Look-back Review Process Guideline

Process Checklist

Look-back Review Process
The purpose of the check-list is to act as an aide memoir to managers and staff to assist them to ensure compliance with the HSE Look-back Review Process Guidelines.
The check-list must always be used in conjunction with the HSE Look-back Review Process Guidelines. References to the relevant sections of the Guideline have been included in the check-list. / You should refer to the relevant Guideline Section(s) for guidance on each stage of the process. / Tick as appropriate
1 / Stage 1: Preliminary Risk Assessment / Section / Yes / No / N/A
1.1 / Senior Accountable Officer was notified that a Look-back Review Process may be required / 7.2
1.2 / Senior Accountable Officer established a Safety Incident Management Team within 24 hours of being notified / 7.3-7.4
1.3 / The Preliminary Risk Assessment was commissioned by the Safety Incident Management Team / 7.6
1.4 / Using the information obtained from the Preliminary Risk Assessment, the Safety Incident Management Team made a decision to progress to the Audit and Recall stages of the Look-back Review Process / 7.6.5
1.5 / The Safety Incident Management Team informed the relevant National Director of the decision to progress with the Look-back Review Process / 7.6.6
2 / Stage 2: Audit Stage / Section / Yes / No / N/A
2.1 / The Safety Incident Management Team agreed the Scope and the Terms of Reference of the Audit and Recall stages of the Look-back Review Process / 7.7
2.2 / The Safety Incident Management Team developed a Look-back Review Action/Work Plan to inform the Audit and Recall Stages of the Look-back Review Process / 7.7
2.3 / A data collation tool was established collate and track the information gathered by the Look-back Review Process / 7.7
2.4 / The Audit was undertaken by Service Providers or experts commissioned by the Service Providers / 7.7
2.5 / The Audit identified persons affected to be included in the Recall stage / 7.7
2.6 / The Communication Plan was rolled out by the Safety Incident Management Team / 7.7
2.7 / The Information Line was established by the Safety Incident Management Team / 7.7
2.8 / The Safety Incident Management Team established Recall Team(s) / 7.7
3 / Stage 3: Recall Stage / Section / Yes / No / N/A
3.1 / The Recall stage was announced by the relevant National Director / 7.8
3.2 / The Recall stage was announced after persons affected had been informed of their inclusion in the Recall stage of the Look-back Review Process / 7.8
3.3 / The Recall Team(s) implemented the Recall stage as per the Look-back Review Action/Work Plan / 7.8
3.4 / The Recall Team identified actions to be taken to address any deviations from required standards of care / 7.8
3.5 / The Recall Team implemented actions and/ or communicated required actions to the Safety Incident Management Team / 7.8
3.6 / The Safety Incident Management Team developed an anonymised report of the Look-back Review Process / 7.8
3.7 / The Chair of the Safety Incident Management Team submitted the anonymised report of the Look-back Review Process to the Senior Accountable Officer, the National Director and any others identified in the Look-back Review Action/Work Plan / 7.8
3.8 / The Chair of the Safety Incident Management Team communicated recommendations arising from the Look-back Review Process to the Senior Accountable Officer and national Director / 7.8

NIMLT F016: Look-back Review Process Checklist, December 2015