21HSerious adverse event review of incident

#### 21H Serious adverse event review of incident 21H Serious adverse event review of incident > > (1) A serious adverse event review team is to carry out a serious adverse event review of the incident in respect of which it was appointed. > > > (2) A serious adverse event review team must, on completion of the serious adverse event review of an incident, provide a report in writing to the relevant health services organisation that sets out a description of the incident and details of the following findings identified by the team— > > > > > (a) how the incident occurred, > > > > > (b) any factors that caused or contributed to the incident, > > > > > (c) any procedures, practices or systems that could be reviewed (areas for review findings) for the purposes of a recommendations report. > > > (3) After considering the findings of the serious adverse event review team, the relevant health services organisation may (and must if the findings include areas for review findings) direct the team to prepare a report (a recommendations report) setting out its recommendations (if any) as to the need for changes or improvements in relation to a procedure, practice or system (including clinical redesign) arising out of the incident. > > > (4) The relevant health services organisation may, for the purposes of the preparation of a recommendations report, appoint additional persons to the serious adverse event review team. > > > (5) The serious adverse event review team must provide the recommendations report in writing to the relevant health services organisation. > > > (6) Subject to section 21O (Information not to be given in evidence), the contents of a report of a reviewer under this section may be disclosed to any person and used for any purpose. > > **s 21H:** Ins 2018 No 2, Sch 1\[2\].