Critical incident management

Question 1

Definition

Answer 1

Critical Incident means an event which may cause or is likely to cause extreme physical and /or emotional distress to staff, patients and other workers or visitors to the hospital and which may be regarded as outside the normal range of experience of the people affected

Question 2

Possible consequences of CI

Answer 2

 May not necessarily require an initial emergency response;
 May significantly disrupt the operations of the hospital and impact on and/or
 May have the potential to bring the hospital into disrepute; and/or
 May impact on a number of areas of the hospital

Question 3

Examples of events which may be deemed critical incidents include

Answer 3

 Any fatality, near fatality or incident likely to affect seriously a number of staff and/or patients;
 Serious traffic accidents e.g. an accident during a patient outing field;
 Murder or suicide involving patients/staff and their family members;
 Fire, explosion, bomb threat;
 Chemical, radiation or bio-hazard spillage;
 Hold-up or attempted robbery;
 Threats or acts of violence to staff/patients;
 Storms/natural disasters that cause major damage;
 Major failure in internal processes;
 Interruption to utilities (e.g. electricity, water) for an extended period; and

Question 4

Roles and responsibilities of line managers/supervisors

Answer 4

Line Managers/Supervisors are responsible for:
 Implementation of this procedure within their area of responsibility
 Identifying potentially critical incident circumstances, assessing and controlling of critical incident risks effectively
 Implementing, monitoring and maintaining risk control measures for critical or potentially critical incidents in their areas of responsibility
 Regularly monitoring the effectiveness of critical incident risk control measures and rectify any deviations from procedures
 Consulting with employees on critical incident practices or any proposed changes
 Ensuring employees are trained and competent in how to behave during a critical incident
 Ensuring the well-being of employees following a critical incident

Question 5

Roles and responsibilities of employees

Answer 5

Employees are responsible for:
 Not placing themselves or others at risk of injury
 Reporting to line management any critical or potentially critical incident and any significant symptoms which may have resulted from a critical incident
 Assisting Line Managers with the identification of hazards, the assessment of risks and implementation of risk control measures related to critical incidents
 Following established critical incident procedures availing themselves of the support mechanisms in the event of exposure to critical incidents

Question 6

Critical incident phases

Answer 6

Critical Incident Phases means: the various management phases of critical incidents. The following critical incident phases are identified:
Phase 1 – Immediate Response to a Critical Incident
Phase 2 – Crisis Management during a Critical Incident
Phase 3 – Recovery from a Critical Incident
Phase 4 – Evaluation and Critical Incident Review.
Candidates are expected to show an appreciation of the wider issues, such as whether this incident represents a “one – off” or is part of a pattern of incidents. Whether there are issues with the ward environment, staffing, pharmacological management, management of aggression, management of substance abuse. Candidates should recognise the need to have a coordinated response to staff that may incorporate education or review of policy and procedures

Question 7

Initial management plan overview- registrar assaulted by patient

Answer 7

1) the registrar - ensures his wellbeing, including immediate medical care, access to debriefing, discussion of time off, 2). the patient - mental state assessment, appropriate risk management and review of treatment and the ward, 3) any other patients or staff members involved - assessing whether they need attention. Informs the service or unit clinical director

recognising the need for a critical incident review process, including conducting a team review and root cause analysis, reporting to the critical incident review committee. Can describe the principles pertaining to the review process. Reviewing ward procedures including registrars seeing patients alone, access to alarms.

Question 8

Important questions to ask

Answer 8

answering the following
questions about each patient safety incident:
• What happened?
• How and why it happened?
• What can be done to reduce the likelihood of recurrence and make care safer?
• What was learned?
• How can the learning be shared?

Question 9

Incident analysis as part of the incident management continuum.

Answer 9

BEFORE THE INCIDENT
Ensure leadership support.
Cultivate a safe and just culture.
Understand essential principles
and concepts.

IMMEDIATE RESPONSE
Care for and support patient
/family/clinicians/others.
Report incident.
Secure items. Begin disclosure
process. Reduce risk of
imminent recurrence

PREPARE FOR ANALYSIS
Preliminary assessment.
Select an analysis
method. Identify the team.
Coordinate meetings.
Plan for/conduct
interviews.

ANALYSIS PROCESS
Understand what happened.
Determine how and why it
happened. Develop and
manage recommended
actions.

FOLLOW THROUGH
Implement recommended
actions. Monitor and assess
the effectiveness of actions.

CLOSE THE LOOP
Share what was learned
(internally and externally).

Question 10

Key features of incident analysis:

Answer 10

Timely—beginning as soon as possible after the incident.
• Inter-disciplinary, involving experts from the frontline services, patient or family, and non-clinical
staff where applicable (e.g. clerical, cleaning, maintenance staff).
• Objective and impartial.

Question 11

To be thorough, an incident analysis must include: (

Answer 11

• Detailed description of the incident being analysed.
• Analysis of underlying systems through a series of ‘how’, ‘why’ and ‘what influenced this’
questions, in order to determine contributing factors (those under control of the organisation,
as well as those that are not) and their relationship (connection points) to other contributing factors.
• Formalised recommended actions related to improvements in processes or systems.
• Follow-through to identify and share learning.

Question 12

To be credible, an incident analysis must include

Answer 12

• Participation from the patient/family/carer and clinicians or staff associated with the incident
(if they are able to contribute).
• Participation by the leadership of the organisation, as well as those most closely involved in the
care processes related to the incident.
• Consideration of relevant literature and other sources of information (e.g. reporting systems
and internal alerts, information from external experts in the analysed process).
• Creation of an evaluation plan to assess implementation of recommended actions and impact
achieved (if any).

Question 13

When unexpected situations occur, patients need the healthcare system and their clinicians to:

Answer 13

1. Explain what unexpected event or change happened.
2. Apologise that it happened.
3. Help the patient/family/carer understand how and why it happened.
4. Explain what will happen next and follow through with commitments made.
5. Include the patient/family/carer in the analysis process, enabling the patient/family to contribute
   what they know from their perspective.

Question 14

System levels

Answer 14

• Micro—the point where the care clinicians interact with the patient (e.g. clinical team or service area
that provides care).
• Meso—the level responsible for service areas/clinical programs providing care for a similar group
of patients, typically part of a larger organisation (e.g. a home care or a cardiac care program).
• Macro—the highest (strategic) level of the system, an umbrella including all intersecting areas,
departments, clinicians and staff (e.g. boards, healthcare network, integrated health system
or region that includes several organisations).
• Mega (external)—the level outside the organisational boundaries that influences the behaviour
or more than one system. The different sectors of healthcare such as regulatory bodies, licensing
organisations, professional groups, liability protection providers, state and federal governments,
national patient safety and quality organisations, the healthcare industry and the community
all fall into this category.

Question 15

Components of open disclosure

Answer 15

Open disclosure is comprised of two components: clinician disclosure (CD) and formal open
disclosure (FOD).
Clinician disclosure is defined as an informal process where the treating clinician informs the patient/
family/carer of what has occurred, and apologises for the harm caused or adverse outcome. In general, it
is used for the initial disclosure after the incident and may be all that is required for less serious events.
Formal open disclosure (FOD) is the structured process to ensure communication between the patient/
family/carer, senior clinician and the organisation in response to the most serious clinical incidents.
To enable this process, an open disclosure team involving members of the treating team and the
organisation executive is activated prior to the meeting with the patient/family/carer. A senior clinician
who is not part of the treating team and trained as an open disclosure consultant (ODC) leads this
team through the FOD process. FOD involves multidisciplinary discussions that support clinical
incident management processes and provides a format that facilitates and enables open
communication between patients, families, carers, clinicians, senior clinical leaders and
hospital executives.

Question 16

SAC 1 incudent

Answer 16

Death or likely permanent harm which is not reasonably expected1
as an outcome of healthcare

Question 17

SAC 2

Answer 17

Temporary harm which is
not reasonably expected as
an outcome of healthcare

Question 18

SAC 3

Answer 18

inimal or no harm
which is not reasonably
expected as an outcome of
healthcare.
In

Question 19

SAC 4

Answer 19

No harm or near miss.