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{"sheet":"SEA form","index":0,"n_rows":44,"n_cols":10,"rows_kept":44,"cut":false,"hidden":false,"merged":[[43,1,44,2],[5,1,5,2],[38,1,38,2],[2,1,2,2],[3,1,3,2],[4,1,4,2],[37,1,37,2],[40,1,40,2]]}
[]
[null,"NHS England South West - \nDevon, Cornwall, Isles of Scilly, Bristol, North Somerset, Somerset, South Gloucester","If you are reporting a \"Serious Incident\" please return this form immediately!",null,null,null,null,null,"For pharmacy incidents : ","england.pharmacysouthwest@nhs.net  "]
[null,"Primary Care Incident notification form ",null,null,null,null,null,null,"For Controlled drug incidents : ","england.southwestcontrolleddrugs@nhs.net  "]
[null,"The purpose of this form is to comply with national guidance and enable timely information sharing and facilitate learning from incidents.  Please return this form asap after you have identified your actions and learning. \n\nDO NOT INCLUDE PATIENT IDENTIFIABLE INFORMATION OR THAT OF INDIVIDUALS OTHER THAN THOSE OF THE REPORTER FOR COMMUNICATION PURPOSES.",null,null,null,null,null,null,"For Screening, Immunisation, Cold chain incidents: ","england.swscreeningandimms@nhs.net  "]
[null,"All General Practice & Dental incidents - pls return form to:                     england.devcorn-incidents@nhs.net              \nAll Pharmacy related incidents - pls return form to:                                   england.pharmacysouthwest@nhs.net \nAll Controlled drug incidents pls return form to:                                       england.southwestcontrolleddrugs@nhs.net\nAll Screening, Immunisation, Cold chain incidents pls return form to:      england.southwestscrimms@nhs.net ",null,null,null,null,null,null,"For Safeguarding incidents : ","england.devcorn-safeguarding@nhs.net "]
[null,"Definition of Serious / Significant & Never events & levels of harm",null,null,null,null,null,null,null,{"$f":"IFERROR(VLOOKUP(C8,Lists!$J$1:$L$9,3,0),\"\")","v":""}]
[null,"\nSerious incident -  The definition of a ‘Serious Incident’  is set out in the ‘Serious Incident Framework March 2015 – (NHS England Patient Safety Domain).  Broadly, ‘Acts and/or omissions occurring as a part of NHS funded healthcare’ , including the community) that resulted in;\n• Unexpected or avoidable death, serious harm, injury, abuse, psychological or psychological; or where healthcare did not take appropriate action\n• Or an event that seriously prevents or threatens to prevent an organisations ability to continue to deliver an acceptable quality of healthcare.\nNever event – Never Events are serious, largely preventable patient safety incidents that should not occur if the available preventative measures have been implemented eg removal of wrong tooth, wrong site surgery\nSignificant event - Definition of a Significant Event -  The Royal College of General Practitioners (RCGP) states that significant events suitable for analysis are events where the practitioner can identify an opportunity for making improvements, either because the outcome was substandard or because there was a potential for an adverse outcome (‘near miss’), but these incidents involve a lower level of safety concern than a ‘serious incident’\n","\n\nDefinition of levels of harm (National Patient Safety Agency definition): \n  \nNo harm:   \nImpact prevented – any patient safety incident that had the potential to cause harm but was prevented, resulting in no harm to people receiving NHS-funded care. \n  \nImpact not prevented – any patient safety incident that ran to completion but no harm occurred to people receiving NHS-funded care. \n  \nLow: Any patient safety incident that required extra observation or minor treatment and caused minimal harm, to one or more persons receiving NHS-funded care. \n  \nModerate: Any patient safety incident that resulted in a moderate increase in treatment and which caused significant but not permanent harm, to one or more persons receiving NHS-funded care. \n\nSevere: Any patient safety incident that appears to have resulted in permanent harm to one or more persons receiving NHS-funded care. \n  \nDeath: Any patient safety incident that directly resulted in the death of one or more persons receiving NHS-funded care. \n","critical or not",null,null,null,null,null,"england.devcorn-governance@nhs.net"]
[1,"CCG name (click on box opposite for drop down listing):",null,"yes",{"$f":"IF(D8=\"Yes\",IF(ISTEXT(C8),1,0))","v":0},{"$f":"SUM(E8:E37)","v":0},null,null,{"$f":"IFERROR(VLOOKUP(C8,Lists!$C$1:$D$8,2,0),\" - Incomplete\")","v":" - Incomplete"},{"$f":"IFERROR(CONCATENATE(I10,TEXT(I9,\"ddmmyy\"),I8),\"\")","v":"000100 - Incomplete"}]
[null,"Reporter name & contacts",null,null,{"$f":"IF(D9=\"Yes\",IF(ISTEXT(C9),1,0))","v":false},null,null,null,{"$f":"Lists!F1","v":"00:00:00"}]
[2,"Organisation name reporting  incident:",null,"yes",0,null,null,null,{"$f":"IFERROR(VLOOKUP(C16,Lists!$H$1:$I$21,2,0),\"\")","v":""}]
[3,"Organisation postcode:",null,"yes",0]
[4,"Reporter name: ",null,"no",false]
[5,"Reporter job title:",null,"no",false]
[6,"Reporter email: ",null,"yes",0,null,{"$f":"IFERROR(IF(C14=\"\",J6,C14),\"\")","v":""}]
[7,"Name of organisation responsible for incident (if different from reporting organisation above)",null,"no",false]
[8,"Specify care sector involved in this incident? Please specify (Choose from drop down list):",null,"yes",0]
[null,"Patient details",null,null,false]
[9,"Gender (Choose from drop down list):",null,"no",false]
[10,"Patient date of birth:   Day/Month/Year ie: 01/02/2016 ",null,"no",false]
[11,"Patient's GP Practice:",null,"no",false]
[null,"Incident date, time & location",null,null,false]
[12,"Date of incident:   Day/Month/Year ie: 01/02/2016",null,"no",false]
[13,"Time of incident: eg 13:45",null,"no",false]
[14,"Location of incident (Choose from drop down list):",null,"no",false]
[null,"Incident description",null,null,false]
[15,"Is this a Serious Incident or Significant Event or Never event? (See definition above- Choose from drop down list)",null,"yes",0,null,{"$f":"IF(C26=\"SI - Serious Harm\",\"england.devcorn-governance@nhs.net\",0)","v":0}]
[16,"Type of incident a) general:  (Choose from drop down list)",null,"yes",0]
[17,"Type of incident b) specific:\n (Choose from drop down list, scroll down)",null,"yes",0]
[18,"Medication name(s) if responsible/involved in incident:",null,"no",false]
[19,"Description of incident & what happened (please summarise):\n(NB when typing - to get a new line or paragraph press ALT and return together)",null,"yes",0]
[20,"Immediate action taken:  \n(NB when typing - to get a new line or paragraph press ALT and return together)",null,"yes",0]
[21,"Media - might this incident attract media interest?",null,"no",false]
[22,"Duty of Candour - detail contact with patient/family or carers:",null,"yes",0]
[null,"What lessons have you learned and which you could share with others in Primary Care?",null,null,false]
[23,"Learning from incident\n(NB when typing - to get a new line or paragraph press ALT and return together)",null,"yes",0]
[24,"What action has been taken to reduce the risk of this incident being repeated, including action completion dates:\n(NB when typing - to get a new line or paragraph press ALT and return together)",null,"yes",0]
[25,"Date incident reported:\n Day/Month/Year ie: 01/02/2016",null,"yes",{"$f":"IF(D37=\"Yes\",IF(ISNUMBER(C37),1,0))","v":0}]
[null,"REMEMBER to notify the CQC of any incident regarding patient harm or service delivery.  Regulation 18 - \nThe intention of this regulation is to specify a range of events or occurrences that must be notified to CQC so that, where needed, CQC can take follow-up action.  Providers must notify CQC of all incidents that affect the health, safety and welfare of people who use services. The full list of incidents is in the text of the regulation.\nAll providers must send their notifications directly to CQC unless the provider is a health service body, local authority or provider of primary medical services and it has previously notified the NHS Commissioning Board Authority (now known as NHS England). CQC can prosecute for a breach of this regulation or a breach of part of the regulation. This means that CQC can move directly to prosecution without first serving a warning notice. Additionally, CQC may also take any other regulatory action. See the offences section for more detail.\n"]
[null,"For completion by NHS England Quality & Safety team"]
[26,"Incident Number",{"$f":"IFERROR(J8,\"\")","v":"000100 - Incomplete"},null,null,{"$f":"TODAY()","v":"2018-04-20"}]
[null,"For any queries please contact:   england.devcorn-incidents@nhs.net  "]
[]
[]
[null,"Escalation Buttons"]

{"sheet":"Incident type lists","index":1,"n_rows":49,"n_cols":3,"rows_kept":49,"cut":false,"hidden":true,"merged":[]}
["Type of incident a) general","Type of incident b) descriptor","Medication description "]
["Access, admission, transfer, discharge (including missing patient)","Cold chain","Adverse drug reaction when used as intended"]
["Clinical assessment (including diagnosis, scans, tests, assessments)","Communication - 111, Out of Hours","Contra-indication to use of medicine re drugs or condition"]
["Consent, communication, confidentiality","Communication failure","Controlled drug"]
["Death","Confidentiality & Communication - Breach of confidentiality","Medication delay"]
["Disruptive, aggressive behaviour (includes patient-to-patient)","Consent - failure to gain consent","Omitted medicine or ingredient"]
["Documentation (including electronic & paper records, identification and drug charts)","Diagnosis - delay, failure to","Other"]
["Immunisation, Screening, Vaccination","Diagnosis - wrong","Passed expiry date"]
["Implementation of care and ongoing monitoring / review","Discharge - delay, failure","Wrong dose"]
["Infection Control Incident","Do not resuscitate (DNR)","Wrong dose or quantity"]
["Infrastructure (including staffing, facilities, environment)","Documentation - missing, delayed, inadequate","Wrong drug or medicine"]
["Medical device / equipment","Documentation - patient incorrectly identified","Wrong frequency"]
["Medication","End of Life issue","Wrong patient"]
["Other","Health and Justice incident","Wrong storage"]
["Patient abuse (by staff / third party)","Healthcare professional issue"]
["Patient accident","Immunisation"]
["Self-harming behaviour","Infection control - Cdiff"]
["Treatment, procedure","Infection control - MRSA"]
[null,"Infection control - Other"]
[null,"IT system failure"]
[null,"Lost or missing documents"]
[null,"Meningitus C"]
[null,"Prescribing/Dispensing - EPS"]
[null,"Prescribing/Dispensing - lost prescription"]
[null,"Prescribing/Dispensing - Other"]
[null,"Prescribing/Dispensing - preparation incorrect"]
[null,"Prescribing/Dispensing - wrong dose, quantity"]
[null,"Prescribing/Dispensing - wrong drug"]
[null,"Prescribing/Dispensing - wrong label"]
[null,"Prescribing/Dispensing - wrong patient"]
[null,"Pressure ulcer"]
[null,"Professional Registration issues"]
[null,"Referral - delayed 2WW"]
[null,"Referral issue"]
[null,"Safeguarding concern"]
[null,"Scans, X-rays, specimens "]
[null,"Screening"]
[null,"Sepsis"]
[null,"Sharp incident"]
[null,"Slip, Trip, Fall"]
[null,"Suicide suspected"]
[null,"Test results or reports - failure to report, act, receive, incorrect, missing"]
[null,"Transfer - delay, failure"]
[null,"Transport - delay,  failure"]
[null,"Treatment, delay in obtaining clinical assistance"]
[null,"Treatment, failure to discontinue treatment"]
[null,"Treatment, failure to monitor"]
[null,"Treatment, sharps, instruments"]
[null,"Vaccination"]

{"sheet":"PROTECTED lists","index":2,"n_rows":49,"n_cols":9,"rows_kept":49,"cut":false,"hidden":true,"merged":[]}
["CCG names","Care sector","Location of Incident","Type of incident a) general","Type of incident b) descriptor","Medication description ","Gender","Media attention","SI or SEA"]
["NHS Bristol CCG",111,"Acute Hospital","Access, admission, transfer, discharge (including missing patient)","Cold chain","Adverse drug reaction when used as intended","Female","Yes","Never event"]
["NHS England SSW","Acute Hospital","Community Hospital","Clinical assessment (including diagnosis, scans, tests, assessments)","Communication - 111, Out of Hours","Contra-indication to use of medicine re drugs or condition","Indeterminate/intersex","No","SE - not serious harm  "]
["NHS Kernow CCG","Ambulance service","GP Surgery - Dispensary","Consent, communication, confidentiality","Communication failure","Controlled drug","Male",null,"SI - Serious harm"]
["NHS North Somerset CCG","Community Hospital","GP Surgery - external ","Death","Confidentiality & Communication - Breach of confidentiality","Medication delay","Multiple patients"]
["NHS Northern, Eastern, Western Devon CCG","Community service ie District Nurse","GP Surgery - internal","Disruptive, aggressive behaviour (includes patient-to-patient)","Consent - failure to gain consent","Omitted medicine or ingredient","Not known"]
["NHS Somerset CCG","Dentist","Home","Documentation (including electronic & paper records, identification and drug charts)","Diagnosis - delay, failure to","Other","Transgender"]
["NHS South Devon & Torbay CCG","District Nurses","Mental Health Unit","Immunisation, Screening, Vaccination","Diagnosis - wrong","Passed expiry date"]
["NHS South Gloucestershire CCG ","General Practice (GP)","Nursing or Residential home","Implementation of care and ongoing monitoring / review","Discharge - delay, failure","Wrong dose"]
[null,"Health visitor","Other","Infection Control Incident","Do not resuscitate (DNR)","Wrong dose or quantity"]
[null,"Immunisation","Public space","Infrastructure (including staffing, facilities, environment)","Documentation - missing, delayed, inadequate","Wrong drug or medicine"]
[null,"Local Authority","Social care facility","Medical device / equipment","Documentation - patient incorrectly identified","Wrong frequency"]
[null,"Mental Health provider","Unknown","Medication","End of Life issue","Wrong patient"]
[null,"Nursing or Residential Home",null,"Other","Health and Justice incident","Wrong storage"]
[null,"Optometrist",null,"Patient abuse (by staff / third party)","Healthcare professional issue"]
[null,"Out of Hours Doctors",null,"Patient accident","Immunisation"]
[null,"Patient transport",null,"Self-harming behaviour","Infection control - Cdiff"]
[null,"Pharmacy",null,"Treatment, procedure","Infection control - MRSA"]
[null,"Referral Service (DRSS)",null,null,"Infection control - Other"]
[null,"School Nurse",null,null,"IT system failure"]
[null,"Screening",null,null,"Lost or missing documents"]
[null,"Social Care",null,null,"Meningitus C"]
[null,null,null,null,"Prescribing/Dispensing - EPS"]
[null,null,null,null,"Prescribing/Dispensing - lost prescription"]
[null,null,null,null,"Prescribing/Dispensing - Other"]
[null,null,null,null,"Prescribing/Dispensing - preparation incorrect"]
[null,null,null,null,"Prescribing/Dispensing - wrong dose, quantity"]
[null,null,null,null,"Prescribing/Dispensing - wrong drug"]
[null,null,null,null,"Prescribing/Dispensing - wrong label"]
[null,null,null,null,"Prescribing/Dispensing - wrong patient"]
[null,null,null,null,"Pressure ulcer"]
[null,null,null,null,"Professional Registration issues"]
[null,null,null,null,"Referral - delayed 2WW"]
[null,null,null,null,"Referral issue"]
[null,null,null,null,"Safeguarding concern"]
[null,null,null,null,"Scans, X-rays, specimens "]
[null,null,null,null,"Screening"]
[null,null,null,null,"Sepsis"]
[null,null,null,null,"Sharp incident"]
[null,null,null,null,"Slip, Trip, Fall"]
[null,null,null,null,"Suicide suspected"]
[null,null,null,null,"Test results or reports - failure to report, act, receive, incorrect, missing"]
[null,null,null,null,"Transfer - delay, failure"]
[null,null,null,null,"Transport - delay,  failure"]
[null,null,null,null,"Treatment, delay in obtaining clinical assistance"]
[null,null,null,null,"Treatment, failure to discontinue treatment"]
[null,null,null,null,"Treatment, failure to monitor"]
[null,null,null,null,"Treatment, sharps, instruments"]
[null,null,null,null,"Vaccination"]

{"sheet":"Lists","index":3,"n_rows":21,"n_cols":12,"rows_kept":21,"cut":false,"hidden":true,"merged":[]}
["Access, admission, transfer, discharge (including missing patient)",null,"NHS Bristol CCG","BRI",null,{"$f":"'SEA form'!C37","v":"00:00:00"},null,111,11,"NHS Bristol CCG","NHS_Bristol_CCG","BNSSG.qualitysteis@bristolccg.nhs.uk"]
["Clinical assessment (including diagnosis, scans, tests, assessments)",null,"NHS England SSW","ENG",null,null,null,"Acute Hospital","AH","NHS England SSW","NHS_England","england.devcorn-incidents@nhs.net "]
["Consent, communication, confidentiality",null,"NHS Kernow CCG","KER",null,null,null,"Ambulance service","AS","NHS Kernow CCG","NHS_Kernow_CCG","KCCG.SI@nhs.net"]
["Death",null,"NHS North Somerset CCG","NSO",null,null,null,"Community Hospital","CH","NHS Northern, Eastern, Western Devon CCG","NHS_North_East_and_West_Devon_CCG","d-ccg.safetysystems@nhs.net"]
["Disruptive, aggressive behaviour (includes patient-to-patient)",null,"NHS Northern, Eastern, Western Devon CCG","NEW",null,null,null,"Community service ie District Nurse","CS","NHS North Somerset CCG","NHS_North_Somerset_CCG","Quality.steis@swcsu.nhs.uk"]
["Documentation (including electronic & paper records, identification and drug charts)",null,"NHS Somerset CCG","SOM",null,null,null,"Dentist","DE","NHS Somerset CCG","NHS_Somerset_CCG","siri@somersetccg.nhs.uk"]
["Immunisation, Screening, Vaccination",null,"NHS South Devon & Torbay CCG","SDT",null,null,null,"District Nurses","DN","NHS South Devon & Torbay CCG","NHS_South_Devon_and_Torbay_CCG","quality.sdtccg@nhs.net"]
["Implementation of care and ongoing monitoring / review",null,"NHS South Gloucester CCG ","SGL",null,null,null,"General Practice (GP)","GP","NHS South Gloucestershire CCG ","NHS_South_Gloucestershire_CCG","Quality.steis@swcsu.nhs.uk"]
["Infection Control Incident",null,null,null,null,null,null,"Health visitor","HV","NHS South West Commissioning Support Unit","NHS_South_West_Commissioning_Support_Unit","Quality.Steis@swcsu.nhs.uk"]
["Infrastructure (including staffing, facilities, environment)",null,null,null,null,null,null,"Immunisation","IM"]
["Medical device / equipment",null,null,null,null,null,null,"Local Authority","LA"]
["Medication",null,null,null,null,null,null,"Mental Health provider","MH"]
["Other",null,null,null,null,null,null,"Nursing or Residential Home","NH"]
["Patient abuse (by staff / third party)",null,null,null,null,null,null,"Optometrist","OP"]
["Patient accident",null,null,null,null,null,null,"Out of Hours Doctors","OH"]
["Self-harming behaviour",null,null,null,null,null,null,"Patient transport","PT"]
["Treatment, procedure",null,null,null,null,null,null,"Pharmacy","PH"]
[null,null,null,null,null,null,null,"Referral Service (DRSS)","RS"]
[null,null,null,null,null,null,null,"School Nurse","SN"]
[null,null,null,null,null,null,null,"Screening","SG"]
[null,null,null,null,null,null,null,"Social Care","SC"]