Incident Reporting & Learning System

Incident Reporting started as part of Quality Assurance tool in MOH Hospitals. First document on Incident Reporting was produced as part of Quality Manual in 1999. A specific policy and guideline on Incident Reporting & Learning System 1.0 was produced in 2013 as part of Patient Safety initiative, to learn from error and improve healthcare system. In 2013, the scope of IR implementation was extended to all healthcare facilities in Malaysia when Incident Reporting and Learning System was included as one of the Malaysian Patient Safety Goals.

In Ministry of Health hospitals, IR system is further strengthen with the development of National online reporting, e-IR. This Incident Reporting & Learning System 2.0 is produced based on the feedback of the implementers and Ministry’s aspiration in improving Patient Safety further and to be High Reliability Organisation. This is the reason why incidents should not be ignored and should be seen as an opportunity for improvement. Although priority should be given to incident with “severe” patient outcome or death, ‘near miss’ that could have resulted in serious harm or death should also be taken seriously, reviewed and managed before actual harm occurs.