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Incident reporting system

Incident reporting has proved to be a useful tool in preventing error in high-risk industries, such as aviation, nuclear and petro-chemical industries. If an aviation incident occurs it is reported, investigated and lessons are learnt. Reporting when things go wrong is essential, as it explores the underlying causes of patient safety incidents. Your practice should have a systematic approach where staff know what type of incidents to report, what information is required and how to learn from it.
Reporting when things go wrong is essential, as it explores the underlying causes of patient safety incidents
Staff should feel they can report incidents without the fear of personal reprimand. A positive patient safety culture is one that has open communication, mutual trust, shared perceptions of the importance of safety and confidence in the efficacy of preventative measures.

Health and safety

As a workplace, your practice comes under occupational health and safety legislation, which imposes certain obligations on you (even if you work alone). These are briefly set out in Box 11. While health and safety issues lie outside the benefits of MPS membership and have more to do with public liability and work compensation than with clinical negligence claims, we can give the following generic advice.

Box 11: Health and safety in the workplace

Employers and the self-employed must make every effort to ensure health and safety in the workplace. Health and safety incidents must be reported to health and safety representatives and inspectors.

Employer’s duties

All employers must –

  • Provide and maintain a safe, healthy working environment
  • Ensure workers’ health and safety by providing information, instructions, training, and supervision
  • Inform health and safety representatives of – incidents, inspections, investigations, and inquiries.

Self-employed people must ensure that they, their workers, or others are not exposed to health or safety risks.

Department of Labour.

A lack of attention to health and safety often contributes to adverse incidents involving patients, so the separation between this aspect of practice and clinical care is not always clear-cut.
Poorly maintained equipment may cause harm to patients if it malfunctions during a procedure

If you do not have suitable hand-washing facilities in your consulting and treatment rooms, for example, there will be a high likelihood of cross-infection between patients. Similarly, poorly maintained equipment may cause harm to patients if it malfunctions during a procedure.

It is therefore important that you make sure your physical work environment is a safe place not only for you and your staff and visitors, but also for patients. If you wish to carry out a risk assessment of your premises, you might find the NHS guide useful.

Although it was written in the context of UK legal requirements, its focus is on assessing common hazards in general practices, so much of its content would be applicable in any country. The five steps to risk assessment are set out in Box 12 (these apply equally well to a clinical risk assessment).

Box 12: Five steps to risk assessment

Step 1 – Look for the hazards

A walk around the premises is useful here, but this step may also be informed by records of injuries or threats of violence, etc.

Step 2 – Decide who might be harmed and how

Staff, patients, children, contractors and other visitors. Be particularly aware of risks to children – eg. corrosive substances or sharps left within their reach, the condition of toys provided in the waiting room.

Step 3 – Evaluate the risks arising from the hazard

Are existing precautions adequate? Are there shortcomings? Is it possible to eliminate the hazard altogether? Is staff training required (eg. lifting techniques)?

Step 4 – Record your findings

Make a record of each hazard identified, who is at risk, what precautions are in place, what needs to be done to improve or eliminate the risk.

Step 5 – Assess the effectiveness of precautions

Undertake periodic reviews and investigate the underlying causes of untoward incidents, near misses and complaints.

  • NHS Health Education Authority, Health and Safety in General Practice: A Guide to Risk Assessment for GPs and Practice Managers, 1998)