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Identifying systems failures in the pathway to a catastrophic event: an analysis of national incident report data relating to vinca alkaloids

BACKGROUND: Catastrophic errors in healthcare are rare, yet the consequences are so serious that where possible, special procedures are put in place to prevent them. As systems become safer, it becomes progressively more difficult to detect the remaining vulnerabilities. Using inadvertent intratheca...

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Detalles Bibliográficos
Autores principales: Franklin, Bryony Dean, Panesar, Sukhmeet S, Vincent, Charles, Donaldson, Liam J
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4145437/
https://www.ncbi.nlm.nih.gov/pubmed/24643293
http://dx.doi.org/10.1136/bmjqs-2013-002572