Service users and members of the public expect to be safe when using health and mental health services. When the delivery of care falls below an acceptable standard and leads to a patient safety incident and or harm, people are entitled to openness. They are entitled to ask why an event has happened and to be assured that measures have been taken to protect them and others from similar harm in the future. Services must have effective systems in place to understand what went wrong, why it went wrong and what can be done to lessen the likelihood of a similar incident happening again.
The National Standards for the Conduct of Reviews of Patient Safety Incidents are divided into five broad themes: Theme 1: Governance and Accountability.Theme 2: Person-centred Approach to the Review of Patient Safety Incidents. Theme 3: Workforce. Theme 4: Reviews of Patient Safety Incidents. Theme 5: Sharing the Learning for Improvement.Read Full Article