{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T15:16:33Z","timestamp":1792509393841,"version":"4.5.0"},"reference-count":61,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2023,3,15]],"date-time":"2023-03-15T00:00:00Z","timestamp":1678838400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000272","name":"National Institute for Health and Care Research","doi-asserted-by":"crossref","award":["PR-R20-0318-21001"],"award-info":[{"award-number":["PR-R20-0318-21001"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"\nBackground<\/jats:title>\nReducing avoidable healthcare-associated harm is a global health priority. Progress in evaluating the burden and aetiology of avoidable harm in prisons is limited compared with other healthcare sectors. To address this gap, this study aimed to develop a definition of avoidable harm to facilitate future epidemiological studies in prisons.<\/jats:p>\n<\/jats:sec>\n\nMethods<\/jats:title>\nUsing a sequential mixed methods study design we first characterised and reached consensus on the types and avoidability of patient harm in prison healthcare involving analysis of 151 serious prison incidents reported to the Strategic Executive Information System (StEIS) followed by in-depth nominal group (NG) discussions with four former service users and four prison professionals. Findings of the NG discussions and StEIS analysis were then synthesised and discussed among the research team and study oversight groups to develop an operational definition of avoidable harm in prison healthcare which was subsequently tested and validated using prison patient safety incident report data derived from the National Reporting and Learning System (NRLS).<\/jats:p>\n<\/jats:sec>\n\nResults<\/jats:title>\nAnalysis of StEIS incident reports and NG discussions identified important factors influencing avoidable harm which reflected the unique prison setting, including health care delivery issues and constraints associated with the secure environment which limited access to care. These findings informed the development of a new working two-tier definition of avoidable harm using appropriate and timely intervention, which included an additional assessment of harm avoidability taking into the account the prison regime and environment. The definition was compatible with the NRLS incident report narratives and illustrated how the prison environment may influence identification of avoidable harm and judgements of avoidability.<\/jats:p>\n<\/jats:sec>\n\nConclusions<\/jats:title>\nWe have developed a working definition of avoidable harm in prison health care that enables consideration of caveats associated with prison environments and systems. Our definition enables future studies of the safety of prison healthcare to standardise outcome measurement.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0282021","type":"journal-article","created":{"date-parts":[[2023,3,15]],"date-time":"2023-03-15T17:43:25Z","timestamp":1678902205000},"page":"e0282021","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":7,"title":["Defining avoidable healthcare-associated harm in prisons: A mixed-method development study"],"prefix":"10.1371","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7854-8154","authenticated-orcid":true,"given":"Richard N.","family":"Keers","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Verity","family":"Wainwright","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9766-2681","authenticated-orcid":true,"given":"Joy","family":"McFadzean","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kate","family":"Davies","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen M.","family":"Campbell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline","family":"Stevenson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4504-2111","authenticated-orcid":true,"given":"Thomas","family":"Purchase","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Shaw","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7580-7699","authenticated-orcid":true,"given":"Andrew","family":"Carson-Stevens","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2023,3,15]]},"reference":[{"issue":"1","key":"pone.0282021.ref001","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1136\/qshc.2007.022491","article-title":"Patient safety events reported in general practice: a taxonomy","volume":"17","author":"MA Makeham","year":"2008","journal-title":"Qual Saf Health Care"},{"key":"pone.0282021.ref002","doi-asserted-by":"crossref","first-page":"l4185","DOI":"10.1136\/bmj.l4185","article-title":"Prevalence, severity, and nature of preventable patient harm across medical care settings: systematic review and meta-analysis","volume":"366","author":"M Panagioti","year":"2019","journal-title":"BMJ"},{"issue":"1","key":"pone.0282021.ref003","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1186\/s12916-020-01774-9","article-title":"Preventable medication harm across health care settings: a systematic review and meta-analysis","volume":"18","author":"A Hodkinson","year":"2020","journal-title":"BMC Med"},{"key":"pone.0282021.ref004","article-title":"Global Patient Safety Action Plan 2021\u20132030: Towards Eliminating Avoidable Harm in Health Care","author":"World Health Organization","year":"2021","journal-title":"Third Draft January 2021. 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