The concept of an incident has evolved over the years, as laboratory medicine, like healthcare in general, has been affected by changes in government regulation, legal definitions, and increased public awareness of patient rights. Competent incident management is another key component of providing quality patient care.
Many years ago, when I began my career as a laboratory professional, an “incident “: was a reportable error, such as an employee needle stick due to an uncapped syringe, or causing a hematoma in a patient. Generally, a form was completed, the employee counseled, the report filed, and that was the end of it. Certainly, more significant occurrences (especially in healthcare facilities) always warranted additional attention by administrations.
However, my sense has been that one of the key forces behind a more complex view of incidents, along with an increased emphasis on incident management was the anxiety and fears brought on by the HIV/AIDS epidemic, as well as new information about the viruses that cause Hepatitis.
It became ever more imperative that when an incident occurred, whether defined as an accident, a non-conformance to standards, an act of nature, or a deliberate action by an individual, that procedures for investigation, evaluation, determination of cause, corrective action and effective follow up, had to be carefully defined, confirmed and monitored. Incidentally (excuse the pun), follow up not only meant that resolution, but also included tracking the health needs of those impacted by the incident.
Today, we have specific requirements for maintaining policies and procedures for the management of incidents. These not only include all of the above, but must define the Who, What, When and Why for investigative procedures: Who is in charge? What are their responsibilities? What is the time-line? Questions to be answered include Why did this occur and how can it be prevented in the future? (Root Cause Analysis)
It is also important to make the determination as to whether an incident reflects a systemic problem or if it was a random occurrence.
Thus, as regulation of healthcare has evolved, including concerns for workplace and patient safety (OSHA), patient confidentiality (HIPAA), quality of testing (CLIA), the need for competent incident management continues to grow. In a larger sense, Incident Management is a guardian for quality patient care and accountability.