Maternity and neonatal (perinatal) adverse event review process: guidance

3. Overview of perinatal adverse event review pathway

The HIS National Framework identifies six stages of adverse event management.

1. Risk assessment and prevention

2. Identification and immediate actions following an adverse event, including consideration of duty of candour

3. Initial reporting and notification

4. Assessment and categorisation, including consideration of duty of candour

5. Review and analysis

6. Improvement planning and monitoring

When an adverse event occurs, the HIS Framework outlines the actions that should be taken (Fig 1):