An adverse incident is where harm has occurred, and a near miss is where harm could have occurred.

If an adverse incident occurs you should:

1. apologise to the patient
2. explain what has happened
3. explain any remedial action.
   
   This is what is meant by the duty of candour.

If necessary, you should also:

1. investigate the adverse incident
2. take the appropriate action
3. keep a written record.

You should record any adverse incident somewhere central to the practice, for example in your practice’s system or in the practice Accident Book. This applies even if it was not due to any fault of the practice or practitioner.

If a near miss occurs, you should learn from it and you should reassure the patient if you think it caused them concern.

You should report any near misses or adverse clinical incidents involving patients receiving NHS-funded care:

1. in England and Wales to the National Reporting and Learning System (NRLS). This does not collect any patient or practitioner identifiable information²²³ 
2. in Scotland to your local health board²²⁶
3. in Northern Ireland to the Northern Ireland Adverse Incident Centre.²²⁴ 

If the adverse incident was due to a drug or medical device you should report this to the Medicines and Healthcare Products Regulatory Agency, as appropriate.^225, 227 See sections on Infection control and Use and supply of drugs or medicines in optometric practice.