Report an incident

Use the form below to report an incident. None of the fields are compulsory but the more information you provide the more useful the report. Please avoid submitting any details which could indentify an individual.

Part 1: Who and where
Occupation of reporter
Patient(s):
Number of patients
Age (to the nearest year, e.g. 45)
Ethnicity
Where did the incident occur
Part 2: What happened

Including the following would be helpful; a description of what happened, how it was detected, what the outcomes were for both the patient and the healthcare professional, and what if any actions were taken to rectify the problem.

Please describe the incident

It would be helpful if you could try to classify the incident using the categories below. Not all incidents will be easily categorised, please choose what you consider to be the closest match.

Select a category
Select ProcessSelect Problem
Medication involvedSelect Medication use/ProcessSelect Problem
Select Document involvedSelect Problem
Type of device/propertySelect Problem
Select Staff wereSelect Patient was
Part 3: Prevention

Please describe any changes made to try and prevent this type of incident occurring again?

Are there any systemic changes that could be made or checks put in place that might prevent this type of incident occurring elsewhere?

Save Report

The Reporting System

The bpacnz Patient Safety Incident Reporting System is designed for people working in primary care (e.g. general practitioners, practice nurses, pharmacists, administrators) to report and review patient safety incidents.

The system is:

  • Non-punitive and independent of any authority with the power to punish
  • Completely anonymous, no identifying information is collected or recorded
  • Focused on systems or processes rather than individuals

The primary purpose of the bpacnz Patient Safety Incident Reporting System is to improve safety by identifying the factors that commonly contribute to incidents in primary care, and sharing solutions to prevent these incidents from occurring again.

Reports will be analysed by experts in primary care and clinical systems, and regular feedback based on these analyses will be published on the bpacnz website and in the Best Practice Journal. As well as published analyses, brief summaries of individual incident reports can be reviewed online. This onlinereview facility includes the ability to comment on reports and view comments and observations made by peers on an incident.