The College of Optometrists

Adverse incidents and near misses

B103
An adverse incident is where harm has occurred, and a near miss is where harm could have occurred.
B104
If an adverse incident occurs you should take the following steps; this is what is meant by duty of candour:
  1. apologise to the patient
  2. explain what has happened, and
  3. explain any remedial action.
B105
If necessary, you should also:
  1. investigate the adverse incident
  2. take the appropriate action, and
  3. keep a written record.
B106
You should record any adverse incident somewhere central to the practice, for example in your practice’s system or in the practice Accident Book. This applies even if it was not due to any fault of the practice or practitioner.
B107
If a near miss occurs, you should learn from it and you should reassure the patient if you think it caused them concern.
B108
You should report any near misses or adverse clinical incidents involving patients receiving NHS-funded care:
  1. in England and Wales to the National Reporting and Learning System (NRLS). This does not collect any patient or practitioner identifiable information182 
  2. in Scotland to your local health board, and
  3. in Northern Ireland to the Northern Ireland Adverse Incident Centre.183 
B109
If the adverse incident was due to a drug or medical device you should report this to the Medicines and Healthcare Products Regulatory Agency, as appropriate.184, 185 See sections on Infection control and Use and supply of drugs or medicines in optometric practice.

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