Incident decision tree: An end to the blame culture in patient safety incidents?
 It is estimated that one in 10 in-patients experience some form of adverse incident during their care. Thankfully, the vast majority of these are minor. However, when things go badly wrong, the NHS is traditionally inconsistent and opaque in the way that staff are dealt with.
The National Patient Safety Agency has developed an on-line flowchart tool to help guide managers through analysis of incidents. It is being officially released in May but the tool is available now (see link below) for use and feed back.
The incident decision tree has been developed by the NPSA to help NHS managers decide how to handle staff involved in a serious patient safety incident. Following excellent feedback on a prototype from the secondary care sector, there is now a web-based version of the tool covering the whole healthcare community, including primary care organisations, GP and dental practices and community pharmacists and optometrists. This new version was launched on 3 October on a six month working pilot basis, during which comments, ideas and feedback from users will be sought.
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