RISK MANAGEMENT ADVERSE INCIDENT MANAGEMENT POLICY (AIM)

Transcription

1 RISK MANAGEMENT ADVERSE INCIDENT MANAGEMENT POLICY (AIM) Author: Multidisciplinary Lead: Head of Safety, Governance and Risk Review Group: Adverse Incident Management Review Date: December 2010 Last Update: December 2009 Document No: RM/03 Issue No: 6 UNCONTROLLED WHEN PRINTED Signed: Executive Lead (Authorised Signatory)

2 CONTENTS Section Title Page Number 1. INTRODUCTION 3 2. AIMS AND OBJECTIVES 3 3. ROLES AND RESPONSIBILITIES 4 4. COMMUNICATION 4 5. INCIDENT REPORTING - THE ELECTRONIC IR NPSA INCIDENT DECISION TREE APPENDICES Appendix I Flow Chart 1 Incident Reporting Mechanism 11 Appendix II Form 2 Executive Summary of a Red Event 12 Appendix III Form 3 Incident Analysis Review Report 13 Appendix IV Examples of Tools for Incident Review 15 Appendix V Incident Decision Tree REFERENCES / BIBLIOGRAPHY NHS TAYSIDE POLICY APPROVAL CHECKLIST RAPID IMPACT CHECKLIST 20

3 1. Introduction ADVERSE INCIDENT MANAGEMENT POLICY (AIM) NHS Tayside recognises and accepts that it has legal and other requirements for managing all adverse events and near misses. The organisation seeks to establish a balance of proactive and reactive risk management processes to enable early identification of potential problems thus creating prevention cycles to enhance patient and staff safety. Many current incident reporting systems rely on data capture, recording trends, in particular events/near misses, followed by investigations to determine the cause or blame of particular incidents. While the focus of counting numbers is important, changes in practice will only occur where there are established systems to learn from adverse events/near misses to prevent them recurring. Emphasis on error prevention in healthcare is a National priority demonstrated in the publications; An Organisation with a Memory (Department of Health (DoH), 2000), Doing Less Harm (DoH, 2001) and Building a Safer NHS (DoH, 2001), Safety First: A Report for Patients, Clinicians and Healthcare Managers (DoH, 2006), Better Health, Better Care Action plan: What it Means for you (Scottish Government, 2008). These documents provide structure and direction for the development of local adverse events systems focused on learning. Research has been conducted in NHSScotland to establish a coherent framework for risk assessment. Following the consultation paper Learning from Experience: How to Improve Safety for Patients in Scotland (Scottish Executive, 2004) a framework document 1 has been published, by NHS Quality Improvement Scotland (NHS QIS) to address the key themes identified. Improving the safety of patients and staff in NHSScotland through incident reporting was highlighted as a priority within this publication. 1.1 Definitions The following definitions apply to this document: Individual/s refers to the person/s directly or indirectly involved in service provision, including employees, bank, locum or agency staff, contractors and volunteers. All health care staff are covered by this definition. The term adverse incident covers all incidents/near misses, events or circumstances arising during NHS service provision that could have or did lead to unexpected harm, loss or damage. Harm is defined as injury (physical or psychological), suffering, disability or death which was unexpected. Near Miss where no harm, loss or damage is caused but could have resulted in harm, loss or damage in other circumstances. 2. Aims and Objectives The NHS Tayside Adverse Incident Management (AIM) System covers all accidents, incidents and near misses which, either caused, or could have caused, injury to individuals or damage or loss to NHS Tayside property. This document sets out a policy framework to 1 NHS Quality Improvement Scotland (2006) Safer Today SaferTomorrow Patient Safety Review of Incident and Near Miss Reporting. NHS Quality Improvement Scotland.

4 report all adverse events and near misses within the organisation. Our aim in NHS Tayside is to minimise the risk of adverse events occurring and maximise our opportunities to learn. The primary purpose of our adverse incident management framework is to improve systems and practice and NOT to apportion blame. However, in the event of negligence, intended harm and professional mal-practice the reporting system will convert to a disciplinary procedure where appropriate. It is important to remember that Incident Reporting /Investigation are distinct from disciplinary procedures. The purpose of this is to encourage staff to recognise a just reporting culture as the bedrock for sustained changes in practice to improve patient care and services. This policy determines the reporting framework for all adverse events/near misses. The immediate impact of the event must be categorised as Red, Amber or Green and reported in accordance with the local organisational Incident Reporting Mechanism (see flow chart 1). 3. Roles and Responsibilities For further information on Individual roles and responsibilities please also refer to flowchart 1 at the rear of this policy where this information is defined. 4. Communication In the event of an incident involving a patient, the incident should be noted in the patient case record and in addition, an incident recorded in the Adverse Incident Management (AIM) System. On advice from the Central Legal Office staff must not file a paper copy of the incident in the patient case record. As Incident Reports are legal documents, they may be called in the event of a Legal Claim or Fatal Accident Inquiry. As such, it is imperative that all narrative is objective and factual. All information should normally be disclosed to the patient as soon as practical after the incident occurs. Prompt communication with the patient and/or relative following an incident promotes good relationships with patients and service providers (NPSA ). A full and frank explanation must be shared with the patient as soon as is practical. For particular patient groups, e.g. children, ventilated patients or vulnerable adults, this may not be possible. In these circumstances discussion with carer, guardian or relative is appropriate. In all other circumstances incidents should not be disclosed to the next of kin, carer or GP etc without the patient s consent. In the case of incidents involving patients who commit suicide, the Consultant is responsible for notifying NHS Quality Improvement Scotland (QIS). They are also responsible for requesting an Adverse Significant Incident (ASI) review through the Board Nurse Director. The Nurse Director is responsible for reporting the outcome of the review, if held, to NHS QIS. Mental Health Services Line Managers may also request an ASI where appropriate, this should be discussed with their Head of Service. It is expected that an incident be recorded in the AIM system to enable the process of Root Cause Analysis or Adverse Significant Incident Review to be instigated. For any other Mental Health Services related incident, the Consultant is responsible for notifying NHS Quality Improvement Scotland (QIS). They are also responsible for requesting an Adverse Significant Incident (ASI) review through the Board Nurse Director. The Nurse Director is responsible for reporting the outcome of the review, if held, to NHS QIS. In the case of sudden death through suicide or other causes, serious assault on patients, staff, visitors or suspected arson the line manager dealing with the incident should also notify the police. Child Protection incidents should be reported through the Adverse Incident Management (AIM) System and reference made in the patient case record where appropriate. The local manager (verifier) is responsible for ensuring that the Senior Nurse Child Protection in your

5 area of work is informed. The Senior Nurse Child Protection will then take any appropriate action to communicate the incident to other relevant agencies/individuals. For further advice/guidance please refer to the Senior Nurse Child Protection in your area of work. Where incidents also require to be reported to external bodies, the line manager is responsible for ensuring that a report is sent at the earliest appropriate opportunity. All adverse incidents involving health, social care, estates and facilities equipment including those from JELS must be recorded within the NHS Tayside Adverse Incident Management System as soon as possible but within 24 hours of occurrence. The Incident Report must highlight the type of equipment involved in the heading. All such incidents should be notified to the NHS Tayside Equipment Co-ordinator, who is the Head of Instrumentation in Medical Physics and include details of the AIM Incident Reference number. Equipment involved or suspected to have been involved in an incident must be removed from use if at all possible. It should be quarantined (secured out of use) along with any consumables and patients leads etc. In the interest of infection control all equipment and consumables should be bagged as appropriate and labelled with details of the incident. Settings on the equipment must not be altered and no attempt should be made to replicate the incident or diagnose a fault. It is essential to capture the equipment before it is put back into service or settings and other evidence lost. If the equipment is to be sent to Medical Physics : v v do attach an equipment repair requisition to the equipment, do note a summary of the incident on the requisition. Medical Physics are tasked with the review of all medical equipment related adverse incidents and their remit is to investigate what happened and ascertain if there is a fault in the equipment or use. Medical Physics are also responsible for escalating such incidents to Health Facilties Scotland (HFS), and the Medicines and Healthcare products Regulatory Agency (MHRA). This is necessary where an equipment fault may affect equipment out with NHS Tayside. External enquires regarding any incident must be referred to the Communications Manager in all instances. The Communications Manager and the relevant Executive Director will agree a response to media enquiries. The communication team provides communication support and advice across NHS Tayside to any emergency situation. This includes: Crisis Management Internal Communications Issuing of proactive Press Release Responding to and dealing with multiple media enquiries There is one telephone number for all calls including media calls The communications team also operate an out of hours rota to ensure cover 24 hours a day, 365 days a year. Out of hours anyone calling will be redirected to the on call Communications Manager. The switchboard at Ninewells Hospital will also hold out of hours contact numbers. Input from the communications team to all emergency situations will be under the direction of the Head of Corporate Communications.

6 In the instance of an incident where an incident control team is established, a member of the communications team will attend all incident control team meetings. Members of the communications team will always be in a position to respond to any incident and provide support and advice regarding the communication channels to use to ensure the right message gets to the right people at the right time. 5. Incident Reporting - The Electronic Adverse Incident Management System (AIM) The Electronic AIM will record the following: Minimum Data Set What happened? Near miss or actual adverse event Consequence calculation (What is the impact of this event? Red, Amber or Green. This is the actual consequences and not the potential consequences. This grade will give guidance regarding reporting arrangements (see flow chart 1). The Red, Amber and Green selection will enable forward reporting (see flow chart 1). Location. How it happened? Immediate or proximal causes. Why did it happen? Underlying causes. What action was taken/proposed? (Immediate and longer term). What impact did the event have? (Harm to the organisation, the patient /others). What factors did or could have minimised the event? Is this event likely to recur? (Red, Amber or Green risk). Once the electronic IR1 form is complete within the AIM system, consider: How significant was this incident and how quickly should the incident be reported and shared to prevent further harm? Grading The Harm Caused In This Adverse Event/ Near Miss What has happened and what is the impact? Check Table 1 and determine the severity of the incident/near miss. Choose a score from 1-5 to describe the harm caused i.e 1=Negligible, 5=Catastrophic and report forward (see flow chart 2) accordingly. This can also be described as a Red, Amber or Green Event. Near misses will always be graded Category Green Green Green Amber Red Red

7 Table 1 Consequence Score Impact Score 1 Green 2 Green 3 Amber 4 Red 5 Red Descriptor Negligible Minor Moderate Major Catastrophi c CONSEQUENCES Objectives Cost Physical Harm People Affected Minimal Impact No service disruption Minor impact on service provision Service objectives partially achievable Over 3 day lost time RIDDOR incident Significant impact on service provision Unable to function inability to fulfil corporate obligations Minimal financial loss, < 10k Moderate financial loss 10-50k Significant financial loss k Major financial loss 100k-1M Severe financial loss> 1M No obvious harm/ injury First aid treatment Nonpermanent harm up to 1 month Medical treatment required Semi - permanent harm up to 1 year. Extensive Injury Major permanent harm. None Death >50 Schedule Minimal Increased level of care /length of stay1-7 days Increased level of care /length of stay 8-15 days Pressure on service provision Increased level of care /length of stay >15 days Temporary service closure Extended service closure Reputation No interest to the press Internal Some public embarrassment No damage to reputation or standing in the community Local adverse public embarrassment leading to limited damage Local MP interest or ME Legal implications National adverse publicity major loss of confidence in organisation Highly Damaging International adverse publicity severe loss of public confidence Court Enforcement Public Accounts Committee Enquiry Could This Event Recur? Following the initial impact consider if this event were to happen again how frequently do you believe it will happen (likelihood) and what could the outcome be (consequence). Consider Tables 1, 2 and 3. The risk of recurrence will result in a Potential Risk Exposure Rating (see Table 3) of red, amber or green which will also help to identify those events which have not caused harm but potentially could in the future. For example, a near miss event which has had minor consequences this time (GREEN) may have a significantly more serious outcome should the event recur. Re-evaluation of this event with a potentially more serious outcome will result in a RED risk exposure rating requiring a detailed risk control plan. According to the grade, these events may require an incident review to prevent recurrence. The information gained from near miss review will be shared across the organisation through the Clinical Governance/Risk Management structures.

8 Likelihood Score Table 2 Likelihood Score 5 Almost certain Will undoubtedly recur, possibly frequently Daily, weekly, monthly 4 Probable Could occur several times Quarterly 3 Possible May occur occasionally Annually 2 Unusual Not expected to happen but might 2-5 years 1 Remote Can t believe this event would ever happen 5-10 years Table 3 Potential Risk Exposure Rating Potential Consequences/Severity Likelihood Negligible 1 Minor 2 Moderate 3 Major 4 Catastrophic 5 Colour Rate Colour Rate Colour Rate Colour Rate Colour Rate Almost Certain 5 Amber 5 Amber 10 Red 15 Red 20 Red 25 Probable 4 Green 4 Amber 8 Red 12 Red 16 Red 20 Possible 3 Green 3 Amber 6 Amber 9 Red 12 Red 15 Unusual 2 Green 2 Green 4 Amber 6 Amber 8 Amber 10 Remote 1 Green 1 Green 2 Green 3 Green 4 Amber 5 The level of incident review and analysis required for actual events should not be solely dependent upon the incident grading but must include consideration of the Potential Risk Exposure Rating for both Adverse Events and Near Misses. Flow Process Of Information Complete the electronic Incident Reporting E-Form within the AIM system as directed by the AIM training manuals as soon as possible but within 24 hours. The incident e-form must be sent in the first instance to the immediate line manager. The line manager will verify incidents within 72 hours of receipt where practicable, manage and report the adverse event in accordance with the grade and type of incident/near miss within 72 hours. Discussion with colleagues may be necessary to confirm the type, grade and impact of the adverse event /near miss. Managers must escalate all incidents verified as having an initial impact as red to the appropriate member of the Executive Team within 24 hours of verification. Managers must report follow-up action regarding particular incidents/near misses as considered appropriate. However, managers can escalate any incident they feel is appropriate to the attention of the Executive Team. Consequence Of Adverse Event/ Near Miss Forward Reporting (Flow Chart 1) Category Red In Hours Person reporting incident must contact line manager immediately. Line Manager will inform appropriate Executive Director(s). Line Manager to manage and begin incident review. Line Manager to complete Executive Summary of a Red Event to Executive Team (See Form 2) immediately Identify named individual(s) to undertake incident review. Incident Review Report (see Form 3) to be completed within 4 weeks.

9 Ensure Risk Control Plan is generated where appropriate Inform Safety, Governance and Risk Department who will forward follow up reports from all red incidents to Adverse Incident Management (AIM) Group and Delivery Unit Risk/Health and Safety Management Group. Category Red - Out of Hours Out with working hours the line manager should notify the on call Communications Manager by calling the communications department on or via the Ninewells Hospital switchboard on The Communications Manager will decide whether the Chief Executive/Chief Operating Officer and others, inclusive of Executive Director(s) on call should be notified of the incident immediately. Within Secondary Care if the incident/near miss occurs out of hours the Duty Manager On Call can be contacted for further advice and support. Category Amber Line Manager instigate incident review, where appropriate and complete Incident Review Report (Form 3) within 4 weeks. Remedial action must be taken and the Clinical Group/Departmental Manager must be notified of the outcome. Category Green Near misses will always be graded category green. Trends, Clusters of incidents/near misses may require a more in-depth review decision made by verifier. Incident/Near Miss Review Incident review for all red and amber incidents should consider the following Determination of the human and other factors most directly associated with the event, and the processes and systems related to its occurrence Analysis of the underlying systems and processes through a series of why questions to determine where redesign might reduce the risk Identification of the risks points and their potential contribution to the event Determination of potential improvements in processes or systems that would reduce the likelihood of such events in the future must be reported formally within a designated timescale Formal recommendations for change must have action and monitoring plans in order that the information is shared throughout organisation. Example of tools which can be utilised during the incident review process are provided in Appendix IV. In addition, support from the Safety, Governance and Risk Team and Members of the AIM Group is available to assist in the review of any incident. Feedback As demonstrated in flow chart 1, feedback to frontline staff is a key element of the Incident Reporting Mechanism. All clinical groups have a Clinical governance structure which should be used as a forum for discussing adverse events and sharing learning.

10 National Patient Safety Agency s (NPSA) Incident Decision Tree The Incident Decision Tree 2 (click to launch Incident Decision Tree) is a key component of the National Patient Safety Agency s (NPSA 2 ) drive to help the NHS move away from asking Who was to blame? to Why did the individual act in this way? when things go wrong. This tool has been utilised to aid the decision making to determine whether or not the incident was deliberate harm or malpractice and thus handled via a disciplinary route, or unintended harm or system error and thus handles via the Incident Reporting Mechanism. The Incident Decision Tree is a web-based tool and is simple to use. Depending on the nature of the incident and the amount of information gathered, it usually takes 30 to 60 minutes to work through. It helps NHS managers and senior clinicians decide initial action to take with staff involved in a patient safety incident. It is intended to promote a consistent and fair approach, avoiding unnecessary and costly suspensions and exclusions. How the Incident Decision Tree works The Incident Decision Tree is based on a flowchart (appendix v), and takes you through a series of structured questions about the individual's actions, motives and behaviour at the time of the incident. These questions move through four sequential 'tests': the Deliberate Harm Test; the Physical/Mental Health Test; the Foresight Test; the Substitution Test. In the majority of cases system failure turns out to be the cause of the incident. Summary The NHS Tayside Adverse Incident Management Policy aims to provide clarity around the systems and processes in existance to report, investigate and share learning from adverse events. The Safety, Governance and Risk Department may be contacted for further advice or guidance on any of the issues discussed above. 2 National Patient Safety Agency Incident Decision Tree: (April 2009)

11 APPENDIX I - FLOW CHART 1 Adaptation of Incident Reporting Mechanism from Doing Less Harm Version 1.0a(August 2001)pg 11 Incident Staff Response Line Manager External reporting requirements Safety, Governance and Risk Internal Organisation Department ❶ ❷ ❸ ❹ ❺ ❾ Adverse Incident Manage and report the incident and inform immediate line manager as soon as possible but within 24 hours. Learn lessons change practice improve safety and quality of care ❽ Check and verify Grade and type of incident including actual impact and potential risk and determine additional reporting requirements within 72 hours Chief Exec /Chief Operating Officer Feedback to Local Staff ❻ ❼ Category Red Category Amber Category Green Review /analyse as appropriate Fast track information on serious incidents internally to appropriate Executive Director/Communications Team within 24 hours of verification Use Incident Review analysis for Red and Amber incidents within 4 weeks and trend analysis for green Report externally as required Report internally Learn and disseminate lessons from local and wider experience implement and monitor improvement strategies Agency: (examples) NHS QIS HSE MHRA NPSA Confidential Enquiries Procurator Fiscal Mental Welfare Commission SHS Professional bodies NMC GMC Public Health Scottish Government NHSiS Two monthly progress reports to AIM Group and DU R/H&S Group Lead Adverse Incident Management Group meetings Two monthly Produce getting It Right Newsletter for all staff - quarterly Produce Risk Alerts as required

12 APPENDIX II - FORM 2 Event (include date of event) Location EXECUTIVE SUMMARY OF A RED EVENT Incident Grade Score 1 5 Recurrence Red / Amber / Green What was the actual and potential impact of the event How did it happen Why did it happen What initial action was taken or proposed What factors could have minimised or did minimise the event? Persons informed: Name: No Exec Director / Service Manager Risk Management Department (Mandatory) Specialist Adviser i.e. Pharmacist, Heath & Safety, Medical Physics etc Chief Executive Local Contacts: Clinical Group/Dept Manager Clinical Team Leader Clinical Team Manager/Supervisor Lead Consultant For Care Person identified to lead Root Cause Analysis review Date Manager s Signature

13 APPENDIX III - FORM 3 INCIDENT REVIEW REPORT 1. Introduction (include date of event) 2. Contributors 3. Details the facilitation tools used in the review 4. Provide a factual account of the incident and its consequences 5. Identify the human and system factors which contributed to the adverse event. Good Practice Areas for Improvement Patient Individual Task Equipment Team and Social Skills Working Conditions Communication

14 6. Was the event avoidable? No 7. Give details of improvements to be made to reduce risk of event recurring By When? By Whom? 8. Give details of how the learning (including good practice) will be shared across the organisation 9. Give details of how improvements will be communicated to the patient, carer/significant other. Report led by: Name Designation Location Persons Notified: Date:

15 APPENDIX IV EXAMPLE OF TABULAR TIMELINE TEMPLATE Event date and time Event Supplementary Information Good Practice Care Delivery/Service Delivery Problem Additional Information Required Areas for Improvement

16

17 APPENDIX V

18 REFERENCES AND BIBLIOGRAPHY Department of Health, An Organisation With a Memory. Crown Copyright: London Department of Health, Doing Less Harm. Crown Copyright: London Department of Health, Building a Safer NHS. Crown Copyright: London Department of Health, Safety First: A Report for Patients, Clinicians and Healthcare Managers. Crown Copyright: London Dineen M Six Steps to Root Cause Analysis. Consequence: Oxford (accessed December 2009). Harvard Hospitals When Things Go Wrong Responding to Adverse Events. Massachusetts Coalition: MA. Available at (accessed December 2009) Institute for Healthcare Improvement Website (accessed December 2009) National Patient Safety Agency Seven Steps to Patient Safety (accessed December 2009). National Patient Safety Agency Root Cause Analysis Toolkit. (accessed December 2009). National Patient Safety Agency Being open. Communicating patient safety incidents with patients and their carers. (accessed December 2009). National Patient Safety Agency Incident Decision Tree: (accessed December 2009) NHS Quality Improvement Scotland Clinical Governance and Risk Management national Standards - Clinical Governance and Risk Management: Achieving Safer, effective, patient-focused care and services. Available online (accessed December 2009) NHS Quality Improvement Scotland (2006) Safer Today Safer tomorrow Patient Safety Review of Incident and Near Miss Reporting. NHS Quality Improvement Scotland. (accessed December 2009) Safer Healthcare Website - (accessed December 2009) Scottish Government (2008) - Better Health, Better Care Action plan: What it Means for you. February, ISBN: Standards Australia International Limited and Standards New Zealand Risk Management. Sydney: Standards Australia International Limited and Standards New Zealand. AS/NZS 4360:2004 Standards Australia International Limited and Standards New Zealand, Guidelines for managing risk in the Healthcare sector. Sydney: Standards Australia International Limited and Standards New Zealand HB228:2001

19 NHS TAYSIDE - POLICY APPROVAL CHECKLIST This checklist must be completed and forwarded with policy to the appropriate forum/committee for approval. POLICY AREA: Risk Management POLICY TITLE: Adverse Incident Management (AIM) LEAD OFFICER Patricia O Connor, Head of Governance Safety and Risk Why has this policy been developed? Has the policy been developed in accordance with or related to legislation? Please give details of applicable legislation. Has a risk control plan been developed? Who is the owner of the risk? Who has been involved/consulted in the development of the policy? Has The policy been assessed for Equality and diversity in relation to:- To advise staff on the arrangements within the organisation for incident reporting and incident management. No but developed to conform with Scottish Executive Recommendations & NHS QIS Clinical Governance & Risk Management Standards. Head of Governance Safety & Risk AIM Group Has the policy been assessed For Equality and Diversity not to disadvantage the following groups:- Race/Ethnicity Gender Age Religion/Faith Disability Sexual Orientation Does the policy contain evidence of the Equality & Diversity Impact Assessment Process? Is there an implementation plan? Minority Ethnic Communities (includes Gypsy/Travellers, Refugees & Asylum Seekers) Women and Men Religious & Faith Groups Disabled People Children and Young People Lesbian, Gay, Bisexual & Transgender Community YES YES Which officers are responsible for implementation? Risk Management Department/Local Managers When will the policy take effect? Has been in effect from 30 th November 2002 Who must comply with the policy? How will they be informed of their responsibilities? Is any training required? If yes, has any been arranged? Are there any cost implications? If yes, please detail costs and note source of funding Who is responsible for auditing the implementation of the policy? What is the audit interval? Who will receive the audit reports? When will the policy be reviewed and by whom? (please give designation) All Staff Circulated through Executive Team and Strategic Management Group YES YES NO Not Applicable Risk Management Department/Adverse Incident Management Group Annual Adverse Incident Management Group and Risk Management Groups March 2008 by Head of Governance, Safety & Risk Name: Patricia O Connor Date: March 2007

20 1. Rapid Impact Checklist (RIC) Each policy must include a completed and signed template of assessment Page 1 of 2 Which groups of the population do you think will be affected by this proposal? minority ethnic people (incl. gypsy/travellers, refugees & asylum seekers) women and men people in religious/faith groups disabled people older people, children and young people lesbian, gay, bisexual and transgender people N.B. The word proposal is used below as shorthand for any policy, procedure, strategy or proposal that might be assessed. What impact will the proposal have on lifestyles? For example, will the changes affect: Diet and nutrition? Exercise and physical activity? Substance use: tobacco, alcohol or drugs? Risk taking behaviour? Education and learning, or skills? Will the proposal have any impact on the social environment? Things that might be affected include Social status Employment (paid or unpaid) Social/family support Stress Income Will the proposal have any impact on Discrimination? Equality of opportunity? Relations between groups? Will the proposal have an impact on the physical environment? For example, will there be impacts on: Living conditions? Working conditions? Accidental injuries or public safety? Transmission of infectious disease? Will the proposal affect access to and experience of services? For example, Health care Transport Social services Housing services Education people of low income Other Groups: ALL GROUPS people with mental health problems homeless people people involved in criminal justice system staff What positive and negative impacts do you think there may be? Which groups will be affected by these impacts? Risk Taking behaviour will be positively effected. By analysing risks, near misses and incidents looking at potential risk exposure ratings and the Incident Review process, learning from experience can take place and shared throughout NHS Tayside. This will in-turn will have a positive impact on the safety of patients and staff. The Incident Review process is designed to be a positive experience for all concerned, thereby reducing stress caused by incidents or near misses. No Impact Positive impact, as reporting of incidents, incident review and learning from experience will promote a safer physical environment for staff and patients. No

21 Rapid Impact Checklist (RIC): Summary Sheet Each policy must include a completed and signed template of assessment 1. Positive Impacts (Note the groups affected) 2. Negative Impacts (Note the groups affected) All groups will experience a positive impact: Risk Taking behaviour will be positively effected. By analysing risks, near misses and incidents looking at potential risk exposure ratings and the Incident Review process, learning from experience can take place and shared throughout NHS Tayside. This will in-turn will have a positive impact on the safety of patients and staff. None identified. AIM Policy provides all groups with guidance on incident reporting. The Incident Review process is designed to be a positive experience for all concerned, thereby reducing stress caused by incidents or near misses Reporting of incidents, incident review and learning from experience will promote a safer physical environment for staff and patients. None 3. Additional Information and Evidence Required None 4. Recommendations 5. From the outcome of the RIC, have negative impacts been identified for race or other equality groups? Has a full EQIA process been recommended? If not, why not? Not recommended as no adverse impacts identified. Manager s Signature: Arlene Napier, Acting Head of Safety, Governance and Risk Date: March 2008