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To improve our approach to responding to patient safety incidents, we are preparing to move from the existing Serious Incident Framework to NHS England's new Patient Safety Incident Response Framework (PSIRF).

The video below introduces PSIRF, and you can also visit the NHS England website for more information.

What is PSIRF?

PSIRF sets out new guidance on how NHS organisations respond to patient safety incidents, and ensures compassionate engagement with the patients affected and their families. It supports the key principles of a patient safety culture, focussing on understanding how incidents happen, rather than apportioning blame - allowing for more effective learning, and ultimately safer care for patients.

What happens next?

We are developing a Patient Safety Incident Response Plan which will identify our individual patient safety incident profile and review existing improvement work to identify the areas that will benefit most from learning and maximise the opportunities for improvement.

What does it mean for investigations?

Some incidents will qualify for a Patient Safety Incident Investigation but there will be others where alternative responses, such as case note reviews, open conversations involving the team or after-action reviews will be indicated. In some cases, where it is already clear why the incident happened, it will be more appropriate to concentrate on making improvements rather than spending more time on investigations.

Essentially, there will be fewer formal investigations of incidents, but staff will be more likely to be involved in other approaches to learn from incidents and improve patient safety.

We will update this page as the project progresses. In the meantime, if you have questions or would like to get involved please contact our Patient Safety Specialist Sharon Mooney on sharon.mooney@dchft.nhs.uk

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