。参与者的描述突出了普通实践中工作的差异性，并且应该将解决特定 NE 的举措的实施置于学习和系统实施方法中。一些 NE 被认为比其他 NE 更相关且更容易采用简单的解决方案，这可能会影响实施。
总体而言，NE 概念被认为是帮助解决关键初级保健患者安全问题的重要方法。个别 NE 的实用性可能因需要管理相关风险的举措的复杂性而异，以尽可能合理地降低风险。
