Policy for Incident Reporting and Recording Process for Nursing Programs

Purpose

The purpose of this Policy is to provide a clear process for the identification, collection, management, and analysis of patient or clinical safety incidents in relation to students within the Nursing programs. This is a requirement of the College of Nurses of Ontario program approval for nursing programs, and in-line with best practices from the Canadian Patient Safety Institute (CPSI, 2012). The Nursing Incident Reporting and Recording Process includes actions and processes required at the program level to conduct the immediate and ongoing activities following an incident. Incident Analysis will aim to identify what happened, how and why it happened, what can be done to reduce the risk of recurrence and make care safer, and what was learned. This policy will NOT be used for student evaluation, but rather to build a culture of safety that supports excellence in clinical learning, and a no-blame approach to incidents that have occurred.

Definitions

For the purposes of this Policy the following definitions apply:

"Harmful Incident" means a patient safety incident that resulted in harm to the patient. Replaces “adverse event”, “sentinel event” and “critical incident”

"Near Miss" means a patient safety incident that did not reach the patient. Replaces “close call”

"No Harm Incident" means a patient safety incident that reached a patient, but no discernible harm resulted.

"Patient" means everyone who receives health services across the continuum of care (e.g., patient, client, resident, customer).

"Patient Safety" Incident means an event or circumstance that may have resulted, or did result, in unnecessary harm to a patient. "Incidents" arise from either unintended (e.g., errors) or intended acts. Errors are, by definition, unintentional.

"Provider" means professional and non-professional staff, and others engaged in the delivery of health services (e.g., student, clinical instructor)

"Student Incident" means a student related incident that was not directly related to patient safety.

Scope and authority

This Policy applies to all students, faculty members, sessional instructors, and staff of the nursing programs which include clinical instructor staff, faculty advisors and Year level coordinators, faculty and/or staff in the simulation labs, placement office staff who work with students in the clinical setting, simulation labs and students enrolled in any nursing programs with Ontario Tech University (OTU) and Durham College (DC) (OTU DC within the Collaborative BScN program (Ontario Tech University and Durham College) and the RPN-to-BScN Bridge Program (OTU-DC-Georgian College [GC]).

The Nursing Program Safety Incident Report Form shall be revised as needed to support the program processes according to this policy.

The Associate Dean (Nursing) or successor thereof, is the Policy Owner and is responsible for overseeing the implementation, administration and interpretation of this Policy.

Policy

In the event of an incident in the clinical setting, the nursing student is to follow the agency’s reporting in addition to the university policy. Disclosure of an Incident shall be conducted in accordance to agency policies. Sessional instructors or clinical instructors/faculty advisors should notify Year level coordinators of all incidents (including near misses) and ensure that immediate action is taken to care for and support the patient/family/provider/others, secure items and reduce risk of imminent recurrence. Incidents are to be reported in a timely manner as soon after the incident as possible. The Nursing Program Safety Incident Report Form should be completed by students with the assistance of the appropriate supervisor (e.g. clinical sessional, faculty advisor) members and/or students and submitted to the Nursing Practicum Office and Clinical Course Coordinator. Internal agency processes must be followed and therefore forms should also be completed and submitted as required by the agency policy.

The success of the Incident Reporting Policy relies on the creation of a confidential environment where participants can safely report incidents and express their opinions about underlying contributing factors without fear of reprisal. The clinical instructor and Year Lead, in consultation with the Associate Dean (Nursing) as needed, shall determine whether the Incident was a result of actions of intention, recklessness or of unforeseen circumstance or complications of care, and such determination shall guide disciplinary action or impact on student progress in the program. Ideally, clinical instructor and Year Lead response to the Incident should facilitate student learning

The clinical instructor/faculty advisor and Year level coordinator are responsible for reporting and forwarding a copy of the Nursing Program Safety Incident Report Form to the Nursing Program Office. Redacted forms will be forwarded to the Students Affairs Committee (or a subcommittee) for reviewing incidents. Recommendations shall be developed after each Incident reviewed addressing how to reduce the risk of recurrence and make care safer, how student/faculty learning can be facilitated to prevent such an incident in future and to determine what was learned and how learning should be shared.

Faculty members responsible for course oversight are also responsible for overseeing the incident reporting, including any action steps initiated. Their report must be retained in the Nursing Program Office for quality assurance monitoring.

The Student Affairs Committee (or subcommittee) is responsible for combining all data into one quarterly report and bringing forward as a standing agenda item to each praxis committee meeting for discussion and review.

The Student Affairs Committee (or subcommittee) shall review annually ALL Incidents submitted and produce an aggregate report to ensure that patterns of incidents can be assessed, if present, and identify needed changes to program processes and curriculum to minimize risks and potential injuries to patients/families, and students and faculty members.

Monitoring and review

This Policy will be reviewed as necessary and at least every three years. The Student Affairs Committee or successor thereof, is responsible to monitor and review this Policy.

Relevant legislation

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Related policies, procedures & documents

Nursing Program Safety Incident Report

College of Nurses of Ontario, Program Approval. Available from: http://www.cno.org/en/become-a-nurse/nursing-education-program-approval/

Canadian Patient Safety Institute, Reporting and Learning Systems: Incident Management Toolkit. Available from:
17. https://www.patientsafetyinstitute.ca/en/toolsResources/PatientSafetyIncidentManagementToolkit/PatientSafetyManagement/Pages/Reporting-and-Learning-Systems.aspx

Incident Analysis Collaborating Parties. Canadian Incident Analysis Framework. Edmonton, AB: Canadian Patient Safety Institute; 2012. Incident Analysis Collaborating Parties are Canadian Patient Safety Institute (CPSI), Institute for Safe Medication Practices Canada, Saskatchewan Health, Patients for Patient Safety Canada (a patient-led program of CPSI), Paula Beard, Carolyn E. Hoffman and Micheline Ste-Marie. Available from: https://www.patientsafetyinstitute.ca/en/toolsResources/IncidentAnalysis/Documents/Canadian%20Incident%20Analysis%20Framework.PDF#search=Definitions%20of%20patient%20incident

World Health Organization. World Alliance for Patient Safety. More Than Words: Conceptual framework for the International Classification for Patient Safety. Geneva: World Health Organization; 2009 Jan. Report No: WHO/IER/PSP/2010.2. Available from: http://www.who.int/patientsafety/taxonomy/icps_full_report.pdf