Incident reporting policy - Homerton University Hospital

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• Review sessions throughout the above so staff member involved (and their manager) is kept up todate, understands what is going on and reviews action plan as necessary.11.2 Personal DebriefThe personal debrief is where the manager and the staff member involved sit in private and discuss theincident in an uncritical atmosphere. The location of this debrief should be discussed and could include aprivate office, at the staff member‟s home or in a neutral location.It is a good idea (with the permission of the staff member) to write some notes e.g. on the incident andhow this has affected staff and what assistance has been offered by the manager.11.3 Leave ArrangementsIn some incidences, staff may wish to return to work e.g. after a couple of hours. A personal debriefshould always take place before the member of staff returns to work, even if they return to work shortlyafter the incident. This will ensure that both the member of staff and manager are in agreement they canreturn and make any necessary changes to their duties.When the member of staff is not ready to return to work, they should be allowed to go home. Due toHealth & Safety Executive reporting requirements regarding incidents at work, all subsequent leave willneed to be taken as sick leave and this incident will then become RIDDOR reportable, if it has not beendeclared already.If the member of staff and manager disagree as to whether the member of staff is ready to return to work,advice should be sought from the Human Resources Department as a matter of urgency.11.4 Access to CounsellingThe Line Manager or his/her nominated Deputy can request for formal counselling to be arranged throughEmployee Health Management Service. Individuals may however wish to organise this themselves. Thisshould be arranged within 5 days of the incident. No one should be forced into counselling but it should bemade available and offered to all those involved and/or affected by the incident.11.5 Useful ContactsEmployee Health Management Service (previously known as the Occupational health department) issituated on the ground floor in Chatsworth House towards the back of the hospital, past Clifden House.Hours of opening: Mondays to Fridays from 9am to 5pm.For needlestick injuries outside these hours, staff should contact the A&E department.Tel: 020 8510 7259Fax: 020 8510 7528External ContactsVictim Support National Office - Tel: 020 7735 9166Health and Safety Executive - Tel: 020 7717 600012.0 Anonymous ReportingPlease also refer to the Raising Concerns at Work Policy & Procedure (Whistle blowing policy) for furtherguidance.Staff who report an incident may not want their identity to be disclosed, if staff want to raise a concernanonymously they can do.Under the Public Interest Disclosure Act 1998, employees who have an honest and reasonable suspicionthat corruption or malpractice has occurred and/or is likely to occur at work, and speak out against it, havestatutory protection against victimisation and dismissal.Page 10 of 47
13.0 Reporting to external agenciesSenior Managers and Assistant General Managers for Quality and Risk will be responsible for ensuringescalation of incidents to the Clinical and Non-Clinical Risk Managers where they are graded as major /catastrophic (Red – Refer to Trust Matrix at Appendix 1) that may require notification to the NationalPatient Safety Agency (NPSA). These incidents will however, be normally reviewed through the IncidentReview Group (See Appendix 3)The Clinical and Non-Clinical Risk Manager(s) will then escalate this requirement to the Head ofGovernance and/or Chief Nurse who will then make the final decision as to the level of investigationrequired and whether the incident requires a Serious Incident Investigation or should be onward reportedas a Serious Untoward Incident.Local Supervising Authority Midwifery Officer should be informed of all incidents graded as major /catastrophic (Red) midwifery incidents and / or maternal deaths.In addition, there will be a requirement to report incidents to other external bodies within prescribedtimescales as outlined in Appendix 4.13.1 Other External Agencies13.1.1 National Patient Safety Agency (NPSA)The NPSA is a special Health Authority established to ensure that the National Health Service learns fromAdverse Patient Incidents involving patients so that improvements to the delivery of healthcare and thesystems supporting care can be made for the benefit of patients in the future.To support this the NPSA has established the National Reporting and Learning Service (NRLS).Thefunction of the NRLS is to collect and analyse patient safety incidents, including prevented patient safetyincidents (near misses) and provide feedback to healthcare organisations in a way that promotes learningand risk reduction through environmental and / or system changes in organisational, management orclinical practice.Reporting to the NPSA / NRLS is conducted by the Risk Management team.The Trust, through the Risk Management Dept, will upload all clinical patient safety incidents to the NPSAon a bi-weekly / monthly basis.Any incident that involves the unexpected death of a patient must be reported to the NPSA13.1.2 Strategic Health Authority (SHA)In line with the NHS London Serious Untoward Incident Reporting Policy including the procedure to befollowed for Safeguarding Children (2009) and the Contract for NHS Services with the commissioningPCT, the Trust will report all SUI‟s to City & Hackney Teaching PCT. The trust will ensure that the PCT isinformed via upload of all SUI incidents to the STEISS database managed by NHS London.Though it is not compulsory for Foundation Trusts to report SUIs to NHS London as there is no direct lineof accountability, the trust will aim to participate in the established reporting system in order to contribute tothe learning from the wider reporting of SUIs. Where there is a concern that other organisations could beat risk of a similar incident occurring (such as an equipment malfunction) the trust will inform NHS Londonat the earliest opportunity as well as other appropriate bodies (e.g. the MHRA).14.0 Escalation of Reported Incidents14.1 All reported incidents are systematically analysed to identify trends and produce information formanagement review and action. Details of reported accidents are provided to the following groups:14.2 Patient Safety CommitteeMeest on a monthly basis and receives an update of all current serious incidents. The committee receivescompleted serious incident investigation reports, ratifies, or otherwise, the report recommendations andensures that appropriate action plans are put in place.Page 11 of 47
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Incident reporting policy - Homerton University Hospital

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