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Incident Reporting in Healthcare Guide: A Step Towards Improved Patient Safety

Abishek Goda
Incident Reporting in Healthcare: The Complete Guide in 2021 by Quasr.

Hypothetically, if you ask someone where you are likely more going to meet with an accident — in a hospital or while driving a car — most people will say hospitals are the most unlikely place to get injured.  

Unfortunately, the actual medical situation is a bit different compared to a hypothetical situation. According to a 2015 study by the UK National Health Services (NHS), it is believed that 10% of critical accidents occur in all hospitals. 

Even the World Health Organisation (WHO) has estimated that 20-40% of global healthcare spending goes waste due to poor quality of care. This poor healthcare quality leads to the death of more than 138 million patients every year. 

Patient safety in hospitals is in danger due to human errors and unsafe procedures. Everyone makes mistakes, even good doctors and nurses. However, by recording these mistakes, analysing and following up, we can avoid the future occurrence of mistakes/accidents.

To err is human, they say. The best thing we can do as humans is to learn from these mistakes and avoid repeating them in the future. When we adopt this feedback approach in hospitals and other healthcare spaces, we can improve patient safety in healthcare.

Knowing why, when, and how to report an incident can help improve patients, hospital staff, and organizations’ safety. This guide will walk you through all the different aspects of incident reporting in healthcare. It will show how to file an accurate incident report to establish high healthcare standards worldwide. 

What Does Incident Reporting in the Healthcare System Means?

To err is human, to cover up is unforgivable, and to fail to learn is inexcusable.”

Prof Liam Donaldson (WHO Envoy for Patient Safety)

An incident is an unfavourable event that affects patient or staff safety. The typical healthcare incidents are related to physical injuries, medical errors, equipment failure, administration, patient care, or others. In short, anything that endangers a patient’s or staff’s safety is called an incident in the medical system. 

The process of collecting incident data and presenting it properly to action is known as ‘Incident Reporting in Healthcare.’ With incident reporting, an emerging problem is highlighted in a non-blaming way to provide a catalyst for changing the factors contributing to the error. 

Designated staff with authority to file a report, or staff who has witnessed an incident firsthand, usually file the Incident report. Usually, nurses or other hospital staff file the report within 24 to 48 hours after the incident occurred. The outcomes improve by recording incidents while the memories of the event are still fresh. 

When To Write Incident Reports in Hospitals?

When an event results in an injury to a person or damage to property, incident reporting becomes a must. Unfortunately, for every medical error, almost 100 errors remain unreported. There are many reasons for unreported medical incidents, but not knowing when to report is one of the most common ones. 

Unfortunately, many patients and hospital employees do not have a clear idea about which incidents to report. Knowing when to report in hospitals can boost safety standards to a great extent. Let’s consider three situations:

1. A nurse is helping a patient walk from his bed to the bathroom. However, he stubs the big toe on his left foot on the IV pole that he is dragging. 

2. While injected the accident patient’s IV with pain medication, the nurse misread the label and administered a heavy dosage than prescribed, which increased the patient’s blood pressure level. 

In these situations, it is necessary to fill in the incident reports. Simply because an unexpected event occurred and lead to harm, it doesn’t matter how severe or minor the incident is. It is essential to report all incidents.

Purpose of Incident Reports

Incident reports provide valuable information to hospital admin facilities. They capture data required to highlight necessary measures to improve the overall safety and quality of the hospital. An accurate incident report serves multiple purposes, such as:

#1 Root Cause Identification

All incidents have a cause. Mishaps are pretty uncommon in hospital settings, and most incidents can be root caused to a potential reason. Correcting the root causes can easily avoid future incidents of that type. In this sense, root cause analysis of an incident is an essential investigation step for all hospitals to ensure their staff and patients are safe under most conditions.

#2 Policy and Process Improvements

Some incidents are part of a larger pattern that can only be identified by looking at them together – let’s say, for example, through a Swiss cheese analysis model. Such assessments usually identify more significant issues that aren’t immediately apparent from individual incident reports or investigations. These assessments feed into clinical risk management as well as helps guide the hospital administrators to tweak their policy or process guidelines to help staff adhere to a safer care routine. 

For example, let’s take a pattern of incidents. Each has a root cause individually to what looks like a handover issue – but at different stages or different type of facilities. It would be possible to tweak each of these handover processes individually to fix that specific issue. However, it may be more productive to improve the overall handover process by taking all the incidents as a whole and tweak to address them together. 

#3 Clinical Risk Management

All hospitals have and use their enterprise risk management processes. Clinical risk management, a subset of healthcare risk management, uses incident reports as essential data points. Risk management aims to ensure the hospital administrators know their institution’s performance and identify addressable issues that increase their exposure. And the ability to assess clinical risks ensures the hospitals can stay ahead in their business and provide high-quality care and a safe workplace for all staff.

#4 Continuous Quality Improvement (CQI)

All hospitals have continuous improvement plans that help them stay updated with all the latest developments in patient safety and quality by assessing, evaluating, and improving their processes and methods over time. Having incident reports duly filled and followed up to closure helps the CQI process to identify potential areas of improvement and help the organization achieve a more successful CQI cycle that takes them forward.

#5 Better Training and Continuous Learning

Incident data are essential sources of knowledge and on-the-job training material. Incident investigation is a rich source of information that will help new staff understand why the hospital has a specific process that may differ from their previous workplaces. Similarly, having a robust incident management system helps implement a good continuous learning program for the staff that helps them learn the most important details they need to be efficient in their day-to-day work.

Different Types of Incident Reporting in Healthcare

An incident is an unfavorable event in health organizations. But, the nature of the incident can vary based on numerous circumstantial factors. Broadly, there are four types of incident reports:

#1 Clinical Incidents

A clinical incident is an unpleasant and unplanned event that causes or can cause physical harm to a patient. These incidents are harmful in nature; they can severely harm a person or damage the property. For example—

  • A patient falls out of bed while sleeping. 
  • A patient brutally scratched a nurse while she was taking his temperature. 
  • Nurse mislabelled the medicine box while storing it. 

#2 Near Miss Incidents

Sometimes an error/unsafe condition is caught before it reaches the patient. Such incidents are called “near-miss” incidents. However, the problem might have diffused before the severe harm, but it is still essential to report near-miss incidents. Nearly 50 near-miss incidents occur for each injury reported. For example— 

  • A nurse notices the bedrail is not up when the patient is asleep and fixes it
  • A checklist call caught an incorrect medicine dispensation before administration. 
  • A patient attempts to leave the facility before discharge, but the security guard stopped him and brought him back to the ward. 

#3 Non Clinical Incidents

Non-clinical incidents include events, incidents, and near-misses related to a failure or breach of EH&S, regardless of who is injured or involved. For example—

  • Misplaced documentation or documents were inter-changed between patient files. 
  • A security mishap at a facility. 

#4 Workplace Incidents

A work accident, occupational incident, or accident at work is a discrete occurrence that can lead to physical or mental occupational injury. The workplace incidents are related to mental as well as physical hurts. According to the BLS’s Workplace Injuries and Illness News, nursing assistant jobs have the highest incidence rates. For example—

  • Patient or next-of-kin abuses a care provider – verbally or physically – leading to unsafe work conditions. 
  • A healthcare provider suffered a needle prick while disposing of a used needle.  

Who Prepares Incident Reports in Healthcare Facilities?

At QUASR, we believe all staff (and patients, too) should be able to report incidents or potential incidents they have witnessed. But in practice, it is a bit different. Some hospitals have designated persons who are authorized to file the reports. In some other hospitals, the staff usually updates their supervisor about an incident, then can file the report. 

QUASR clients, usually, have configured to give access to all their staff so that they can initiate an incident report enabling them to stay aware of all the issues that occur – however minor or inappropriate it may be. Allowing all staff to report requires a training effort from the quality and safety teams to ensure all the employees understand what and when to file an incident report.

Preparing incident reports in a healthcare facility

Critical Components of Incident Report

One comprehensive incident report should answer all the basic questions — who, what, where, when, and how. Most hospitals follow a preset reporting format based on their organizational needs. However, an incident report must cover the following aspects:

#1 General Information

The well-informed incident report needs basic information such as the date and time of the incident. Additionally, for future analysis, your report must include general information, like:

#2 Location of the Incident

Specifically, mention the location of the incident and the particular area within the property—for example, patient X fell in Ward no. 2 near the washroom. With the location specifications, administration staff can better investigate the reason behind the incident and fix it.

#3 Concise yet Detailed Incident Description

The incident description needs to be clear and meaningful — don’t use vague language, never add baseless information, and keep personal biases out. Whenever you have to add your opinion to the report, mark it as an assumption or subjective opinion.

#4 Type of the Incident

You should define the nature of the incident while reporting to get a clear view. We can categorise the hospital incidents into different sections such as Medication Error, Patient Fall, Equipment Damage, Abuse, Pressure Ulcer, Radiation, Surgery/Anesthesia, Laboratory related, Security, Harassment, Loss or damage to property, Patient Identification, among others. QUASR offers 25 such incident types built-in by default.

#5 Information of all Parties Involved in the Incident

The administration needs the name and contact details of all the parties involved in the incident. The report should capture all the relevant information required to follow up with the involved parties.

#6 Witness Testimonies

If there are witnesses available to the incident, it will be helpful to add their statements in your report. While writing witness statements, focus on the following attributes — specific details provided related to the incident, use quotation marks to frame their accounts, note witnesses’ location at the time of the incident, and how they are related to the incident.

#7 Level of Injury

In case of injury, the reporting staff must record the injury level and cause in the report. If the incident involves an in-patient at the hospital, their medical records will reflect the treatment and diagnosis of the injury. However, for others, it might be required to follow up and record their injury diagnoses.

#8 Follow Up

The incident report is incomplete without the follow-up action details. Each report should include remarks stating what preventive measurements and tactics you have opted to avoid such incidents in the future. 

#9 Reviews

Once a final follow-up on the incident report is made, the next phase is reviewing. In this step, the supervisor or manager ensures the implementation of corrective actions against the report. The goal of the review is to prevent the recurrence of the incident and create immediate action plans. While reviewing incident reports, a reviewer should consider the following things:

#10 SBAR

SBAR abbreviates Situation, Background, Assessment, and Recommendations. The reporting person’s supervisor at the time of the incident typically performs SBAR. SBAR attempts to capture more structured information about the incident, what happened, pre-conditions leading to the incident, information about the patient or staff, if involved, a first assessment of what caused the incident, and recommendations for follow-up or corrective actions. 

#11 Risk Scoring

A risk score is a calculated number that reflects the severity of risk due to some factors. We compute risk scores as a factor of probability and impact. It is common in the industry to use a 5×5 risk scoring matrix. But there are other methods too, and sometimes the scoring changes based on the type and nature of the incident.

#12 Investigation Information

An investigator or an investigation team needs to go through all the supporting evidence to analyze the incident. The incident supporting comes in different forms, such as photos, CCTV footage, and witness statements. It is essential to verify the supporting evidence during an investigation. Information investigation often leads to:

#13 Root Cause Analysis

Root cause analysis is a problem-solving method used to identify the root cause of the problem. The typical output of the RCA step is a set of contributing factors that then indicate systemic issues that may be addressed together by policy or process changes.

Standard RCA tools used in the industry include the Five Why method, Ishikawa, or the Fishbone Analysis. Some cases use more advanced techniques like the Swiss cheese model or PRISMA.

#14 Contributing Factors

Contributing factors are those factors that influenced a single event or multiple events to cause an incident. If contributing factors are accelerated, it will affect the severity of the consequences. Therefore, with the knowledge of contributing factors, management can eliminate them to prevent similar incidents from occurring in the future. 

QUASR implements a form of the London Protocol for capturing these factors.

#15 Executive Summary

The compelling executive summary is the final step in incident reporting. It is a short document produced for management purposes. It summarises a more extended report so that readers can quickly become acquainted with the material. Management can get a crisp reading of the incident from the executive summaries without reading the entire report. 

Benefits of Patients Safety Reporting

Through healthcare data analysis, setting the correct key performance indicators in your organization becomes simpler. Here are some vital benefits that you can gain from reporting:

#1 Preventive Measures

One of the most powerful elements of an incident report is streamlining historical and current data to spot potential incidents in advance. Using predictive analysis, healthcare facilities can improve the quality of patient care and reduce workplace mishaps. Around 60% of healthcare leaders have confirmed that adopting predictive analytics has improved their efficiency considerably. 

#2 Disease Monitoring

Disease monitoring is one aspect of the first predictive analytics. With the incident reports, healthcare organizations can monitor potential disease outbreaks by using past and present metrics. 

During COVID-19, many hospitals have struggled to prevent disease outbreaks on their premises. But, the organizations that have insightful data with them may have managed the pandemic outbreak a lot easier. 

#3 Cost Reduction

Reporting can also make healthcare operations more economically effective. By gathering and analyzing incident data daily, hospitals’ can keep themselves out of legal troubles. A comprehensive medical error study compared 17 Southeastern Asian countries’ medical and examined how poor reporting increases the financial burden on healthcare facilities. 

#4 Enhanced Patient Safety

Improving patient safety is the ultimate goal of incident reporting. From enhancing safety standards to reducing medical errors, incident reporting helps create a sustainable environment for your patients. Eventually, when your hospital offers high-quality patient care, it will build a brand of goodwill. 

Healthcare Incident Reporting Challenges

Healthcare incident reporting has various managerial and safety-related benefits. To create a result-driven incident report, you have to cross the next hurdles also:

#1 Paper-based Reporting

In this technology era, many healthcare organizations still rely upon traditional paper-based reporting. Paper-based reporting is a manual approach where the incident details are recorded and managed using paper and often hand-written reports.

Paper-based reporting has numerous disadvantages, including low-quality data, limited flexibility, costly process, error-prone, time-consuming, and more. Get started digitizing your incident data by downloading our Excel-based Incident Reporting Template and quickly replace paper-based reporting. We even have a post explaining the template and how you can benefit from it.

#2 Underreporting

The problem of underreporting is widespread in the healthcare industry. Common causes of underreporting include:

1) Lack of awareness about when and what to report.

2) Fear of repercussions from colleagues or seniors. 

The reason behind underreporting might vary, but no one can deny that it is the biggest reporting challenge. We had written a detailed article on our assessment of under-reporting in our blog.

According to the Agency for Healthcare Research and Quality, all healthcare facilities should offer a simple and anonymous reporting way to their staff. QUASR has built-in features to encourage reporting in a pseudo-anonymous manner encouraging staff to file a report without fear. 

#3 Busy Schedule

The busiest hospital personnel, nurses, and doctors are mainly responsible for filing incident reports. Due to their busy and often overworked schedule, they sometimes fail to report incidents. A solution must factor in this constraint at the time of design and implementation to ensure all incidents are recorded in a timely fashion without over-burdening the staff.

Conclusion

After understanding the purpose, benefits, and challenges of incident reporting in healthcare, it is clear that reporting is essential for medical facilities. Whether you wish to improve patient safety or reduce workplace mishaps, incident reporting can serve multiple purposes. But, compiling, reviewing, and investigating incidents in a timely and unbiased fashion isn’t a simple task. 

You require an automatic incident reporting system to manage hundreds of incidents at any given time. We can say that QUASR has practical tools to help you create track-analyse incident reports. QUASR is easy to use and access, which allows fast and accurate incident reporting. 

We have various elements in our software for resilient healthcare incident reporting ensuring all the best practices. To better understand what QUASR can do for you, book a free demo today

Also, please stay connected with us as we will be covering more topics related to healthcare incident reporting. Meanwhile, feel free to contact us for further information!