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Table 1 Structure of the mMERIT Incident Review Report, relationship between the 11 questions in mMERIT and the original 18 MERIT items and examples of expected standard for assessors. Examples of highly satisfactory content are provided at the end of each of the three sections

From: Learning from errors: assessing final year medical students’ reflection on safety improvement, five year cohort study

Incident Review Report Original 18 MERIT Items Guide for Assessors
Personal Learning Factor 1: Personal Characteristics of QI Examples of expected standard
1. What do you think were the contributing factors for the doctors involved in this incident? • Quality of reflection on doctors practice
• Sufficient details to delineate contributing factors
Demonstrates an understanding of the situation and can discuss the contributory factors within their incident and discusses in detail.
2. What could the doctors do to avoid similar problems in the future? • Relevant new behaviours were proposed Communicate with the team, patient, family
Take a break, eat
Find a more suitable environment to do task
Consult a senior, Use protocols
3. What personal learning needs have you identified from this incident review? • Doctor questioned their readiness to practice.
• Multiple options for personal change were considered.
• Contributing personal factors were identified
Characteristics – both technical and non-technical skills – readiness to practice i.e. lateness, attention to detail, memory
Use of checklists, memory aids, asking for help
4. How will you meet these learning needs? • Next steps towards personal change were identified. Identifies specific ways to change
Personal Learning Score Mark from 1 to 7: A score of 6 or 7 would include examples of: situational awareness, specific and timed learning objectives.
Changes required to the system Factor 2: System characteristics of QI Examples
1. What do you think were the systems factors that contributed to this incident? Systems factors includes: the characteristics of the team and clinical setting where the incident took place, in addition to the organisation. • Quality of reflection on the institution or wider health care system.
• Current institutional practice or system was questioned
• Contributing system factors were identified.
Culture – hierarchy structure, team work, communication between teams, different staff teams
Environment e.g. noisy, lack of space to work cramped conditions, continually interrupted
2. What changes to the system might avoid similar problems in the future • Relevant changes to the system were proposed
• Next steps towards system change were identified
Use of multiprofessional handover, safety briefings, medicines reconciliation e.g. use of more than one source to confirm medications. Effective communication
3. What tests could be done to see if the changes might work? • Multiple options for system change were considered Testing any of the ideas above.
System Characteristics Score Mark from 1 to 7: A score of 6 or 7 would include examples of changes to doctors and nurses working and small tests of change
Why it is an important incident Factor 3: Problem of Merit Examples
1. What was the impact of this incident on the patient? • Event was patient centred Patient had an increased length of stay, patient had to undergo other investigations, patient developed infection, DVT, Investigations/theatre cancelled or delayed
2. How likely is it that similar incidents could affect other patients? • Potential for event to affect other patients Evidence of Impact of this incident on other patients
3. What is the worst that could happen to a patient because of an incident like this? • Event could cause negative clinical impact
• Overall problem of merit
Recognising the worst consequences from this incident e.g. The patient could have lost the wrong leg, required renal replacement, patient had to be admitted to HDU/ICU.
4. Event was evidence based in description • Quality gap established from standards and guidelines (local or national) Evidence of further reading, highlights local /national guidelines, relates other initiatives to incident, examples of good practice e.g. use of new folder for current admission.
Incident Importance Score Mark from 1 to 7: A score of 6 or 7 would include examples of patient involvement and of negative impact on patient and public confidence in the NHS or on patient experience
Overall Score Mark from 1 to 7  
*Guide to scoring (1–7) Description
1–2 Concern
3–5 Satisfactory
6–7 Highly satisfactory