2017 ORS 442.837¹
Oregon Patient Safety Reporting Program

This section is amended
Effective April 3, 2018
Relating to health care facilities; creating new provisions; amending ORS 192.660, 441.020, 441.025, 441.030, 441.065, 441.077, 442.015, 442.120, 442.700, 442.837 and 677.515; and declaring an emergency.

(1) The Oregon Patient Safety Reporting Program is created in the Oregon Patient Safety Commission to develop a serious adverse event reporting system. The program shall include but is not limited to:

(a) Reporting by participants, in a timely manner and in the form determined by the Oregon Patient Safety Commission Board of Directors established in ORS 442.830 (Oregon Patient Safety Commission Board of Directors), of the following:

(A) Serious adverse events;

(B) Root cause analyses of serious adverse events;

(C) Action plans established to prevent similar serious adverse events; and

(D) Patient safety plans establishing procedures and protocols.

(b) Analyzing reported serious adverse events, root cause analyses and action plans to develop and disseminate information to improve the quality of care with respect to patient safety. This information shall be made available to participants and shall include but is not limited to:

(A) Statistical analyses;

(B) Recommendations regarding quality improvement techniques;

(C) Recommendations regarding standard protocols; and

(D) Recommendations regarding best patient safety practices.

(c) Providing technical assistance to participants, including but not limited to recommendations and advice regarding methodology, communication, dissemination of information, data collection, security and confidentiality.

(d) Auditing participant reporting to assess the level of reporting of serious adverse events, root cause analyses and action plans.

(e) Overseeing action plans to assess whether participants are taking sufficient steps to prevent the occurrence of serious adverse events.

(f) Creating incentives to improve and reward participation, including but not limited to providing:

(A) Feedback to participants; and

(B) Rewards and recognition to participants.

(g) Distributing written reports using aggregate, deidentified data from the program to describe statewide serious adverse event patterns and maintaining a website to facilitate public access to reports, as well as a list of names of participants. The reports shall include but are not limited to:

(A) The types and frequencies of serious adverse events;

(B) Yearly serious adverse event totals and trends;

(C) Clusters of serious adverse events;

(D) Demographics of patients involved in serious adverse events, including the frequency and types of serious adverse events associated with language barriers or ethnicity;

(E) Systems’ factors associated with particular serious adverse events;

(F) Interventions to prevent frequent or high severity serious adverse events;

(G) Analyses of statewide patient safety data in Oregon and comparisons of that data to national patient safety data; and

(H) Appropriate consumer information regarding prevention of serious adverse events.

(2) Participation in the program is voluntary. The following entities are eligible to participate:

(a) Hospitals as defined in ORS 442.015 (Definitions);

(b) Long term care facilities as defined in ORS 442.015 (Definitions);

(c) Pharmacies licensed under ORS chapter 689;

(d) Ambulatory surgical centers as defined in ORS 442.015 (Definitions);

(e) Outpatient renal dialysis facilities as defined in ORS 442.015 (Definitions);

(f) Freestanding birthing centers as defined in ORS 442.015 (Definitions); and

(g) Independent professional health care societies or associations.

(3) Reports or other information developed and disseminated by the program may not contain or reveal the name of or other identifiable information with respect to a particular participant providing information to the commission for the purposes of ORS 442.819 (Definitions for ORS 442.819 to 442.851) to 442.851 (Limit on amounts collected to fund Oregon Patient Safety Reporting Program), or to any individual identified in the report or information, and upon whose patient safety data, patient safety activities and reports the commission has relied in developing and disseminating information pursuant to this section.

(4) After a serious adverse event occurs, a participant must provide written notification in a timely manner to each patient served by the participant who is affected by the event. Notice provided under this subsection may not be construed as an admission of liability in a civil action.

(5) The commission shall collaborate with providers of ambulatory health care to develop initiatives to promote patient safety in ambulatory health care. [2003 c.686 §4; 2009 c.436 §5; 2011 c.30 §4]

Note: See note under 442.819 (Definitions for ORS 442.819 to 442.851).

Chapter 442

Atty. Gen. Opinions

Participa­tion of hospital owners or administrators in joint review of hospital expenses, services, (1978) Vol 38, p 2060; State Health Planning and Develop­ment Agency’s responsibility to evaluate and act upon nursing home budget and rate increase notifica­tions where posi­tions and funds are deleted from agency’s budget, (1979) Vol 40, p 56; health systems agency’s failure to review or submit recommenda­tion and findings on applica­tion for certificate of need, (1979) Vol 40, p 135

1 Legislative Counsel Committee, CHAPTER 442—Health Planning, https://­www.­oregonlegislature.­gov/­bills_laws/­ors/­ors442.­html (2017) (last ac­cessed Mar. 30, 2018).
2 Legislative Counsel Committee, Annotations to the Oregon Revised Stat­utes, Cumulative Supplement - 2017, Chapter 442, https://­www.­oregonlegislature.­gov/­bills_laws/­ors/­ano442.­html (2017) (last ac­cessed Mar. 30, 2018).
3 OregonLaws.org assembles these lists by analyzing references between Sections. Each listed item refers back to the current Section in its own text. The result reveals relationships in the code that may not have otherwise been apparent.