Internal
Internally, organizations need a system to report occurrences in a timely and confidential
manner. AHCA requires that a report must be received in the Risk Management
Department within three (3) business days following the event. An occurrence/variance is
any event that is not, or may not be, consistent with normal routine and/or established
policies, guidelines and procedures.
Occurrence reports can be generic, patient/visitor/employee related, unit specific or
medication specific. Reporting of all incidents includes near misses or activities that may
be viewed as contributing to a mistake. Occurrence reporting allows identification of
trends and problem areas and provides the necessary information to establish effective
processes to promote patient safety and improve staff development. Generally, patient
and visitor incidents are reported to the risk management department and employee
incidents/injuries are reported to the employee health office.
Organizational leaders must remain focused on improving systems through reporting
and analysis of occurrences – not on blaming individuals. The IOM report made several
recommendations regarding reporting of medical errors. The ultimate goal of reporting is
to analyze the information gathered and identify ways to prevent future errors from
occurring.
Barriers to Reporting
- Lack of time
- Fear of punishment
- Unclear reporting protocols
- Poor record of improvement
- Forgetting to complete report
