- Determine if the event meets the adverse event definition (PDF). The Resources webpage has more guidance on adverse event definitions.
- Confirm that the adverse event is included in the list. Notify the Department of Health by completing and submitting the notification form (Word). An electronic notification form is also available. Once our office has received your notification, an email will be sent to confirm notice of an adverse event at your facility.
- Optional: Complete the Contextual Information Form (Word) and submit it with the notification form. Facilities may want to provide more explanation of a reported event. Contextual information forms will be posted on the Adverse Events Reports webpage.
- Conduct a root cause analysis (RCA) to determine the causes of the event. Refer to the RCA Process Guide (PDF) to gather and review information. Acceptable RCA form reports include those offered by The Joint Commission on Accreditation of Health Care Organizations and The Department of Veterans Affairs National Center for Patient Safety.
- Implement a corrective action plan for each adverse event consistent with the findings of the RCA.
- Prepare the RCA report and include the corrective action plan. Remove any patient or staff identifiers.
- Submit the completed RCA report: Include facility name, event type, and confirmation date on the report cover letter. Also, when mailing multiple RCA reports, identify the RCA that corresponds to each adverse event
By mail:
Washington State Department of Health
Community Health Systems, Adverse Events
P.O. Box 47853 | Olympia, WA 98504-7853
By courier delivery:
Washington State Department of Health
Community Health Systems, Adverse Events
111 Israel Rd. S.E. | Tumwater, WA 98501
We do not recommend sending Root Cause Analysis and Action Plans electronically. We are not able to ensure confidentiality is maintained via non-secure email.
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