Mercy Health is committed to providing the best care possible, but hospitals are complex environments and sometimes incidents occur that result in harm to a patient.
These can include things such as medication errors, falls and pressure injuries.
One very serious category of incident is called a sentinel event. Sentinel events are the result of unexpected events that result in death or serious harm to a patient while in the care of a health service. Other serious incidents are categorised as Incident Severity Rating 1 or Incident Severity Rating 2. Incident Severity Rating (ISR) describes the actual severity of an incident and is based on three things – the degree of impact (or harm), the level of care required and the treatment required. An incident could be rated as 1 (the most severe), 2, 3 or 4 (the least severe), depending on the severity.
In NSW, incidents are classified in the same way using a scale called the Severity Assessment Code (SAC).
In 2019/20, Mercy Health completed reviews on 92 ISR/SAC 2 and 99 ISR/SAC 1 incidents, including 10 sentinel events.
Mercy Health takes all patient incidents very seriously. Incidents are investigated and reports are provided to our Executive, Board and consumer advisors.
All incidents are reviewed in line with the Victorian Department of Health and Human Services and New South Wales Health sentinel event requirements and reported to the relevant Incident Response Teams within Safer Care Victoria and the Clinical Excellence Commission in New South Wales.
As a result of the reviews conducted on serious adverse events, we reviewed processes and procedures in line with best practice, and implemented changes as required. Some of the changes implemented included staff education and capacity building, as well as technology improvements.
Last reviewed February 17, 2021.