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The immediate response includes the care, support, and communication actions that take place immediately following an incident to mitigate further patient harm and ensure the safety of patients/families and providers.  As appropriate, the immediate response continues throughout the incident management process to promote healing, recovery and learning.

“We could forgive them that our daughter died but we could not forgive them for how they treated us after she died.”  -- Mother, Focus Group Participant

Recommended strategies

Depending on the incident and circumstances, the steps taken immediately after an incident can vary in their order or occur simultaneously. Knowledge of local policies, procedures and available resources, developed before the incident, ensure effective management of these crucial early steps in the incident management process.

Immediate care and support for patient(s), family, providers and others.

• First and foremost, address the immediate clinical needs of the patient(s) involved in the incident
• Attend to the immediate emotional needs of patient(s) and/or family involved in the incident including acknowledgement of the event, empathy, and support
• Ensure that other patients, families and visitors impacted by the incident are cared for, including support for their ongoing clinical needs
• Attend to the safety and well-being of care providers(s) involved in the incident as needed, including arranging for coverage of duties, facilitating access to counselling, and providing peer support
• Document facts in the patient’s health record as soon as possible in accordance with professional standards and organizational policies

Make the environment and surroundings safe.

• Institute measures to reduce the risk of imminent recurrence or other potential threats, such as removing  potentially harmful medications, equipment or other hazards
• Alert others, such other areas within the organization or other institutions, to risks that extend beyond the local environment

Secure items related to the event that may need to be assessed as part of the incident analysis.

• Items to be secured can include biomedical equipment, intravenous solutions, medications, packaging, garments, linens, technology, video recordings, etc.
• Label and secure items in a protected environment with restricted access
• As directed by organizational policies, secure the health record and provide a copy to care providers if the patient is receiving ongoing care
• Photograph the items and the area where the incident occurred when appropriate as this may prove to be helpful in the review process

Report the incident and ensure appropriate notifications.

• Report the incident in accordance with organizational processes to trigger appropriate notifications and determine next steps in the incident management process
• Notify the attending physician and unit manager and consider others including the leadership team, risk management and public relations in accordance with organizational policy
• Initiate external notifications as required and depending on the nature of the event, organizational policy and governing legislation; this may include the coroner/medical examiner, Ministry of Health, insurers, and the media

Begin disclosure.

• Begin the disclosure process with the patient and family as soon as reasonably possible
• Consider adapting the process to fit patient/family needs
• Document the disclosure discussion in accordance with organizational policies

Ongoing support

• Begin to create a plan to provide support and information to patients/families, providers, and others as appropriate.