1255 / Incident Reporting System - initial testing

ITALY
Classification of the PSP
Type of Patient Safety Practice Not Evaluated
 
Clinical Risk Management Practice (CRMP)
Related practices from PaSQ database
"Best fit" category of the reported practice
Assessment of risk and harm
Identification of risk and harm There is no specified text here
Topic of the reported practice
Incident reporting and learning system
Aim and the benefit of the Patient Safety Practice
 
The main objective of the approach herein described is to better understand the organization, in particular, to identify the factors that can contribute to the occurrence of adverse events
Description of the Patient Safety Practice
 
In the University Hospital of Sassari Incident Reporting system has been proposed and then tested for six months in 6 units: General Surgery, Urology, Pneumology, Infectious Disease, Gynecology, Pediatrics. The reporting form used for the test is composed of two pages and collects data according to the following scheme: 1) Unit 2) the professional who fills in the report (physician, nurse, physical therapist, etc.); 3) circumstances of the event: date and place; 4) type of event; 5) description of the event; 6) possible factors that contributed to its occurrence (the patient's condition, problems among staff, problems related to environment or organization; 7) the severity of consequences for the patient. In each unit, whenever there is an adverse event / incident or near miss, the professional can fill in the reporting form anonymously. This will be put into the reporting box each unit has. The Risk Management Service of the institution forward the report to an ad hoc system for data collection so as to be able to analyze the reports received, analyze data and classify cases according to their severity and the chances they could happen again. In cases of particular importance , the risk management services, once gathered all the necessary information about the case, organize an audit to identify the causes of the event and the actions to take to prevent it. During and at the end of the testing phase, the business group carries out an analysis on the reports received, so as to identify the causes of adverse events or near-miss and define possible improvement interventions. At the end of the testing the results, including any improvement actions and organizational solution identified, will be presented.
Attachment of relevant written information and/or photos, as appropriate
There is no specified text here
There is no specified text here
There is no specified text here
There is no specified text here
Effectiveness of the Patient Safety Practice
 
Degree of implementation of reported practice
Yes, partly
Level of implementation of reported practice
Unit or ward level
Specific and measurable outcome for the reported practice were defined
Yes
A baseline measurement before implementation of the reported practice was obtained
No
A measurement after full implementation of the reported practice was obtained
No
Evaluation of a "positive" effect of the reported practice on Patient Safety
Effect not known or the intervention has not yet been evaluated
Type of before-and after evaluation
There is no specified text here
Enclosure of a reference or attachment in case of published evaluation's results
There is no specified text here
There is no specified text here
Health care context where the Patient Safety Practices was implemented
 
Hospital
Transferability
 
Successful implementation of this Patient Safety Practice in other health care settings than above stated
No
Specification of implementation in another health care setting(s)
There is no specified text here
Successful implementation's level  of this Patient Safety Practice across settings
There is no specified text here
Involved health care staff
 
Physicians
Nurses
Clinical manager
Quality manager
Risk manager
Patient Involvement
 
Direct service user's involvement as integral part of this Patient Safety Practice
No
Specification of the service users or their representatives' involvement in the implementation of this Patient Safety Practice
There is no specified text here
Point of time in which service user or their reprasentatives' involvement takes place
There is no specified text here
Active seeking of service users' opinion, feedback, experience, etc. as integral part of this Patient Safety Practice
There is no specified text here
Short description of the service users' level of involvement
There is no specified text here
Public accessibility of information regarding this Patient Safety Practice to patients and citizens/service users
Yes
List of sources where public information is accessible
http://buonepratiche.agenas.it/questionnaire.aspx?id=5327
Implementation of the Patient Safety Practice
 
Existing collaboration with other countries or international organisations related to implementation of this Patient Safety Practice
No
Problems encountering in the implememntation course of this Patient Safety Practice like lack of motivation, no management support, etc.
Yes
List of the most prevelent difficulties encuntered during implementation of this Patient Safety Practice
No motivation among staff
List of the most prevalent drivers for a successful implemetation of this Patient Safety Practice
There is no specified text here
Use of any specific incentives to enhance motivation while implementing this Patient Safety Practice
No
Description of used incentives, if any.
There is no specified text here
Existence of support or approval by the clinical or hospital management or any other hihg level authority in the implementation process of this Patient Safety Practice
Yes
Costs of the Patient Safety Practices
 
Completion of cost calculation related to this Patient Safety Practice
No
Total number of person days required to implement this Patient Safety Practice
Clinical staff: There is no specified text here
External consultants: There is no specified text here
Support staff: There is no specified text here
Managerial staff: There is no specified text here
Others: There is no specified text here
Not relevant: There is no specified text here
Total number of person days required for training as preparation for implementation of this Patient Safety Practice
Clinical staff: There is no specified text here
External consultants: There is no specified text here
Support staff: There is no specified text here
Managerial staff: There is no specified text here
Others: There is no specified text here
Not relevant: There is no specified text here
Total cost in Euro of specific equipment (machines, software, communications supplies, etc.) needed to support implementation of this Patient Safety Practice
There is no specified text here
Associated cost with a work reduction or foregoing in order to deliver this Patient Safety Practice
There is no specified text here
Contact information
 
Name: Dott.ssa A. Virdis; Dott. R. Foddanu; Dott. ssa E.Mara;
Country: ITALY
Organisation: AOU SASSARI
E-mail: a.virdis@aousassari.it
Phone: There is no specified text here
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