Reported SEA - Audit Definition of a significant event; 'Any event thought by anyone in the team to be significant in the care of patients or the conduct of the practice''.
Start date of the SEA:
Stage 1 - Awareness and prioritising a Significant Event Audit
Does the practice have a disignated person(s) who can be consulted to make a judgement on whether a specific significant event should be formally audited immediately, or be dealt with in a simpler way?
1.1 -Name of designated person(s):
1.2 - Description of the SEA:
1.3 - SEA Category:
1.4 - Could the incidence have been prevented?
Stage 2 - Information gathering
2.1 - What happened (summary)?
2.2 - How it happened:
2.3 - Why it happened (summary):
2.4 Evidence Collected:
Stage 3 - The facilitated team-based meeting
3.1 - Is the SEA part of the monthly practice meetings?
3.2 - Is the meeting in addition to the routine practice meetings due to the urgency of the event?
3.3 - Is there a named nominated facilitator?
3.4 - Aims and process of the discussion:
3.5 - Summary of Findings:
Stage 4 - Analysis of the significant event
4.1 - What happened (in detail)?
4.2 - Why did it happen (in detail)?
4.2.1 - Main Reasons:
4.2.2 - Underlying Reasons:
4.3 - What has been learnt?
4.4 - Did the event occur due to a lack of knowledge and training?
4.5 - Could the event have been prevented if the system s and/or procedures?
4.6 - Was the event due to a lack of team work?
4.7 - Was the event due to a lack of effective communication?
4.8 - Has the care and service provided been shown to be exemplary (eg team-based effort in the successful resuscitation of a patient)?
4.9 - is no action required?
4.10 - Has a learning need been highlighted?
4.11 - Has a learning point been highlighted (eg a protocol which requires altering)?
4.12 - Is a conventional audit required?
4.13 - Is there a need for immediate action/change?
4.14 - Is there a need for further investigation and an in-depth SEA required (eg in the event where multiple organisations are involved)?
4.15 - is the information going to be shared?
Information to be shared with:
Stage 5 - Agree, implement and monitor change
5.1 - What actions have been agreed upon?:
5.2 - How and when will the changes be implemented?:
5.3 - How will the changes be monitored?:
Stage 6 - Write it up
Additional information not already mentioned:
Stage 7 - Report, share and review
7.1 - Is one or more of the following to receive a copy of this SEA?
7.2 - How many of the following will be sent a copy?
7.2.1 - Patient and/or carer?
7.2.2 - Educational peer reviewers?
7.2.3 - Care Quality Commission (CQC) Assessors/reviewers?
7.2.4 - General Dental Practice (GDP) appraisers?
7.2.5 - British Dental Association (BDA) Good Practice assessors?
7.2.6 - Clinical governance assessors?
7.2.7 - Primary Dental Care (PCT) Cluster assessor/advisor?
7.2.8 - General Dental Council (GDC) assessor?
7.2.9 - National Patient Safety Agency (NPSA)?
7.2.10 - Health & Safety Executive?
7.2.11 - National Radiographic Practice Board (NRPB)?
What was effective about this SEA:
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Please note that this checklist template is a hypothetical example and provides only standard information. The template does not aim to replace, among other things, workplace, health and safety advice, medical advice, diagnosis or treatment, or any other applicable law. You should seek your professional advice to determine whether the use of such a checklist is appropriate in your workplace or jurisdiction.
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