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Recommendations for QCIPA a good step forward

The recommendations made by the Quality of Care Information Protection Act (QCIPA) Review Committee are a positive start to bringing about change to the legislation, says Toronto health lawyer Michael Gleeson.

“This is a first step, but there will be second and third steps down the road before we actually see changes to the legislation or the recommendations being put into a practical format for implementation,” he tells AdvocateDaily.com

Gleeson, senior corporate counsel at Dykeman Dewhirst O’Brien LLP, says the committee did a good job given the compressed time frame of under one year to review the legislation.

“They’ve outlined next steps and several of the recommendations relate to which organizations should be engaged to implement the recommendations that have been put forward,” he says. 

QCIPA is legislation that was introduced in 2004 to improve the identification and investigation of critical incidents so that their causes are fully understood and changes can be instituted to prevent similar incidents from occurring in the future.

A critical incident is an unintended event that occurs when a patient receives treatment in an institution and results in death or serious disability, injury or harm to the patient, and the event does not result primarily from the patient’s underlying medical condition or from a known risk inherent in providing the treatment, explains the committee's report.

The legislation provides “a cloak of confidentiality” around the internal investigation at the health-care organization. This "cloak" encourages providers to be frank and forthright about what occurred to find out the true cause of the adverse effect. This then helps health-care organizations prevent similar incidents from happening in the future, adds Gleeson. 

The Ministry of Health and Long-term Care called for a review last year and a committee was formed to look at current practice in the interpretation and implementation of QCIPA and to make recommendations for improvement, if needed. Read Toronto Star

Patients and families had raised concerns that they weren't being fully informed of what happens when a critical incident occurs because of the confidentiality surrounding the QCIPA investigations.

The committee was established to look at how the act is used in conjunction with other legislation that has come into effect since QCIPA was enacted.

The review committee, which submitted its report to the ministry in December 2014, came up with 12 recommendations. Some recommendations directly relate to changes that should be made to the legislation itself while others focus on the need for fuller disclosure to patients.

Gleeson points to a recommendation that calls for the need to interview patients and families as part of the investigation process, which hadn’t been routinely done before the review.

“The committee recommended that the patient and families be part of the process,” he says.

“It also recommended that patients and families be informed at the time of the incident as much as possible, including about whether an investigation is going to take place, what the process is going to be for the investigation, and that they should be informed of the results of the investigation. Any changes implemented as a result of the investigation should be explained to the patient and family.”

The committee also recommended that a database be formed to facilitate the sharing of information about investigation results between health-care organizations.

“And that would be subject to keeping individual health-care providers' comments or actions confidential,” says Gleeson. 

Of the 12 recommendations, he says the database is a significant step forward.

“It will help health-care organizations across the province learn from mistakes that occur — or changes that are implemented — at other health-care facilities,” he says. “I think the more these organizations are able to learn from mistakes or changes across the system, the better it is for everyone in the province."

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