Patient Safety Incident – Investigation and Response (PSIRF)

Course Outline:

This course equips delegates to identify triggers for investigating patient safety incidents, selecting appropriate staff, gathering information, and assessing the evidence.

The duty of candour places a requirement on NHS Bodies to investigate incidents which trigger the threshold of moderate or serious harm. Patient Safety Incident Response Framework (PSIRF) is the tool by which this is done. Health providers must ensure that these incidents are identified correctly, investigated thoroughly and trigger actions that will prevent them from happening again.

Using a variety of investigative processes, including root cause analysis, interviewing skills and issue identification, delegates will identify systemic shortfall in service delivery and the importance of responding to identified risk reporting. Delegates will be introduced to human factors and their potential influence in the investigative and reporting process.

The course will enable delegates to better identify triggers to investigating patient safety incidents. Delegates will consider the importance of getting the right staff with the appropriate degree of skills and seniority to undertake such investigations. They will participate in information gathering with practical sessions on setting terms of reference, collecting, reviewing evidence from a variety of sources, and placing the relevant weight to that evidence.

With a focus on defensible decision making, these practical sessions guide delegates to negotiate the investigation process and draft a report for presentation to a panel, basing any recommendations on facts derived from collected evidence.

Key Learning Outcomes:

• Acquire a sound knowledge of the investigative and reporting process
• Use best practice in evidence gathering techniques
• Be able to distinguish between different types of evidence and their reliability, credibility and weight
• Use effective communication and interviewing to obtain best possible evidence
• Recognise the influence of human factors and their impact on investigations and reporting
• Use investigative processes including root cause analysis to identify and address key issues
• Evaluate evidence and make recommendations which logically derive from the facts
• Share findings, recognition of potential barriers and implementation of identified learning