Health Ministry builds online incident reporting system

System to track incidents of adverse care in health system

The Ministry of Health is planning an online reporting system for what it calls "reportable events", incidents that may result in poor results for patients.

The Quality, Improvement and Innovation team at the ministry is seeking tenders for developing the system, finalising the national policy for management of events and providing training.

"The overarching objective of the repository and policy is to promote and drive implementation of best practice and shared learning across the sector to improve quality and safety," the tender says.

The repository aims to increase the reporting of events by health care providers, to deliver improved quality and safety, it says. This could help avoid the need for health resources to be used to treat "the consequences of errors".

A draft reporting policy (pdf) has already been developed and used by district health boards since September 2009, the tender says. Training in incident management and cause analysis was provided to DHBs throughout 2008/09.

The policy says that when an incident occurs a series of actions must take place.

"It is not necessary however for these steps to occur as discrete entities. In large organisations there must be separate steps where responsibility for each step is identified. However in a small organisation, or a single person provider service, many of these steps may be undertaken by the same person. The importance of identifying these as separate steps is to ensure that all appropriate action is taken," the policy says.

The nine key steps are:

1 Identification

2 Immediate action

3 Notification

4 Prioritisation

5 Investigation

6 Classification

7 Analysis

8 Improvement action

9 Feedback.

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Tags Ministry of Healthreportable events

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