Guide:
Risk Management and Safety Standard

A patient safety incident refers to any event or circumstance that could have or did result in unnecessary harm to a patient. This includes:

• Near misses: Events that could have caused harm but were avoided.
• No-harm incidents: Events that occurred but did not result in patient harm.
• Harmful incidents: Events that resulted in harm to the patient.

Examples of patient safety incidents may include patients falling while performing an exercise or being hurt by the application of a treatment modality.

A patient safety management plan is a written plan that describes how you would handle an incident where a patient was, or almost was, harmed.

Patient safety management plans can be written up in various formats. Make sure to invest time to identify the anticipated risks to patients in your practice setting and personalize the plans to match the kinds of things you do in practice and how you could respond. 

Routinely review the plan to ensure it is easy to understand and accessible. Communicate the plan to anyone who might be involved.

Patient safety incident management plans may include: 

• A list of what could cause harm to a patient during or after assessment or treatment.
• A description of how the incident is recognized – what are the signs?
• What steps need to be taken to immediately manage the situation, and who would be involved while the patient is in the clinic.
  • Do you have a clear plan to respond if a patient should go into cardiac arrest?
  • What if a patient falls or has an episode of dizziness?
  • Is it safe for the patient to leave the setting unaccompanied?
  • What follow-up is needed? And what is the time frame for the follow-up?  
• What steps will be taken when the patient safety incident becomes apparent after the patient has left the practice setting. (e.g., the patient calls with reports of a new pain at the injury site or has greater difficulty with moving)
• Instructions or advice to be given to patients to manage any incidents should they occur after the patient leaves your practice. 
• Instructions to document a summary of any incidents in the patient chart. 

While every patient safety incident will require its own unique approach, below are some guidelines to ensure that you are proactive, transparent, empathetic, and focused on continuous improvement when responding to adverse events.

1. Before the Incident: Maintain your competence in relevant safety protocols, procedures, and risk mitigation measures, including emergency preparedness training, and have a patient safety management plan in place.
2. Immediate Response: After an incident occurs, prioritize the immediate clinical and emotional needs of the patient and their family, including:
   • Addressing their physical well-being and providing necessary clinical care.
   • Offering emotional support through empathetic communication so patients feel heard and understood.
   • Ensuring the environment is safe by removing hazards that might cause recurrence and alerting others in the practice to potential risks.
3. Patient Disclosure: Disclosure is an ongoing process that can be handled sensitively by:
   • Apologizing^[1] sincerely and clearly outlining the facts as they are known.
   • Sharing the steps you are taking to investigate and prevent future occurrences.
   • Customizing the process based on the needs of the patient and family.
4. Learning and Improvement: Analyze the incident after it happened to understand why it occurred and what factors contributed.
   • Share the lessons learned both internally with staff and externally with relevant reporting systems to help identify root causes and prevent recurrence.
   • Encourage transparency in your workplace by debriefing after incidents to discuss what went wrong, how it was handled, and how to improve in the future.
5. Follow-Through and Reflection: Implement changes based on your analysis, monitor their effectiveness, and share outcomes with the patient, staff, and external bodies. This ensures that the incident leads to improvements in safety and care quality.
   • See the College’s Critical Incident Report and Identification of Learning Needs forms to help guide you through this self-reflective process.

[1] According to Ontario’s Apology Act, 2009, an apology is an expression of regret or sympathy and does not, by itself, constitute an admission of fault or liability.

Documenting the inspection, maintenance and servicing of physiotherapy equipment provides evidence that the necessary steps have been taken to ensure that equipment is safe for patient use. Always know where to access the equipment maintenance records in your workplace.

It is your responsibility as a physiotherapist to understand the risks of the equipment you use on patients.

Familiarize yourself with your workplace’s cleaning and maintenance procedures. Ensure equipment is maintained and calibrated per manufacturer guidelines and that infection control protocols are followed. While maintenance may be handled by other trained individuals, you must verify that it has been done and know the completion date.

Even if you do not have direct control over the maintenance of equipment, you are expected to take reasonable steps to ensure that it is safe.

Think about what might reasonably go wrong with the equipment and have a plan to deal with the risk. For example, you may want to visually inspect a walker or cane before providing it to a patient to ensure things like the rubber tips and hand grips are in good condition, and any nuts or bolts are not loose. You must also ensure the equipment is properly cleaned between each patient use.

According to the Health Care and Residential Facilities Regulation under the Occupational Health and Safety Act, employers must retain reports and records for at least one year, or longer if necessary, to ensure the two most recent reports are on file.

This means that if annual examinations are being made, the records would have to be kept for two years. It does not prevent records from being kept for longer periods of time.

Consider keeping the records, at a minimum, for the time recommended by the manufacturer for recalibration. For example, if a company recommends that their machine be recalibrated every two years, records of recalibration must be kept for two years from the date of the last entry, even if the equipment is discarded. However, you may consider keeping these records for longer depending on the equipment’s risk level and maintenance schedule.