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ACTIONS AFTER A CLINICAL INCIDENT
The General Medical Council clearly sets out the responsibilities of a doctor in responding to clinical incidents in the Good Medical Practice document (https://www.gmc-uk.org/ethical-guidance/ethical-guidance-for-doctors/good-medical-practice)
23. To help keep patients safe you must:
a. contribute to confidential inquiries
b. contribute to adverse event recognition
24. You must promote and encourage a culture that allows all staff to raise concerns openly and safely
25. You must take prompt action if you think that patient safety, dignity, or comfort is or may be seriously compromised.
71. You must be honest and trustworthy when writing reports, and when completing or signing forms, reports, and other documents. You must make sure that any documents you write, or sign are not false or misleading.
a. You must take reasonable steps to check the information is correct.
b. You must not deliberately leave out relevant information.
Writing about the incident:
Most doctors will have at least one claim against them during their practising lives. Documenting consultations thoroughly is essential. Keep records of any specific test or examination carried out – ‘whatever is not written has not happened’ is a good safety motto. You will need to write different types of account for different purposes - the factual account you write for the investigation will differ from the more reflective and personal account you write for your portfolio. Write up a draft as soon as possible.
Checklist for writing an account
Finally, check your statement carefully before you submit it. Keep a copy of your final statement in case you are called to give evidence at a hearing or tribunal.
Talking about the incident:
The GMC provides clear guidance on the principle of confidentiality (https://www.gmc-uk.org/ethical-guidance/ethical-guidance-for-doctors/confidentiality) however, talking about the incident is essential to the progress of investigation and, with appropriate people, talking about it can offer you support.
- Talk with others who witnessed or were involved with the incident
- Participate in the debriefing process when the clinical team talk about the incident in order to maximise your learning from the incident
- Discuss the incident with your educational and clinical supervisors
- Talk to the patient and the family in order for them to understand what happened (this is likely to be undertaken by a senior clinician in the team) (https://www.cqc.org.uk/guidance-providers/regulations-enforcement/regulation-20-duty-candour
- Discuss the incident with your indemnity organisation (see Section 6). Contacting your indemnity organisation does not imply fault or blame. The organisation is there to support you and ensure that everything that happens after the incident happens in a way that is air to you.
- If you would like further personal support contact the Professional Support Unit https://london.hee.nhs.uk/professional-development
- Think about Action point 4. Keep your list of ‘go to’ people updated and easily available
One important factor in recognising and responding proactively to health and wellbeing challenges
is to be confident about exactly who it is you should talk to in your work environment if you do have concerns. GMC recently asked trainees this very question. It is encouraging that around two thirds of trainees and four out of five trainers knew who to contact in their Trust to discuss matters relating to occupational health and wellbeing. However, a third of trainees - over 18,000 doctors - either did not know or were not sure who they should talk to.
The GMC is committed to working with organisations across the UK to support doctors’ wellbeing https://www.gmc-uk.org/-/media/documents/national-training-surveys-initial-findings-report-2019_pdf-84390391.pdf
The GMC has a very helpful webpage on Speaking Up which offers very practical tools and approaches to speaking up when you know you need to. https://www.gmc-uk.org/ethical-guidance/ethical-hub/speaking-up
The National Guardian’s Office
The National Guardian’s Office works to make ‘speaking up’ become business as usual to effect cultural change in the NHS. The office leads, trains and supports a network of Freedom to Speak Up Guardians in England and conducts case reviews of organisations when it appears that speaking up has not been handled according to best practice. Each Trust has one or more Speak Up Guardians who can support individual employees to speak up when things are not right. https://www.nationalguardian.org.uk/
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Action Point 7 Find out who your Freedom to speak up Guardian is and how to access them What work are they doing? List of Guardians can be found at: |
Documenting the incident for professional purposes
- Write a reflective account of the incident, identifying what you have learnt and documenting it in your portfolio. See Section 10.
- Disclose and discuss the clinical incident at your Annual Review of Competency.
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Action Point 8 Read completed reflective accounts of SCIs. Practise writing reflective accounts of clinical events that challenge you in your everyday working life. See Section 10 for resources to support you. The Academy of Royal Colleges offers a helpful reflective toolkit: https://www.aomrc.org.uk/reports-guidance/reflective-practice/ |