Patient safety incident reporting continues to improve

Patient safety incident reporting continues to improve


NHS England today welcomed the publication of six-monthly data on patient safety incidents reported to the National Reporting and Learning System (NRLS) between 1 October 2013 and 30 April 2014. The data shows the NHS is continuing to get better at recognising and reporting patient safety incidents.

Acute hospitals, mental health services, community trusts, ambulance services and primary care organisations report incidents to the NRLS where any patient could have been harmed or has suffered any level of harm. The data published today sees an increase of 12.8% in the number of incidents reported compared to the same six month period in the previous year. This increase shows the NHS is continuing to be more open and transparent around the reporting of patient safety incidents.

The reporting of incidents to a national central system helps protect patients from avoidable harm by increasing opportunities to learn from mistakes and where things go wrong. The NHS uses these reports to identify and take action to prevent emerging patterns of incidents on a national level via patient safety alerts. These alerts are a crucial part of the NHS’ work to rapidly alert the healthcare system to risks and to provide guidance on preventing potential incidents that may lead to avoidable harm or death.

Incident reporting is also important at a local level as it supports clinicians to learn about why patient safety incidents happen within their own service and organisation, and what they can do to keep their patients safe from avoidable harm.

Data published today on the NRLS website shows that:
In the six months from October 2013 to March 2014, 778,460 incidents in England were reported to the system – 12.8% more than in the same period in the previous year.
Of those reported, 69.1% were reported as causing no harm. 24.8% were reported as causing low harm, meaning the patient required only increased observation or minor treatment as a result of the incident.
5.5% were recorded as causing moderate harm, meaning that the patient suffered significant but not permanent harm, requiring increased treatment.
The proportion of incidents resulting in severe harm or death remains less than 1% of all incidents reported, with the percentage resulting in death at 0.24%, down from 0.26% reported for the same period in the previous year.
The top four most commonly reported types of incident have remained the same: patient accidents (20.9%), implementation of care and ongoing monitoring/review incidents (11.4%), treatment/procedure incidents (11.3%), and medication incidents (10.7%).

Clinicians in NHS England review all incidents resulting in severe harm and death, and have observed that the accuracy in coding of these incidents is improving, further demonstrating increased engagement with the importance of reporting and learning from patient safety incidents. NHS Commissioning