Serious Untoward Incident Policy - Health Partnerships Learning ...

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Appendix E - Initial Data Set: Capturing the Immediate Details.Assistant Directors and Managers should use the Serious Untoward Incident Data Form tocapture the information that will initially be needed to brief senior colleagues and inform theHead of Communications, the PCT and the SHA, the Head of Governance& Compliance.[Affected person name not included for reasons of confidentiality but will be required to beshared where appropriate]Serious Untoward Incident Log Form[For initial data collection, does not replace standard incident report]Name of Designated Lead Director:Phone Number:Date of Incident:Service, Site & Location of Incident:Gender of Patient:Time of Incident:Type of Patient:[Inpatient, community, etc.]Ethnic Group (if known):Date of Birth:Type of Incident:[Accident, Infection control, Data protection etc.]Actual/Near MissBrief outline of the issue / Description of what happened: (include any equipment, medical devices, medication involvedensure preserved for the incident investigation)Describe Immediate action taken:Further Action being taken: (include action to support and inform patients, relatives and carers)Patient / Relatives informed: ( ‘Being Open’ procedure applied) Date/Time informed, who informed and by whom)Media Interest: Yes/No (If yes please give sufficient information to form basis of press release. What is the initial view of events andthe approach to the investigation?)Principal Staff contact(s) and contact number(s); (initial SUI Lead and other significant contacts)Further information (if relevant):Managing Director informedDate/Time Informed:Assistant Director Professions and Governance Informed Date/Time Informed:Head of Governance & Compliance informedDate/Time Informed:Head of Communications InformedDate/Time Informed:PCT Senior Management TeamDate/Time Informed:(Name of Senior Manager Informed)Signed:Print Name:Designation:Date & Time:22
Appendix F:EXTERNAL REPORTINGIncident type Recipient Information reportedRIDDOR incidents Health & safety executive (HSE) Injuries from work based accidents.Details of incident and personsinvolved.Medicine incidentsMedicines and Healthcare ProductsRegulatory Agency (MHRA)Comprehensive details of incidentsrelated to adverse drugs reactions.Medical device related incidents MHRA Comprehensive details related todevices involved in incidentincluding manufacture date, expirydate.Serious Adverse Blood RelatedEvents (SABRE)MHRA / Hospital TransfusionCommittee Via Acute TrustHaematology LaboratoryDetails of incident including initialfindings.Patient safety incidents NPSA All patient safety incidents includingnear-miss events.Communicable disease outbreaksand other public health issuesFire related incidents. Estaterelated incidentsHealth Protection Agency (HPA)NHS Estates (NHSME)Infection control and other publichealth incidents with details ofspread of disease, contact etc.Details of fire incident injuries/deathcause type/quantity loss.Insurance claims and incidents NHSLA Details and cost of loss/claim.Environment related incidents e.g.waste disposalData Protection/CaldicottcontraventionsEnvironment AgencyDept of Health through SHAInformation on incidents e.g. type ofwaste and hazards.Description of contravention e.g.patient details disclosedinappropriately.Safeguarding Children Local Safeguarding Children Board Details of child protection relatedincident.Safeguarding vulnerable adults Social Services Details of incident to Protection ofVulnerable Adults Lead [POVA].The Central Alert System (CAS) Department of Health Details of actions taken to addressissues contained in alert.Incident involving a patient detailedunder the Mental Health ActIncident involving individual in aregistered residential care homeIf doctor cannot issue a deathcertificateMental Health Act CommissionCare Quality CommissionHM CoronerDetails of the individual, type ofsection, occurrence.Details of individual, occurrence.Details about patient and fullcircumstances of death.23
Page 3: 1. Policy Statement1.1 This policy
Page 6 and 7: 9 Investigating SUIs9.1 See Section
Page 8 and 9: 18. Bibliography Australia/New Zeal
Page 11 and 12: 5.6 In the event that an external i
Page 13 and 14: The Chief Operating Officer will co
Page 15 and 16: 10.5 Progress on the investigation
Page 17 and 18: Appendix B - Quick reference guide
Page 19 and 20: Appendix C - Deciding whether an in
Page 21: Appendix D - Essential Contact Numb
Page 25 and 26: Coronial Law - request for reports
Page 27 and 28: It is important to remember that ve
Page 29 and 30: Appendix I:- Investigating a Seriou
Page 31 and 32: Main report Headings:3 Relevant doc
Page 33 and 34: Appendix K: - Serious Untoward Inci
Page 35: If you have identified a potential

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