HAZARD: Wrong data is entered into the Digital Growth Chart API (as opposed to the user interface)

[pacharanero]

Description

Incorrect data could be sent to the API. This incorrect input data would cause the API to return the incorrect results.
Importantly, this Hazard is

Cause

A number of causes for this hazard are possible, and these all originate outside of the API.

It is important to note that RCPCH do not control the client software which will use the API. However, all dGC client software systems are themselves subject to NHS Clinical Safety standards, and there should be consideration of this risk within their own Hazard Log and Clinical Safety Case.

Examples of some causes that dGC integrators should watch out for:

• User interface error which allows the user to enter the wrong data into the UI, or a poor UI design which makes it difficult to spot common errors.
• An internal client data transfer error which sends incorrect data to the API despite correct data entered in the UI.

Effect

Incorrect data sent to the API could result in incorrect results being returned from the API and an aberrant clinical decision being made on the basis of those incorrect results.

Hazard

As with most of the Growth Chart Hazards, the potential problem is that a child either:

• doesn't receive intervention when it should, or
• receives inappropriate intervention when it should not.

Harm

In both the above scenarios, our Project Board of clinical paediatrics and growth experts agreed that the absolute risk of directly attributable harm to a child is rather low, because of the multiple clinical practice safeguards that exist whether the growth chart is paper, PDF or digital.

Because growth is slow, such clinical decisions regarding growth monitoring and interventions are often taken on the basis of multiple measurements, over a period of time, and there is always 'clinical correlation' between the Growth Chart findings and the presentation and appearance of the patient.

This means that a single erroneous reading is unlikely to result in an incorrect clinical decision. Furthermore, the actual visual plot points on chart itself are part of the mitigation because a single outlying result that seems at odds with the preceding trend will alert clinical suspicions. The charting is actually part of the clinical error-rejection mechanism, which established in practice and predates digital charting and APIs.

Examples of harm that 'could' happen:

• A child's failing growth is not noticed because of incorrect data, and intervention fails to happen. The child comes to harm because intervention is not taken.
• A child is wrongly referred to Social Services by a clinical practitioner because, based on an erroneous trend in the growth measurement suggesting neglect, and this results in a complaint from the child's parents.

Related Hazards

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Assignment: Assign this Hazard to its Owner. Default owner is the Clinical Safety Officer @pacharanero
Labelling: Add labels according to Severity. Likelihood and Risk Level
Project: Add to the Project 'Clinical Risk Management'

• Subsequent discussion can be used to mitigate the Hazard, reducing the likelihood (or less commonly reducing the severity) of the Harm.
• If Harm is reduced then you can change the labels to reflect this and reclassify the Risk Score.
• Issues can be linked to: Issues describing specific software changes, Pull Requests or Commits fixing Issues, external links, and much more supporting documentation. Aim for a comprehensive, well-evidenced, public and open discussion on risk and safety.

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Next steps

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