The Radiation Incident Safety Committee: Supporting Cancer Programs in the Delivery of High Quality Radiation Treatment

Abstract

Purpose: The Radiation Treatment Program (RTP) at Ontario Health, Cancer Care Ontario, established the Radiation Incident Safety Committee (RISC) responsible for promoting incident learning, safety and quality improvement. The committee uses a provincial approach, discussing regularly reported safety events, to operationalize quality improvement initiatives intended to support integrated cancer programs (ICP)s. A retrospective review of actual incident event types reported identified variation in the number of submitted incidents within a portion of ICPs. In response to this observed variation, RISC sought to identify areas of success and opportunities for improvement in supporting ICPs in effective incident reporting and learning. Methods: RISC distributed a three-part survey to ascertain the current state of the quality and incident reporting practices across the province. The survey explored program quality and incident reporting practices across the following three domains. 1. Compliance with the Canadian Partnership for Quality Radiotherapy's (CPQR) “Quality Assurance Guidelines for Canadian Radiation Treatment Programs” guidance document (specifically exploring the document's key quality indicators relevant to incident reporting). 2. Local incident reporting culture and practices, and 3. The programmatic impact of RISC initiatives. Results: Seventy-three per cent of programs (n=15) identified that they regularly review compliance to the CPQR indicators, with 67% of programs reviewing compliance within the last year. One hundred per cent of programs had procedures to identify critical radiation treatment incidents and report incidents as per requirements of local, provincial, and/or national organizations, as per CPQR guidance. 87% of responding programs identified that they had local written policies and procedures regarding the reporting, investigation, action, documentation, and monitoring of treatment. Finally, with respect to incident learning processes, 80% of programs perform root cause analyses for severe events or those at risk for programmatic impact. Relating to RISC Initiatives, responding ICPs described they had established mechanisms to share RISC deliverables and incident alerts with the inter-professional team and radiation department. Programs also identified that RISC initiatives had a positive impact, providing guidance and improving reporting consistency. Lastly, ICPs identified that there were opportunities for further support, specifically in the interpretation of dosimetric impact and the classification of complex events. Conclusion: The RISC survey identified a number of successes and opportunities for improvement. Programs have implemented policies and procedures surrounding incident reporting and learning, however, there are opportunities to improve aspects of incident reporting at a local and provincial level. RISC plans to establish novel solutions to support programmatic learning as the committee continues to expand its mandate, improving the quality and safety of radiation treatment in Ontario.