How to undertake a root cause analysis investigation to improve patient safety.

Nurs Stand

RCNi Editorial Advisory Board, Surrey, England.

Published: January 2018

Root cause analysis is a tool that can be used when determining how and why a patient safety incident has occurred. Incidents that usually require a root cause analysis include the unexpected death of a patient, serious pressure ulcers, falls that result in injury, and some infections and medication errors. This article outlines the stages of the investigation process for undertaking a root cause analysis. REFLECTIVE ACTIVITY: 'How to' articles can help update your practice and ensure it remains evidence-based. Apply this article to your practice. Reflect on and write a short account of.

Download full-text PDF

Source
http://dx.doi.org/10.7748/ns.2018.e10859DOI Listing

Publication Analysis

Top Keywords

root analysis
16
patient safety
8
undertake root
4
analysis
4
analysis investigation
4
investigation improve
4
improve patient
4
safety root
4
analysis tool
4
tool determining
4

Similar Publications

Objectives: Our study aimed to compare signal characteristics of subdural electrodes (SDE) and depth stereo EEG placed within a 5-mm vicinity in patients with drug-resistant epilepsy. We report how electrode design and placement collectively affect signal content from a shared source between these electrode types.

Methods: In subjects undergoing invasive intracranial EEG evaluation at a surgical epilepsy center from 2012 to 2018, stereo EEG and SDE electrode contacts placed within a 5-mm vicinity were identified.

View Article and Find Full Text PDF

Objectives: To compare the effects of powered and manual stretchers on participants' perceived comfort and measured acceleration during lifting and loading operations.

Methods: This non-randomized, laboratory-based crossover study involved forty-one participants (thirty-one firefighters and ten third-year paramedic students) who served as simulated patients experiencing lifting, lowering, loading, and unloading maneuvers using manual and powered stretchers. Four stretcher types were evaluated: one powered stretcher (Power-PRO™ XT) and three manual stretchers (Matsunaga GT, Exchange 4070, Scad Mate), with each group using the manual stretcher they routinely operated.

View Article and Find Full Text PDF

Researchers have reported that Bacillus megaterium BM18-2 reduces Cd toxicity in Hybrid Pennisetum, but understanding the interaction between plants and associated endophytes is crucial for understanding phytoremediation strategies under heavy metal stress. The current study aims to monitor the colonization patterns of GFP-labeled endophytic bacteria BM18-2 on Hybrid Pennisetum grass. Additionally, it will monitor Cd's effect on plant bacterial colonization.

View Article and Find Full Text PDF

Soybean (Glycine max) is a leguminous crop cultivated worldwide that accumulates high levels of isoflavones. Although previous research has often focused on increasing the soybean isoflavone content because of the estrogen-like activity of dietary soy in humans, the rapidly increasing demand for soybean as a plant-based meat substitute has raised concerns about excessive isoflavone intake. Therefore, the production of isoflavone-free soybean has been anticipated.

View Article and Find Full Text PDF

Proteomics has become a powerful approach for the identification and characterization of type III effectors (T3Es). Members of the species complex (RSSC) deploy T3Es to manipulate host cells and to promote root infection of, among others, a wide range of solanaceous plants such as tomato, potato, and tobacco. Here, we used TurboID-mediated proximity labeling (PL) in tomato hairy root cultures to explore the proxeomes of the core RSSC T3Es RipU, RipD, and RipB.

View Article and Find Full Text PDF

Want AI Summaries of new PubMed Abstracts delivered to your In-box?

Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!