Policy 3.4: Clinical Incident & Exposure Reporting  

I. Policy Statement

The School of Nursing (SoN) requires prompt reporting of all clinical incidents, errors, occupational exposures and near-miss events that occur during coursework or clinical training.

• Incidents involving patients (e.g., patient harm, risk of harm, HIPAA violations or drug diversion) must be reported for patient safety, regulatory compliance and possible escalation to the Washington State Board of Nursing (WABON) under WAC 246-840-513.
• Incidents involving students (e.g., injuries, illnesses, exposures or near-misses) must be reported for student safety, access to follow-up care and compliance with University and EH&S requirements.

Students report every incident to their preceptor or clinical faculty. Faculty report every incident to the School of Nursing. The School makes any report to the Washington State Board of Nursing.

The SoN applies a Just Culture model for incident review, focusing on accountability, learning and system improvement rather than blame.

Failure to report may result in review under UW School of Nursing Policy 4.1: Essential Qualifications & Behaviors. When the failure may also violate the UW Student Conduct Code, it is reported under UW School of Nursing Policy 4.2: Student Conduct & Eligibility for Participation.

II. Process: Clinical Incidents Involving Patients

Clinical incidents include events that result in patient harm, create an unreasonable risk of patient harm, involve diversion of legend or controlled substances or constitute HIPAA violations.

Definitions

Definitions (per the Washington State Board of Nursing Incident Report Form, provided under WAC 246-840-513):

• Unreasonable risk of harm: An act or failure to act, which is below the standard of care for what a reasonably prudent nurse would do in similar circumstances, thereby creating a risk of harm to the patient, whether or not actual harm resulted.
• Patient harm: Anything that impairs or adversely affects the health, safety or well-being of the patient. Harm includes physical, mental, emotional and sexual abuse, exploitation, neglect or abandonment.
• Alleged diversion of legend or controlled substances: A claim or assertion that an individual misappropriated any legend drug or controlled substance.
• Other: An incident that does not fall within the categories above. The form provides for these and requires a description.

Steps to take

Step 1: Immediate Notification

• The student, preceptor and clinical faculty ensure patient safety first.
• The student notifies the preceptor or on-site clinical faculty immediately. When the course faculty member is not on site, the student also notifies the course faculty member the same day.

Step 2: Site Response

• The student completes any incident report the clinical site requires, with the preceptor or clinical faculty.

Step 3: SoN Reporting

• The faculty member closest to the incident completes the SoN Clinical Incident Reporting form the same day they become aware of the incident, whether they learn of it from the student, the preceptor, the clinical site or another source, and including an incident that occurred earlier. For A/BSN students, this is the clinical instructor. For DNP and certificate students, this is the course faculty member, who gathers the details from the student and preceptor.
• A Program Official from OSAA reviews the report and determines whether it is reportable to WABON. Events involving patient harm, an unreasonable risk of patient harm or diversion of legend drugs or controlled substances are reported to WABON within two business days, as WAC 246-840-513 requires.

Step 4: Follow-Up

• Students may be temporarily removed from clinical activities, pending review.
• Faculty and ADAA ensure follow-up is documented in the student record.

III. Process: Incidents Involving Students

Examples: illness, injury, bloodborne pathogen exposure, fire, property damage, near-miss.

Step 1: Immediate Care and Notification

• For a bloodborne pathogen exposure, the student washes the wound with soap and warm water, or flushes the eyes, nose or mouth, for 15 minutes, then seeks care as directed by the UW Health Sciences Immunization Program bloodborne exposure process, which states where to go for care and how that care is paid for.
• The student seeks immediate care (emergency department, employee health or 911 if needed).
• The student notifies the preceptor or on-site clinical faculty immediately. When the course faculty member is not on site, the student also notifies the course faculty member the same day.
• The faculty member or preceptor maintains supervision of the student group. If the instructor leaves the site, all students leave unless another UW faculty member assumes responsibility.
• The faculty member closest to the incident notifies EH&S immediately, after first aid, medical care or emergency services, when an incident involves any of the following. The faculty member calls 206-543-7262 during EH&S business hours (8 a.m. to 5 p.m., Monday to Friday), or the UW Police Department at 206-685-8973 outside those hours to reach EH&S on-call staff:
  • Amputation, in-patient hospitalization, loss of an eye or fatality
  • Recombinant/synthetic DNA/RNA exposures or spills
  • Fire
  • Radioactive material spill, release or exposure, or exposure to a radiation producing device or laser

Step 2: Site Response

• The student completes any incident report the clinical site requires, with the preceptor or clinical faculty.

Step 3: University Reporting

• For a bloodborne pathogen exposure, the student first completes the BBP RedCap survey within 24 hours, following the UW Health Sciences Immunization Program bloodborne exposure process.
• The student reports every education-related injury, illness, exposure, fire, property damage or near-miss event in Enterprise Health within 24 hours of the incident. Students use Enterprise Health at every site, including UW Medicine facilities, because they are not employees of those facilities. The student names as supervisor the Course Coordinator for the clinical course (A/BSN) or the Specialty Director (DNP and certificates), and sends that person the report confirmation the same day.
• The Course Coordinator or Specialty Director confirms within 24 hours that the report has been filed, submits it on the student’s behalf when the student is unable to report or has not reported, and completes the supervisor section of the report.
• The student contacts EH&S (injury@uw.edu) with questions about the Enterprise Health report, the Health Sciences Immunization Program (myshots@uw.edu) with questions about bloodborne exposure care, follow-up, testing or costs, and the ADAA (sonadaa@uw.edu) with any remaining questions about School of Nursing incident reporting.

Step 4: SoN Reporting

• The faculty member closest to the incident completes the SoN Clinical Incident Reporting form the same day they become aware of the incident, whether they learn of it from the student, the preceptor, the clinical site or another source, and including an incident that occurred earlier. For A/BSN students, this is the clinical instructor. For DNP and certificate students, this is the course faculty member, who gathers the details from the student and preceptor.
• A Program Official from OSAA reviews and determines whether follow-up is required.

Step 5: Follow-Up

• The student complies with all recommended testing, treatment and monitoring. Students are not employees at clinical sites, so an exposure is not a workers’ compensation claim. Follow-up care, testing, insurance and billing are handled under the Health Sciences Immunization Program bloodborne exposure process.
• The student is encouraged to use support and referral resources (e.g., UW Counseling Center, Hall Health).

IV. Process Flowchart