Chapters

Chapter 4. Clinical Operations

Liability Protection

Examples of reportable incidents

  • Error in the care of patients (e.g., errors in administration of medications, treatments)
  • Slips or falls in the clinic or on clinic grounds
  • Development of conditions seemingly unrelated to the condition for which the patient was treated
  • Adverse or suspected adverse reactions to a procedure or medication.

What are incident reports and how are they used?

An incident report system can be used to identify and report patient and visitor related occurrences. Health care providers and other clinic staff must complete an incident report regarding any patient or visitor who, while within the clinic and/or on the premises, is involved in an incident that has caused or has the potential to cause injury or loss or damage to their personal property. This includes incidents where the possibility of injury existed although no injury was actually incurred, and those incidents that are inconsistent with the routine care of a particular patient or routine operation of the clinic.

All health care providers should be familiar with the clinic's incident reporting procedures.

Appoint a staff member, preferably someone with clinical training, to receive and review all incident reports. In any case where there was an adverse outcome, or even the potential for an adverse outcome, fully investigate the incident. Incident report forms and other significant incidents should be reviewed on an ongoing basis.

The review process allows for:

  • Identifying and documenting trends that might affect policies or procedures
  • Recognizing and identifying clinic-wide programs to correct identified problems
  • Assessing conformance to required standards of practice and care.

More About Root Cause Analysis

If trends develop in the occurrence of adverse incidents, then a root cause analysis should be performed. This means looking not only at the activities that immediately led to the incident, but also at the systems and procedures in place surrounding the incident. Systems and procedures, rather than provider or staff competence, place providers and staff in positions where mistakes or errors are more likely to occur.

 

 

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