Thursday, Oct. 27
10:45 – 11:45 (1 hr)
Meeting Room: Sheraton Hall B (Lower Concourse)
Andrea Waddell*, MD, MEd, FRCPC; Tara Burra, MA, MD, FRCPC; Michael Dunn, BA, MSc; Lesley Wiesenfeld, MD, MHCM, FRCPC

CanMEDS Roles:

1. Professional
2. Communicator
3. Medical Expert

At the end of this session, participants will be able to: 1) Identify the professional challenges that may arise from a patient safety incident in your practice; 2) Apply the Canadian incident analysis framework to a clinical scenario; and 3) Describe the relevant policies, legislation, and stakeholders and their roles in managing a patient safety incident.

Adverse events arise in 15% to 25% of ambulatory care patients in psychiatry and 17% to 35% of patients admitted to hospital. Although most of these events are “no harm” incidents, some lead to significant harm or distress and trigger some form of incident review. In this workshop, we will navigate the process of responding to a patient safety incident in clinical practice, from detecting the event to developing action plans to learn from these events and reduce the risk of recurrence. Using interactive methods, including role play, demonstration, think-pair-share, and small group case discussion, we will provide psychiatrists with a toolkit to navigate an adverse event. Participants will gain a guide to reporting requirements; an approach to disclosure to clinical leaders, patients, and families; and self-care during a frequently stressful professional experience. Participants will leave the session with a solid understanding of the essential steps required to manage a patient safety incident, the role of hospital and clinic staff in supporting the incident review process, and a play book for how to respond to patient safety incidents in the future.

References:

1. Nilsson L, Borgstedt-Risberg M, Brunner C, et al. Adverse events in psychiatry: a national cohort study in Sweden with a unique psychiatric trigger tool. BMC Psychiatry 2020;20:44.
2. Incident Analysis Collaborating Parties. Canadian incident analysis framework. Edmonton (AB): Canadian Patient Safety Institute; 2012.