Lex Maria is a Swedish law for handling healthcare injuries. Lex Sarah handles events where healthcare has failed.

How to report healthcare injuries or deficiencies in care

The operation is obliged to receive complaints. The complaints should be investigated and the person who has submitted a complaint has the right to take part in the investigation and what actions the operation intends to take. Most deficiencies are detected by someone in the operation. They should then write a deviation report on the event. The deviation should then be investigated and measures taken. The person who wrote a deviation report has the right to get feedback on how the deviation was handled and what happened based on the deviation report. For the reporting of complaints and deviations to work well, there must be an ambition to constantly work with improvements. The mistake that an employee happened to make can just as well be made by someone else. It is therefore not about looking for scapegoats but trying to understand what has happened and why and then do something about the causes of the mistake.

In the case of serious complaints or deviations, the investigation usually takes place at a higher level. It may be a senior manager and/or MAS (Medically responsible nurse) who is in charge of the investigation. The most common deviations in a nursing home are usually deficiencies in medication management and fall injuries. It is important to remember that those who have suffered a healthcare injury may be entitled to insurance compensation from the patient insurance.

A deviation does not always lead to a report according to Lex Sarah or Lex Maria. Most deviations are investigated, then the operation takes measures and reports back the measures taken to the people involved. Sometimes a follow-up is done to see that the measures have had the intended effect.

What is Lex Maria

According to the Patient Safety Act, a report to the Health and Social Care Inspectorate (IVO) should be made in the event of incidents that have resulted in or could have resulted in a serious healthcare injury.

Lex Maria is about deficiencies in the part of care that is health and medical care. Events that should prompt a report based on Lex Maria. Lex Maria came about in the 1930s after four patients died when they accidentally received disinfectant injected instead of anesthetic.

In all care, there is someone who is responsible for reporting. It can be a chief physician or a medically responsible nurse who must investigate and report events to the Health and Social Care Inspectorate. The healthcare provider is obliged to report events that have resulted in or could have resulted in a serious healthcare injury.

If the resident or their relatives are not satisfied with the care, they can complain. There need to be routines for receiving complaints. These should primarily be received by and handled by the operation. It is also possible to turn to the patient committee in the region or directly to the Health and Social Care Inspectorate. IVO has become more restrictive in which complaints they receive and investigate.

All employees who have any form of medical responsibility must be familiar with Lex Maria. It is appropriate to have this legislation and the obligation to write deviations in connection with recurring delegation training every year.

What is Lex Sarah

Anyone working in care that is carried out based on the Social Services Act or the Act on Support and Service for Certain Disabled Persons is obliged to report misconduct in care. Lex Sarah came about when the nursing assistant Sarah Wägnert raised the alarm about misconduct at a residence in Solna.

How this should be done is regulated in the National Board of Health and Welfare's regulations and general advice on Lex Sarah. With misconduct, which should be reported, both actions that have been performed and actions that someone, due to negligence or for other reasons, has omitted to perform and which mean or have meant a threat to or have had consequences for individuals' lives, safety, physical or mental health.
It may be necessary for responsible managers to take immediate action if the situation requires it. There are then a number of requirements for the investigation that should take place and who should be informed.

All employees at the nursing home must have a good knowledge of Lex Sarah. This should ideally be addressed in connection with the introduction and in connection with workplace meetings at least once a year. Ideally as a training point.

There is good material to support these investigations on IVO's website.

Compensation for Lex Maria and Lex Sarah

All healthcare operations are obliged to have patient insurance. This means that the person who has suffered the healthcare injury may be entitled to compensation. Most healthcare operations are insured through LÖF (the county councils' mutual insurance company) but private healthcare providers may have another insurance.

Even those who have been subjected to neglect or violations according to Lex Sarah may be entitled to compensation based on the injury the resident suffered in connection with the event.

Reflection questions - Lex Maria and Lex Sarah
Care Staff:
- Are all deviations reported?
- Is there a good climate for working with continuous improvements?
- Do all colleagues know about Lex Sarah and Lex Maria.

Manager, nurse, occupational therapist and physiotherapist:
- Do all employees know their obligation to report according to Lex Maria and Lex Sarah?
- Do you perform risk analyses and event analyses regularly in the operation?

Resident and relatives:
- Have you seen serious deficiencies in the operation?
- Have you reported to the manager?
- Have you reported to someone else?

Erland Olsson
Specialist nurse
Sofrosyne - Better care every day