Significant Event Audit

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

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:

  Date

• Add signature

  Sign

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?

  Yes

  No

  N/A

• 1.1 -Name of designated person(s):

• 1.2 - Description of the SEA:

• 1.3 - SEA Category:

  Select Clinical Clinician Leadership Managerial Patient Team

  • Clinical
  • Clinician
  • Leadership
  • Managerial
  • Patient
  • Team

• 1.4 - Could the incidence have been prevented?

  Yes

  No

  N/A

Stage 2 - Information gathering

• 2.1 - What happened (summary)?

• 2.2 - How it happened:

• 2.3 - Why it happened (summary):

• 2.4 Evidence Collected:

• 2.5 Evidence:

  Media

Stage 3 - The facilitated team-based meeting

• 3.1 - Is the SEA part of the monthly practice meetings?

  Yes

  No

  N/A

• 3.2 - Is the meeting in addition to the routine practice meetings due to the urgency of the event?

  Yes

  No

  N/A

• 3.3 - Is there a named nominated facilitator?

  Yes

  No

  N/A

• 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?

  Yes

  No

  N/A

• 4.5 - Could the event have been prevented if the system s and/or procedures?

  Yes

  No

  N/A

• 4.6 - Was the event due to a lack of team work?

  Yes

  No

  N/A

• 4.7 - Was the event due to a lack of effective communication?

  Yes

  No

  N/A

• 4.8 - Has the care and service provided been shown to be exemplary (eg team-based effort in the successful resuscitation of a patient)?

  Yes

  No

  N/A

• 4.9 - is no action required?

  Yes

  No

  N/A

• 4.10 - Has a learning need been highlighted?

  Yes

  No

  N/A

• 4.11 - Has a learning point been highlighted (eg a protocol which requires altering)?

  Yes

  No

  N/A

• 4.12 - Is a conventional audit required?

  Yes

  No

  N/A

• 4.13 - Is there a need for immediate action/change?

  Yes

  No

  N/A

• 4.14 - Is there a need for further investigation and an in-depth SEA required (eg in the event where multiple organisations are involved)?

  Yes

  No

  N/A

• 4.15 - is the information going to be shared?

  Yes

  No

  N/A

• 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?:

• Select date

  Date

• 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?

  YES

  NO

• 7.2 - How many of the following will be sent a copy?

  Select 1 2 3 4 5 6 7 8 9 10 11 12

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • 11
  • 12

• 7.2.1 - Patient and/or carer?

  Yes

  No

  N/A

• 7.2.2 - Educational peer reviewers?

  Yes

  No

  N/A

• 7.2.3 - Care Quality Commission (CQC) Assessors/reviewers?

  Yes

  No

  N/A

• 7.2.4 - General Dental Practice (GDP) appraisers?

  Yes

  No

  N/A

• 7.2.5 - British Dental Association (BDA) Good Practice assessors?

  Yes

  No

  N/A

• 7.2.6 - Clinical governance assessors?

  Yes

  No

  N/A

• 7.2.7 - Primary Dental Care (PCT) Cluster assessor/advisor?

  Yes

  No

  N/A

• 7.2.8 - General Dental Council (GDC) assessor?

  Yes

  No

  N/A

• 7.2.9 - National Patient Safety Agency (NPSA)?

  Yes

  No

  N/A

• 7.2.10 - Health & Safety Executive?

  Yes

  No

  N/A

• 7.2.11 - National Radiographic Practice Board (NRPB)?

  Yes

  No

  N/A

What was effective about this SEA:

Completed:

• Select date

  Date

• Add signature

  Sign