DCIQ: NHS South East London ICS Quality Alerts reporting form

NHS South East London ICS Quality Alerts reporting form

A Quality Alert (QA) is a concern or a systemic issue generally affecting a service/ pathway that affects individual/group of patients and affects the ability to deliver a high-quality service within SEL.
The QA process is an integral part of our local system to improve quality in SEL.

The information provided is routinely reviewed and provides intelligence to allow the ICS to identify key themes and trends.
Individual responses will only be provided to those that may have or had the potential to cause an individual significant harm and have been graded amber or red.

1. Type of Record
2. - Type
    You must enter a value in this field
    Quality Alert
  - Clinical or Non-clinical?
    You must enter a value in this field
    Clinical
    Non-clinical
  - Concern / Reason for Reporting
    Please select an option that relates to the patient/service user or service
    You must enter a value in this field
1. Locations
2. - Primary Location
    Which Trust/Provider does the Quality Alert relate to? (Not Location of Quality Alert)
    
    If the location is not listed please select/enter - (NHS SEL / Provider not Listed) A free text box will become available
    You must enter a value in this field
  - Exact Location
    You must enter a value in this field
  - SEL Provider Name
    You must enter a value in this field
1. Services
2. - Primary Service
    Which Specialist / Department does Quality Alert relate to
    You must enter a value in this field
1. Details
2. - Incident date (dd/mm/yyyy)
    You must enter a value in this field
  - Incident time (hh:mm)
    You must enter a value in this field
  - Description
    Enter facts, not opinions. Do not enter names of people
    You must enter a value in this field
  - Action taken
    Enter action taken at the time of the incident
    You must enter a value in this field
  - What was the impact to patient/Service user safety?
    Was any harm caused as a result of this event
    You must enter a value in this field
1. Quality Alert Details
2. - Was this a medication incident?
    You must enter a value in this field
  - Did you contact the organisation directly to discuss?
    You must enter a value in this field
1. Incident Coding
2. - Incident affecting
    You must enter a value in this field
  - Category
    You must enter a value in this field
    Quality Alerts
  - Sub category
    You must enter a value in this field
  - Tick to record person affected contact details
    You must enter a value in this field
  - Patient's / Service user's NHS number
    Enter N/A if Quality Alert does not relate to a Patient / Service user
    You must enter a value in this field
1. Medications
1. Equipment
1. People Affected
1. Result & Severity
1. Notifications
1. Additional Information
2. - Was any employee directly involved in this incident?
    You must enter a value in this field
  - Was any other contact involved in this incident?
    You must enter a value in this field
  - Are there any documents to be attached to this record?
    You must enter a value in this field
1. Employees
1. Other Contacts
1. Documents
1. Details of person reporting the incident
1. LFPSE
1. LFPSE - Risk
1. LFPSE - Went Well
1. LFPSE - Medications
1. LFPSE - Equipment
1. LFPSE - IT Systems & Software
1. LFPSE - Tissues & Organs
1. LFPSE - Involved Persons
1. LFPSE - Reporter
1. LFPSE - Adverse Event Agent
1. LFPSE - Adverse Event Problem Buildings Infrastructure
1. LFPSE - Adverse Event Problem Estates Services
1. LFPSE - Adverse Event Problem Blood
1. LFPSE - Adverse Event Problem Blood Products
1. LFPSE - Adverse Event Safety Challenges

Incidents

NHS South East London ICS Quality Alerts reporting form