How to Prevent and Respond to Patient Safety Incidents
The College sometimes hears from patients who were unfortunately harmed during a physiotherapy appointment. They may have fallen during an exercise, or the application of a modality caused harm or similar incidents.
The patients will sometimes describe how they perceived the situation was poorly managed. The College finds that in many cases, the physiotherapist themselves did not have a plan to manage incidents, and there was no learning or continuous quality improvement after the event.
As a reminder physiotherapists are required to have a written plan for managing adverse events as detailed in the Controlled Acts and Restricted Activities Standard. However, patient safety extends beyond controlled acts, and these principles should be applied in all aspects of practice.
Patient Safety Incident Management Plans
Patient safety incident management plans can be developed proactively or by reflecting on an incident that occurred in your practice.
- Invest time to identify the anticipated risks to patients in your setting. Personalize patient safety incident plans to match the kinds of things you do in practice and how you should respond.
- Develop a plan for you (or other staff) to manage safety incidents.
Patient safety incident management plans should include:
A list of what could cause harm to a patient during or after assessment or the treatment of a patient.
How is the incident recognized? What were the signs?
What steps need to be taken to immediately manage the situation, and who should be involved while the patient is in the clinic.
- Do you have a clear plan to respond if a patient should go into cardiac arrest?
- What if a patient falls or has an episode of dizziness?
- Consider if it is safe for the patient to leave the setting unaccompanied.
- What follow-up is needed? And what is the time frame?
What steps should be taken when the patient's safety incident becomes apparent after the patient has left the practice setting. (e.g., the patient calls with reports of a new pain at the injury site or has greater difficulty with moving)
Instructions or advice to be given to patients to manage any incidents should they occur after the patient leaves your practice.
Instructions to document a summary of any incidents in the patient chart.