Clinical Incident Reporting

Clinical Incident Reporting

From 18th November 2024, the Mindler UK adult mental health service will be used as the pilot site for Mindler global’s new clinical incident reporting system. The hope for the new system is that some reporting pressures will be taken off clinicians, feedback will be provided on the journey of the report, and information will be provided on how the report may impact on service improvements going forward. The pilot will be evaluated in December 2024. 

This means clinicians are to no longer use RISMA to report clinical incidents. 

To ensure we provide high quality and safe care to our patients, we must prevent incidents of healthcare related harm. Reporting and learning from these incidents is a crucial part of patient safety. 

Mindler takes a non-blaming stance towards clinical incidents. Reporting a clinical incident should not be seen as a punishment but instead as an opportunity to learn and improve. Mindler as an organisation is expected to provide a Just Culture to clinicians and patients and clinicians are expected to work in line with Duty of Candour principles . 

What is clinical incident reporting?

It can be a challenge to give a set definition of a clinical incident or detail an exhaustive list of examples. ‘Lists’ run the risk of excluding events that may occur which have not been written on the predefined list, or result in a too in depth response just because an incident is on the list. On the whole, the question as to whether something is a clinical incident or not is to be dealt with on a case-by-case basis.  However, in order to identify an incident, it can be helpful to ask the question:

Did something unintended or unexpected happen during the course of patient service engagement, assessment, treatment or discharge?

Some potential incidents include:

• A suicide or suspected suicide.  

• Emergency services needed to be called.

• High risk scenarios which had the potential for harm but were mitigated through safety plans/ referral to more appropriate services etc.

• Incorrect journal entries.

• Contested diagnosis or treatment plan.

• Therapy sessions which have taken place outside of Mindler Care.

• Clinicians DNAing booked therapy sessions.

• Breaking of patient confidentiality. 

• Block user policy activation. 

• A technical incident which gets in the way of assessment or treatment going ahead as intended. 

• Patients making contact with clinicians outside of Mindler Care.

• Complications around effective patient discharge e.g. a much needed local service was not available for the patient at the time of need.

• Mindler routines not followed resulting in patient harm.

• Mindler routines followed and harm still occurred. 

• A patient complaint that goes beyond dissatisfaction. 

If there are any questions or hesitations about the incident reporting contact your clinical lead for advice. 

How to report a clinical incident

• Log into Mindler Care.

• On your calendar page, click the ? located in the bottom right hand corner of your screen.

• Click on Report a Clinical Incident.

• Complete the form with the relevant details.

• Click ‘submit’.

What will happen once I’ve submitted my report?

You will receive email updates on the progress of your report through the system. A Clinical Incident Report Administrator (CIRA), the service clinical lead, will pick up your report and get back to you if they have any further questions. If there is further action required, the CIRA will update you on this. There may be times that your line manager will be notified if further support is needed. Once the report has been finalised, the CIRA will update you via email on what happened as a result of your report being submitted. At any time, you can communicate with the CIRA by replying to the emails sent to you. 

The full Mindler Global Clinical Incident Reporting, Analysis and Learning Policy can be found here.