Activity 5.1: Critical thinking

Read the critical thinking scenarios in chapter 5 and categorise what sort of incident has occurred and grade the incident in terms of harm. What are the lessons to be learnt?

  • Prevented patient safety incident; harm was none

Although the nurse undoubtedly felt under pressure this is a patient safety incident as the patient’s safety was at risk. This was a prevented incident as although the ward was short of staff the nurse’s actions prevented harm from occurring. It is graded as ‘no harm’ because no harm was apparent at the time. Although staff shortages do commonly occur it is important to report them as themes and hotspots can be identified and should something come to light later there is evidence that the ward was at risk at that time.

  • Staff incident level; harm minor

This is a staffing incident as the scenario indicates the Staff nurse came to non-permanent harm. As she was off for over 7 days as a result of an accident at work this was also would also be reportable according to Reporting of Injuries, Diseases and Dangerous Occurrences Regulations (RIDDOR). This is not a patient safety incident and should not be recorded as death as the patient death was due to natural causes rather than as direct result of care / treatment given.

  • Patient safety incident; major

This incident will require a full investigation including site visit, staff statements and interviews; the patient would also be successful if he decided to make a claim. The refusal of staff to assist the patient would be reported to safeguarding and there would likely be disciplinary action.