Table 1

 Features of the event reporting system (ERS) entry process

• Implemented throughout all clinical care areas
• Levels 1 and 2 user types
• 4 major event classifications: falls, medication, adverse clinical events, and administrative
• 4 major events further classified into 71 subtypes and 301 secondary subtypes
• Demographic/background information for each event
• 18 questions with drop down menus
• Open ended narrative to document incident details
• Level of impact taxonomy (0–10):
    (0) Unknown: level of impact unknown at time of event report.
    (1) Safety environment: there are unsafe practices, conditions or circumstances that could cause an adverse event.
    (2) Near miss: event could cause adverse event but did not involve patient.
    (3) No harm—no increased monitoring: event involved patient but there was no harm.
    (4) No harm—increased monitoring: event involved patient, there was no harm, but there was increased monitoring.
    (5) Temporary harm—no treatment: temporary effect on patient. Intervention not instituted.
    (6) Temporary harm—minor treatment: temporary or reversible effect on patient. Intervention instituted.
    (7) Temporary harm—major treatment: temporary or reversible effect on patient requiring higher level of care such as initial or prolonged hospitalization.
    (8) Permanent harm: event occurred that may have contributed to permanent harm.
    (9) Near death event: for example, anaphylaxis or cardiac arrest.
    (10) Death: event may have contributed to patient death.
• Contributing factors: human, system, patient, equipment, environmental
• Recommendations for improvement