What Is a Significant Event and What’s Its Role in Medical Appraisal?
A significant event is one of the six types of supporting information doctors are expected to collect, reflect on and discuss as part of appraisal and revalidation. The six types are continuing professional development (CPD), quality improvement activity (QIA), significant events, patient feedback, colleague feedback, and complaints and compliments.
For appraisal purposes, a significant event is any unintended or unexpected event that could or did lead to harm to one or more patients. This includes incidents where harm occurred and incidents where harm could have occurred but was prevented or avoided. It is not limited to catastrophic events. It can include errors, near misses, communication failures, system failures, documentation problems, prescribing errors and team-based incidents.
What makes a mistake a significant event?
Well there is no perfect answer to that question, but we have thought of some examples to give you an idea:
Writing milligrams instead of micrograms on a prescription could be significant because the dose difference may expose a patient to serious harm.
Entering notes in the wrong patient record could be significant because another clinician may act on incorrect information.
Taking blood from the wrong patient could be significant because it may lead to incorrect results being attributed to another person, delayed diagnosis, repeat procedures or inappropriate treatment.
A missed abnormal blood result, a failure to action a referral, a delay in escalating sepsis, or a medication being issued despite a documented allergy may also be significant events.
Doctors are human and mistakes happen. The purpose of discussing significant events at appraisal is not to shame the doctor. It is to demonstrate openness, insight and learning. The appraiser is interested in what happened, how the doctor was involved, but more importantly what the doctor learned, and what has changed as a result. The reflection should not become a full medico-legal statement. It should be factual, anonymised and focused on learning.
Involvement in a significant event can mean more than being the individual who made the error. If you were part of the team providing care where the event occurred, you may still need to declare and reflect on it. For example, a hospital doctor may be part of a team managing a deteriorating patient where escalation was delayed. A GP locum may work in a practice where an abnormal result was not followed up because of a workflow problem. In both cases, the key issue is what the doctor / the team learned from the event.
The strongest reflections usually identify both individual and system learning. For example, after prescribing the wrong dose, a doctor may decide to double-check high-risk medicines and review local prescribing guidance. However, the wider team may also introduce a clearer repeat prescribing protocol, pharmacist review, or electronic alert. After notes are entered into the wrong record, a doctor may reflect on checking three identifiers before opening a record and the practice may review how multiple family members are booked into back-to-back appointments.
If you have not personally been involved in a significant event during the appraisal year, that does not mean the section should be ignored. You can still show engagement with patient safety by reflecting on significant events discussed in your team, department or organisation. You can explain how you learned from a colleague’s case, attended a significant event meeting, reviewed a safety bulletin, or checked that you understand your local reporting process. You can also reflect on how you mitigate risk in your own practice.
Doctors who are not currently working clinically may have no personal significant events to declare. In that situation, they can state this clearly and discuss how they maintain awareness of patient safety principles. For example, they may have reviewed GMC guidance, completed patient safety CPD, reflected on previous events, or considered how they would report concerns when returning to practice.
Significant events should be declared honestly. Not declaring or discussing an event shows a lack of probity and honesty which is usually more concerning than the event itself. Appraisal is designed to be formative. It gives doctors an opportunity to show that they can recognise risk, respond appropriately, learn from incidents and improve patient care.
Useful links
Disclaimer
This article provides general information only and should not be treated as clinical, legal, regulatory, employment or professional advice.
Comments