Never Events for Hospital Care in Canada
Patients rightfully expect safe care, and healthcare providers work to provide care that results in better health and safe outcomes for patients. Unfortunately, events that harm patients do occur while care is being provided, or as a result of that care. Many of these events that cause harm are preventable using current knowledge and practices.
"Never events" are patient safety incidents that result in serious patient harm or death that are preventable using organizational checks and balances.
An action team from the National Patient Safety Consortium developed a list of the top 15 never events for hospital care in Canada. The report focuses on events that can occur to a patient while in a healthcare facility (where care providers have a high amount of control over care).
Strategies to identify and reduce never events
This work aims to provide some areas and targets for continually improving patient safety. We believe various strategies can be effective in identifying and reducing never events, including:
- cultural changes
- reporting and learning systems
- identification of opportunities for improvement
- continuous improvement supported by measurement and evaluation
The Incident Management Toolkit, a resource available from HEC, is designed to help healthcare organizations prevent patient safety incidents and minimize harm when incidents do occur.
Never events action team
The never events action team included the following experts and patient representatives:
- Atlantic Health Quality and Patient Safety Collaborative
- British Columbia Patient Safety and Quality Council
- Healthcare Excellence Canada (HEC)
- Health Quality Council of Alberta
- Health Quality Ontario
- Manitoba Institute for Patient Safety
- New Brunswick Health Council
- Newfoundland and Labrador Patient Safety and Quality Committee
- Patients for Patient Safety Canada (a patient led program of HEC)