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🚨  Significant Events

🚨  Significant Events

Being named or involved in a significant event can cause doctors a huge amount of stress. In this section, we explain what a significant incident is, why you should retain evidence of your involvement in SIs, and how you will be asked to present the evidence at your appraisal.

What is considered a significant event?

Significant events are known by many names (i.e. Significant Incidents, Serious Incidents, Serious Untoward Incidents, or Serious Incident Requiring Investigation) but are essentially any unintended or unexpected event, which could or did lead to harm to one or more patients.

How do I know if I am involved in a significant event?

You may notice your own error, be informed by a colleague of an error you have made or be contacted by the Trust regarding a datix you have been named in.

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💡  TOP TIP A datix is not a way of attributing blame, but a mechanism for the Trust to identify and share learning and implement system-wide improvements. Really, it is a quality improvement tool.

If it is not already done, then you should ensure that any error you make or come across has been datixed so that the Trust can share learning and prevent similar incidents from happening again.

Don't be scared if you are named in an SI but speak to your supervisor or line manager about what steps you need to take. This will usually involve self-reflection that is recorded in your ARCP (Form R) or the Significant Events section of your appraisal (section 9).

Will I lose my license to practice if I am involved in an SE?

No, the Serious Incident investigation process is for learning only, and not to apportion blame. The goal of the investigation is to identify contributing factors and root causes, and to agree actions that can be implemented to prevent similar incidents from occurring again. However, it is true that in rare circumstances individuals are referred for investigation if the investigation uncovers evidence of an individual:

  • deliberately intending to cause harm
  • being unfit to carry out their duties,
  • acting in a grossly negligent manner

Do significant events go on my permanent record?

No, they do not.

The GMC lists 6 domains where a doctor's fitness to practice may be impaired and these can go on your GMC record. The one that most closely relates to involvement in a significant event comes under dishonesty - where you do not disclose relevant information to the GMC. Therefore, you may get into trouble for NOT disclosing a significant event, but not for making a clinical error in the first place (unless it was due to being drunk or high…).

Does this count as a significant event?

We recently saw this question from a junior doctor:

This year I was named in a datix because I made a prescribing error. No patient harm came about and the error was quickly rectified. I discussed my mistake with my clinical supervisor who advised that I do a written reflection about the error, which I have now done. Do I need to declare this as a serious incident at my appraisal?

This doctor has already done all of the right things:

  • confirming that the error was rectified and no patient harm came about
  • confirming that the error was appropriately datixed
  • discussing the error with their supervisor
  • writing a reflection about the error and their learning
  • noting that the incident has been closed

The work they have already done can now easily be uploaded to their appraisal document as evidence of involvement and learning from a significant event. Recognizing that none of us are infallible and showing that we can learn from our errors is important.

The key thing to remember here is that the GMC is not looking to punish you, and would much rather that you over-declare mistakes than appear to hide them. You will never be chastised for over-declaring something as an incident, but if you appear to be hiding it then there could be serious ramifications.

What records of my significant events should I keep in my portfolio?

Keep a brief written record of the significant incident and a written reflection on your involvement and any changes you plan to make as a result of the incident. Include information about how you ensured patient safety, who you reported the incident to, and what their advice was. Make sure that your record is confidential and doesn’t include any identifiable patient information.

If you have any email contact from your supervisor or the Trust about the incident then keep these records too, particularly anything detailing how the incident was resolved. Keeping all of your documents about each incident in your portfolio is:

  • a demonstration that you are upfront, honest, and open (Duty of Candor)
  • reassuring down the line when you can’t remember if an investigation was resolved
  • protection in the event that the incident results in legal action by the patient against the Trust

If you leave a Trust and lose access to your Trust email, having the documentation saved to a separate portfolio can ensure that you don’t suffer unnecessary stress down the line.

What do I need to declare at appraisal?

The GMC states that you must declare and reflect on every significant event or serious incident you were involved in at each appraisal. The purpose of this is to encourage you to reflect on your involvement in or contribution to serious incidents or events with the goal of learning from mistakes to improve your professional work.

Your MAG form has a specific section (section 9) for declaring all significant events.

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It looks like this if you have NOT been named in any significant events in the last year:
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It looks like this if you HAVE been named in any significant events in the last year: