Managing Health at Work Partnership Information Network (PIN) Guideline

MANAGING HEALTH AT WORK

APPENDIX 9.G
Rapid follow-up policy

1 Statement

Whilst the [Name of Organisation] is committed to reducing and eliminating risk, it acknowledges that there may be occasions when a significant incident has occurred that needs rapid action. The organisation will therefore:

• make sure that all necessary resources are made available to protect patients, staff and the organisation; and

• communicate verbally first with any patient or their relatives (if appropriate) and any member of staff involved before communicating with any external agencies.

2 Definition

A significant incident is a situation in which staff, or one or more patients are involved in an event which is likely to produce significant legal, media or other interest. If not managed effectively it may result in the loss of life or the loss of organisation's assets or reputation.

Examples of significant incidents include:

• death;

• death or injury where foul play is suspected;

• serious drug dispensing or administration errors;

• systematic screening errors or consistently poor diagnostic performance;

• nosocomial infection, especially legionella;

• major outbreaks of infection;

• major clinical errors;

• failures in engineering infrastructure putting patients at risk (for example, electricity, medical gases); and

• unauthorised interference with or malfunctioning of medical equipment or supplies.

3 Serious Incident Management Procedure

• Upon the occurrence of a serious incident the appropriate person in charge will take immediate measures to ensure that risk to patients, staff, equipment and property is minimised and must ensure the patient(s), and where appropriate, with their consent, their relative(s) are informed.

• Between 9am and 5pm or weekdays, the nurse in charge must inform their line manager, who will inform the appropriate Departmental/Directorate Manager, who will then inform the Clinical Director and Executive Director responsible for Risk Management.

• Between 5pm and 9am and at weekends, the line manager will inform the on-call senior manager.

The on-call senior manager will decide if the incident warrants informing immediately or the next day (if the next day - it must be by 9am): Chief Executive and appropriate Director(s).

If the event results in a fatality, the line manager must immediately contact the on-call senior manager and the Department/Directorate Manager, if between 5pm and 9am, who will then arrange for the following to be contacted as appropriate:

• the Police;

• the Health and Safety Executive (0131-247 2000);

• the Chief Executive; and

• the Health and Safety Advisor.

If it is thought that a criminal act, including acts of violence, has been committed immediate advice must be sought from the police. Call 999.

Every time the police are informed or significant injury has occurred then the Departmental/Directorate Manager or on-call senior manager (if between 5pm and 9am) must be informed immediately.

If the incident is a RIDDOR-defined 'Dangerous Occurrence' or results in a major injury, the line manager must contact the Health and Safety Advisor. A message should be left if the Advisor is not available.

In the event of a serious incident where serious actual harm has occurred, the line manager should arrange a de-brief session for all staff affected by the incident. Depending on circumstances, this may be conducted as one-to-one sessions or in groups. At the debrief, the line manager should make personnel aware of the staff counselling service. An offer should be made by the line manager to arrange referrals for any staff that wish to use this service. Staff may also make direct contact with the counselling service if they prefer.

If there are multiple casualties the Senior Manager in charge will revert to arrangements within the Major Incident Procedure Manual (held in Accident and Emergency) to deal with relatives and multiple enquiries.

The Senior Manager in charge of the area where the incident has occurred will convene a Significant Incident Team which may vary according to the incident but should include:

• Medical Director or representative;

• Director of Nursing or representative;

• Consultant responsible for the patient(s) if applicable;

• Clinical Director;

• Head of any supporting department as appropriate (for example, Pharmacy or Pathology);

• Head of Communications or PR advisers for the organisation (if appropriate);

• Central Legal Office (if appropriate);

• Clinical Governance Co-ordinator; and

• Clinical Risk Manager/Health and Safety Adviser (whichever is more appropriate).

This team will gather all the relevant information as soon as possible and decide a course of action.

4 Objectives of the Serious Incident Team

• Make sure that all immediate necessary actions have been implemented to safeguard patients, staff and the organisation.

• An interim report should be submitted within 14 days.

• Make sure that the confidentiality of the patient or staff member is maintained in the context of the incident.

• Identify an appropriate named person to be responsible for making sure there is adequate communication with the patient and their relatives.

• Establish the accurate facts of the incident.

• Make sure that all documentation, instruments and equipment relating to the incident are clearly identified and kept in a safe condition until the incident is deemed closed.

• A final report of the incident, including action plan, for the Chair of the Clinical Governance Committee and the Executive Groups should be produced within 45 days.

• Agree the content of any statement and the means of dissemination to other professionals.

• Agree the content and timing of a press release (if appropriate) and make sure that any patient, their relatives and any staff involved have a copy beforehand.

• Nominate an appropriate person to deal with the media.

• Make sure that all other agencies and organisations are informed as necessary, for example, the Area Health Board, Health and Safety Executive; Scottish Executive; Medical Devices Agency; manufacturers and suppliers.

• Produce an action plan to make sure changes are made to prevent recurrence of the incident. The action plan will include names of those responsible for implementing the actions with timescales attached.

• Monitor the implementation of the action plan and resolve any problems encountered in doing so.

• Decide when the incident is completed and the file closed and make sure this is communicated to all involved.

The report will set out in full:

• the root cause of the incident, including identification of any relevant breach of policies and procedures;

• the implications/consequences of the incident, including any disruption to services;

• remedial action to minimise disruption to services; and

• recommendations to prevent recurrence of the incident.

The lead for the Serious Incident Team will provide a report to the Clinical Governance Committee, Risk Management Group and the Clinical Governance Support Team who will arrange for the report to be discussed at their next formal meeting. The Director of Nursing and/or Medical Director will decide whether the report should be referred to the organisational Board for discussion. The recommendations from the incident investigation should be disseminated as widely as appropriate as part of the process of learning and continuous improvement.

5 Dealing with the Media

Managers should expect media interest in any serious incident within the organisation, and prepare for it. The NHS is particularly at risk where a child or vulnerable elderly patient is involved, for example, if wrong treatment is given or where groups of people are put at risk as a result of failures in a diagnostic reporting process or where there has been an outbreak of food poisoning.

At all times patients and relatives must be notified before the media.

We will continue to explore ways of establishing good working relationships with the media and will take every opportunity to encourage the establishment of mutual trust and understanding.

Communications with media will only be via the Chief Executive, other senior manager identified for the purpose or the Communications Manager. Contact can be achieved through a variety of means including a press conference, the releasing of press statements or being available for ad hoc press enquiries.