Reporting Notifiable Incidents to HIQA and the Office of the Chief Inspector of Social Services under the Patient Safety Act 2023

Where a health services provider is satisfied that a notifiable incident, as listed in the table below, has occurred in the course of the provision of a health service to a patient, it shall notify HIQA, or the Chief Inspector where appropriate, as soon as practicable, and not later than 7 days from the day on which the provider was satisfied the incident had occurred. The health services provider shall make the notification by means of the National Treasury Management Agency incident management system (NIMS)

  • All private health service providers such as
    • private hospitals,
    • private clinics.
  • All private health service providers that carry out the business of a designated centre such as:
    • nursing homes.

  • All HSE and HSE funded services should use their local NIMS platform (Core NIMS) to notify HIQA and the Chief Inspector of Social Services of a notifiable incident- see link here
  • All approved centres that provide a health service should report to the Mental Health Commission see link here

Type of Notifiable Incident (Short Text)

Full Text Of Notification

1.1 Surgery performed on the wrong patient - unintended and unanticipated death

1.1 Surgery performed on the wrong patient resulting in unintended and unanticipated death which did not arise from, or was a consequence of, an illness, or an underlying condition, of the patient, or having regard to any such illness or underlying condition, was not wholly attributable to that illness. 

1.2 Surgery performed on the wrong site - unintended and unanticipated death

1.2 Surgery performed on the wrong site resulting in unintended and unanticipated death which did not arise from, or was a consequence of, an illness, or an underlying condition, of the patient, or having regard to any such illness or underlying condition, was not wholly attributable to that illness. 

1.3 Wrong surgical procedure performed on patient-unintended unanticipated death

1.3 Wrong surgical procedure performed on a patient resulting in an unintended and unanticipated death which did not arise from, or was a consequence of, an illness, or an underlying condition, of the patient, or having regard to any such illness or underlying condition, was not wholly attributable to that illness. 

1.4 Unintended retention of a foreign object in a patient - unanticipated death

1.4 Unintended retention of a foreign object in a patient after surgery resulting in an unanticipated death which did not arise from, or was a consequence of, an illness, or an underlying condition, of the patient, or having regard to any such illness or underlying condition, was not wholly attributable to that illness. 

1.5 Healthy patient undergoing elective surgery-unintended, unanticipated death

1.5 Any unintended and unanticipated death occurring in an otherwise healthy patient undergoing elective surgery in any place or premises in which a health services provider provides a health service where the death is directly related to a surgical operation or anaesthesia (including recovery from the effects of anaesthesia) and the death did not arise from, or was a consequence of (or wholly attributable to) the illness of the patient or an underlying condition of the patient. 

1.6 Unintended, unanticipated death directly related to any medical treatment

1.6 Any unintended and unanticipated death occurring in any place or premises in which a health services provider provides a health service that is directly related to any medical treatment and the death did not arise from, or was a consequence of (or wholly attributable to) the illness of the patient or an underlying condition of the patient. 

1.7 Patient death due to transfusion of ABO incompatible blood/blood components

1.7 Patient death due to transfusion of ABO incompatible blood or blood components and the death was unintended and unanticipated and which did not arise from, or was a consequence of (or wholly attributable to) the illness of the patient or an underlying condition of the patient. 

1.8 Patient death associated with a medication error

1.8 Patient death associated with a medication error and the death was unintended and unanticipated as it did not arise from, or was a consequence of (or wholly attributable to) the illness of the patient or an underlying condition of the patient. 

1.9 Unanticipated death while pregnant or within 42 days of the end of pregnancy

1.9 An unanticipated death of a woman while pregnant or within 42 days of the end of the pregnancy from any cause related to, or aggravated by, the management of the pregnancy, and which did not arise from, or was a consequence of (or wholly attributable to) the illness of the patient or an underlying condition of the patient. 

1.10 An unanticipated and unintended stillborn child

1.10 An unanticipated and unintended stillborn child where the child was born without a fatal foetal abnormality and with a prescribed birthweight or has achieved a prescribed gestational age and who shows no sign of life at birth, from any cause related to or aggravated by the management of the pregnancy, and the death did not arise from, or was a consequence of (or wholly attributable to) the illness of the patient or an underlying condition of the child. 

1.11 An unanticipated and unintended perinatal death

1.11 An unanticipated and unintended perinatal death where a child born with, or having achieved, a prescribed gestational age and a prescribed birthweight who was alive at the onset of care in labour, from any cause related to, or aggravated by, the management of the pregnancy, and the death did not arise from, or was a consequence of (or wholly attributable to) the illness of the child or an underlying condition of the child. 

1.12 An unintended death of a patient where the cause is believed to be suicide

1.12 An unintended death where the cause is believed to be the suicide of a patient while being cared for in or at a place or premises in which a health services provider provides a health service whether or not the death was anticipated or arose from, or was wholly or partially attributable to, the illness or underlying condition of the patient. 

2.1 (a) A baby who is referred for therapeutic hypothermia

2.1 (a) in the clinical judgment of the treating health practitioner requires, or is referred for, therapeutic hypothermia, or  

2.1 (b) A baby who did not undergo therapeutic hypothermia-contraindicated

2.1 (b) A baby who has been considered for, but did not undergo therapeutic hypothermia as, in the clinical judgment of the health practitioner, such therapy was contraindicated due to the severity of the presenting condition. 

The Patient Safety (Notifiable Incidents and Open Disclosure) Act 2023, expands HIQA’s standard-setting and monitoring functions to new services, such as private hospitals. HIQA held a consultation on amending the scope of the National Standards for Safer Better Healthcare to include private hospitals in March 2024. At the end of this public consultation, comments were collated to inform the amendment to the scope of the National Standards for Safer Better Healthcare. The updated standards were submitted to the Minister for Health for approval. This amendment to scope facilitates monitoring by HIQA in private hospitals against the National Standards for Safer Better Healthcare, on commencement of the Act.

  • Hyperlink to guidance on submitting notifiable incidents to HIQA
  • Hyperlink to PSA NIMS
  • Hyperlink to Chief Inspector of Social Services Guidance