National System for Incident Reporting (NSIR) FAQ

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Introduction

Have a question about the National System for Incident Reporting (NSIR)? Wondering how other Canadian health care facilities collect, report on and analyze medication incident data securely and anonymously? Find out more in the Frequently Asked Questions on NSIR below.

Minimum Data Set

General Information About NSIR

What is the current scope for NSIR?

Types of incidents: NSIR collects data on potential and actual medication/IV fluid incidents. It does not collect information on adverse drug reactions. Adverse drug reactions should be reported to Health Canada.

Types of medications: NSIR collects data on incidents that involve

  • Marketed drug products
  • Special access drug products
  • Clinical trial drug products
  • Extemporaneous drug products

NSIR does not collect data on incidents that involve blood or blood products or on incidents that have to do with natural health care products.

Setting: The NSIR minimum data set helps you collect information on medication/IV fluid incidents that take place in participating Canadian health care facilities, including

  • Acute care and specialty hospitals
  • Ambulatory agencies
  • Long-term care facilities

Incident Impact

Do I need to provide a description of the medication incident?

While the description field is optional, it’s an opportunity to provide further context to the coded data elements. A description of the medication incident may provide a better understanding of the events and is a valuable piece of information to help support data quality and analysis.

Does NSIR have a decision-making tool to help me rate the level of harm resulting from a medication incident?

An algorithm can help you make more consistent and accurate ratings for the Degree of Harm of a medication incident. It can be found on page 4 of the NSIR data collection form and in Appendix A of the NSIR minimum data set document.

Incident Discovery

How do I code dates and times of medication incidents that involved multiple administrations to the same patient/resident over a period of time?

When an incident occurred over a period of time (multiple administrations), you are required to submit the date and time corresponding to the time that the incident first reached the patient (first dose).

Patient Characteristics

What level of patient/resident information is collected by NSIR?

NSIR collects the following optional data elements on patients/residents:

  • Sex
  • Birth month and year

Incident Details

How do I code a medication incident that involved several processes or resulted in more than one problem?

Both the Medication/IV Fluid Use Process and Medication/IV Fluid Problem are single-select data elements. When coding them, you are required to select the most responsible process and the most responsible problem. Usually this means the initial problem or process.

What happens if a medication incident involved more than one patient?

You are required to submit one incident record per patient/resident. Each incident is patient-/resident-specific, and there may be different outcomes.

Can the process of preparing/dispensing be divided into “preparation” and “dispensing” (for example, for something that is prepared incorrectly and caught before being dispensed)?

All activities involving preparing and dispensing have been grouped together under preparing/dispensing, even though only one of these activities might have been responsible for the incident. This approach aligns with the World Health Organization’s Conceptual Framework for the International Classification for Patient Safety.

Medication allergies are a common and significant issue. Why is “allergic reaction” not listed as an option for Medication/IV Fluid Problem?

NSIR’s definition of a medication incident includes the concept of preventability. An adverse reaction to a medication (where there was no previous knowledge of an allergy) cannot be prevented. The only time that a medication allergy would be relevant to a medication incident is if there was prior knowledge of the allergy. In that case, you would select wrong product when you code the Medication/IV Fluid Problem.

Drug Product Information

Can I provide information on more than one drug product for an incident?

Yes, you can submit a maximum of 10 drug products for each incident.

If the wrong drug product was given to the patient/resident, can I report both the drug that was given incorrectly and the one that should have been given?

Yes, you can optionally report both the correct and incorrect drug products; it is mandatory to identify only the incorrect product. When you code the Medication/IV Fluid Problem as wrong product, the system will ask you to identify the drug as the correct or incorrect product.

What is the drug product form for IV fluids or injectable drugs?

IV fluids and injected drug products are in solution form. Drugs that are administered orally can also be in solution form. Intravenous and injection refer to the route of administration.

Investigation and Findings

Can I submit an incident record without completing any data elements in the Investigation and Findings domain?

While the data elements in this domain are optional, you are strongly encouraged to complete all data elements, particularly for incidents that resulted in harm to the patient/resident. Information in this domain can capture lessons learned and encourage strategies to reduce recurrence of similar incidents. Sharing this information is useful to every organization that participates in NSIR.

Does Likelihood of Recurrence pertain to only my facility, or does it pertain to any facility where the medication incident could recur?

This data element seeks to determine if there is a likelihood that this medication incident could occur again in your health care facility.

Does Unplanned Admission/Readmission refer to only admissions and readmissions at my health care facility?

If a medication incident occurred that required admission or readmission to any health care facility (your facility or any other facility), then the response to this data element is yes.

What is meant by “root cause analysis”?

Root cause analysis is a specific investigative process that identifies underlying contributing factors related to an incident. Other investigative methods exist and are used by some organizations to achieve the same goal.

Functionality

Registration and Access

How many NSIR users can a participating health care facility have?

The standard is to have more than 1 but fewer than 10 NSIR users.

Incident Reporting Tool

How do I know which data elements are mandatory?

Mandatory data elements are noted on the electronic and paper copies of the data collection form. Mandatory fields online are marked with an asterisk and must be completed before the system will allow you to advance to the subsequent data entry screens.

Can I create a draft record and not submit it if I am missing information?

Yes, you can create draft records. Only you (the submitting organization) will have access to draft records. The data will not be included in analyses until the record is released. CIHI will send a reminder if a record remains in draft status for 30 days.

Can an incident record be modified after it is released to NSIR?

CIHI does not change data directly. If you need to add information or correct existing data, a record can be “unreleased” to the submitting health care facility. Requests to unrelease a record should be sent to nsir@cihi.ca and should contain

  • The NSIR Case ID
  • The reason for requesting the unrelease

NSIR will notify you via the Communication Tool once the record has been unreleased. You can then modify, save and re-release the record to NSIR.

Communication Tool

What types of messages can I anticipate receiving via the Communication Tool?

Messages from CIHI: CIHI will notify you when records have been held as draft for 30 days, or when quality issues and identifiers in text fields are found.

Messages from other submitting health care facilities and from ISMP Canada: Another user may conduct an analysis that includes records submitted by your facility. Any organization can use the link present on each individual record to send a message to your health care facility asking for more details.

Is the communication anonymous?

Yes, all communication via the Communication Tool is anonymous. Submitting health care facilities are assigned pseudonyms to protect their identity. Only organizations participating in NSIR can use the tool.

Analytical Tool

How do I access the Analytical Tool?

  • Log in to the NSIR Incident Reporting Tool.
  • Click the Analyze tab on the navigation bar to reach the Analyze screen.
  • From the Analyze screen, click the Analytical Tool link.
  • A new window will open.

How do I access the main folders in the Analytical Tool?

You can access a drop-down navigation menu by clicking the CIHI icon at the top left of the report screen. The logout feature is also located in this menu. You can return to the main NSIR screen by expanding the breadcrumb trail and clicking on the NSIR link.

Why do I get an error message when I try to use the back button in my web browser to navigate to a previously viewed screen?

You should use the tool’s back and forward arrows located in the CIHI banner to navigate back and forth between different report levels. Using the web browser’s back and forward buttons will result in a loss of data and a browser error message.

Who can see my health care facility’s data?

All registered NSIR users will be able to use your data for analysis; however, only organizations (and users associated with these organizations) that have been granted read permission to your data will be able to analyze your data identifiably.

How up to date is the data in the Analytical Tool?

Medication incident data is updated once an hour. This provides users with timely and accurate data for reporting.

At what level can I perform my analysis?

Analysis can be done at various levels, from local to pan-Canadian. You have the option to view results at the All NSIR level; by province, region, corporation or site; and even at the ward or unit level.

I would like to run a specific analysis, but a report template doesn’t currently exist. What can I do?

Contact NSIR at nsir@cihi.ca and provide details about the type of analysis you’d like to perform. We will discuss the feasibility of creating a new report template for your use and timelines for doing so.

Can I share the results of my report with others?

Health care facilities that submit data are permitted to analyze and disclose this data from their own facility as they see fit. Any disclosure of identifiable data from another facility must be done only after receiving written approval from that institution. Access to, use of and disclosure of NSIR data must always be in accordance with your organization’s agreement with CIHI.

What incidents are available for analysis?

All medication incident data submitted to NSIR, except records with an incident status of draft or deleted, will be available for analysis. You may limit which incidents are analyzed by providing criteria to filter the desired incidents.

An analysis that I ran produced a frequency greater than the number of known records. What does that mean?

Any analysis that is performed using a multi-select data element in the row, column or filter will likely result in a frequency count that is greater than the number of known incident records. The system provides the frequency of how many times the criteria selected for analysis are met. For example, because an incident can have multiple contributing factors, an analysis that selected specific contributing factor groups as filters will result in a frequency higher than the number of records. That is because the system counts how many times those contributing factors are found.

More Questions?
Please send us an email at nsir@cihi.ca with any other questions or queries that haven’t been addressed here.