The submission of notifications of certain incident or events to the Chief Inspector in HIQA, are a regulatory requirement for specific social care services, primarily nursing homes and residential services for people with disabilities. These notifications describe a range of events which have an actual or potential impact on the health and wellbeing of residents. For example, the outbreak of infectious diseases; allegations of abuse; staff misconduct; and serious injury. The events that should be notified and the services required to submit notifications are outlined in the Health Act, 2007.

The information included in notifications is used by HIQA inspectors, in conjunction with other information, to assess the level of risk in centres and inform their monitoring approach, under HIQA’s regulatory function.

Capturing the occurrence and handling of adverse events is important in order to prevent future similar events. However, some of the statutory notifications are of unavoidable incidents such as the expected death of an older person in a nursing home. Other events captured may be where residents have engaged in positive risk-taking or that something occurred which was outside the control of staff and management in a centre. In this regard, how a centre has dealt with the event is important. As such, HIQA welcomes the submission of statutory notifications and encourages service providers to be transparent and open about what happens in their centres.

The LENS Project (LEarning from Notifications in Social care) was a three-year secondary data analysis project undertaken within HIQA. The project, funded by the Health Research Board [SDAP-2019-005, PI: L O’Connor] and co-funded by HIQA, sought to make use of data from statutory notifications to inform regulatory policy and practice as well as quality improvement initiatives.

The primary objective of the LENS Project was to develop an accessible, analysable and reusable database of statutory notifications from centres for older persons and people with disabilities in Ireland.

The LENS Project also encompassed a range of work packages which targeted specific aspects of statutory notifications:

• Description of trends over time in the volume and type of notifications received
• Identification of determinants of risk in notifications
• Identifying and sharing good practice in the aftermath of notifiable events
• Development of a lexicon to support standardisation of language used in submission of notifications
• Inform prioritisation of notifications based on risk ratings.

For further information please email lens@hiqa.ie

Quality data play an integral role in evidence-based policy-making, informing practice and the provision of quality care within our health and social care services. Publishing data collected from within health and social care services, so that it is findable, accessible, interoperable and reusable (FAIR data) is important as it maximises the potential for use and can stimulate innovation. Compiling data at a national level facilitates analyses that can help us to better understand current practices, determinants and gaps that may not be evident when smaller datasets are used.

As part of the LENS Project, we have assembled a comprehensive dataset of the statutory notifications received by HIQA from designated centres for older persons and people with disabilities in Ireland since the introduction of an electronic system for receipt of notifications in 2013. The database includes detail on the occurrence of an adverse event, and includes for example, the timing of the event, the people present, the risk rating assigned, actions taken in the aftermath. The database also includes demographic detail on the centre, including for example, bed numbers, staff/resident ratios and distance to an acute hospital.

The aim was to create an analysable repository of notifications received and to make the information readily accessible and reusable. As such, we have published an open access version of the database. For reasons of privacy and to protect the identity of people living in these services, it is necessary to desensitise the dataset in order to make it publicly available. All data that could potentially identify a person has been removed from the dataset. Notwithstanding this, every effort has been made to retain as much data as possible.

The database is updated each year with the previous year’s notifications.

While these data are freely available for anyone to use, any publications arising out of their use should clearly acknowledge the database. The database can be cited as follows: Health Information and Quality Authority (Year). Database of Statutory Notifications from Social Care in Ireland (Open Access)

The open database can be accessed on Tableau Public by clicking here. We have developed an eLearning course to support you in interpreting and using the data. People who intend to use the database for analyses should complete the eLearning course first. Database of Statutory Notifications from Social Care in Ireland (Open Access): User Guide.

The database is downloadable under publications below. You can also find useful documents to support the use and interpretation of the data under publications.

Any queries on the database can be directed to: lens@hiqa.ie.

Core LENS project research publications:

• Public reporting of adverse events from long-term care facilities for older persons and people with disability in Ireland 2013-2019: development of an openly accessible database and descriptive analyses
• Management and reporting of safety incidents by residential care facilities in Ireland: A thematic analysis of statutory notifications
• The Association of Organizational, Environmental, and Staffing Characteristics of Residential Care Facilities and the Risk Rating of Statutory Notifications: A Cross-Sectional Study in Ireland

Other research making use of the Database of Statutory Notifications from Social Care:

• Incidence and type of restrictive practice use in nursing homes in Ireland
• Incidence and type of restrictive practice use in residential disability facilities in Ireland, a cross‐sectional study
• To summarise the approach to and findings of the PPIE undertaken as part of a programme of secondary research with a vulnerable, hard to reach population during the COVID-19 pandemic
• Mortality in residential care facilities for people with disability: a descriptive cross-sectional analysis of statutory notifications in Ireland

Presentations:

• Project Overview and Development of the Database - Dr Laura O’Connor
• Accessing and using the database - Paul Dunbar
• Descriptive analyses of statutory notifications - Stephanie O’Regan
• Current practice in the aftermath of notifiable events - Dr Niall McGrane