Failure to Follow ACLS Protocol Suture Cut Incorrectly Poor History Taking Performing Procedure Outside Scope of Practice Breaking Sterile Field (Gown/Torso) Critical Information Delayed Unlisted Error: __________ __________ __________ Specialist Essential to Procedure Absent Failure to Offer Standard of Care Primary Physician Cannot Be Reached Making Excuses for Medical Errors Failure to Share Important Information Wrong Dose of Electricity Something Really Good: __________ __________ __________ Bad Ergonomics Closed Loop Communication Absent Overconfident Physician Poor Operating Room Set-Up Early Cessation of Resuscitation Efforts Inappropriate Surgical Setting Wrong Dose of Medication Lack of Physician Follow- Through Ineffective Defibrillation Needlessly Removing Caregiver/ Family Unlisted Error: __________ __________ __________ Inadequate PPE Unsafe Foreign Objects in Operating Room Performing Procedure Beyond Level of Skill/Training Scrub in Incorrectly Failure to Fixate Equipment Talking About the Patient Like They Aren't There Prolonged Interruption of Compressions Procedure Performed Incorrectly External Pressure/ Rushing a Procedure Excessive Outside Distractions Ineffective CPR Failure to Provide Oxygen Failure to Provide Ventilation Wrong Defibrillator Setting Illegal Declaration of Death Unnecessarily Delaying Procedure Unstructured Sign-Out Incorrect Equipment Breaking Sterile Field (Gloves/ Hands) Failure to Follow ACLS Protocol Suture Cut Incorrectly Poor History Taking Performing Procedure Outside Scope of Practice Breaking Sterile Field (Gown/Torso) Critical Information Delayed Unlisted Error: __________ __________ __________ Specialist Essential to Procedure Absent Failure to Offer Standard of Care Primary Physician Cannot Be Reached Making Excuses for Medical Errors Failure to Share Important Information Wrong Dose of Electricity Something Really Good: __________ __________ __________ Bad Ergonomics Closed Loop Communication Absent Overconfident Physician Poor Operating Room Set-Up Early Cessation of Resuscitation Efforts Inappropriate Surgical Setting Wrong Dose of Medication Lack of Physician Follow- Through Ineffective Defibrillation Needlessly Removing Caregiver/ Family Unlisted Error: __________ __________ __________ Inadequate PPE Unsafe Foreign Objects in Operating Room Performing Procedure Beyond Level of Skill/Training Scrub in Incorrectly Failure to Fixate Equipment Talking About the Patient Like They Aren't There Prolonged Interruption of Compressions Procedure Performed Incorrectly External Pressure/ Rushing a Procedure Excessive Outside Distractions Ineffective CPR Failure to Provide Oxygen Failure to Provide Ventilation Wrong Defibrillator Setting Illegal Declaration of Death Unnecessarily Delaying Procedure Unstructured Sign-Out Incorrect Equipment Breaking Sterile Field (Gloves/ Hands)
(Print)
Failure to Follow ACLS Protocol
Suture Cut Incorrectly
Poor History Taking
Performing Procedure Outside Scope of Practice
Breaking Sterile Field (Gown/Torso)
Critical Information Delayed
Unlisted Error: __________
__________
__________
Specialist Essential to Procedure Absent
Failure to Offer Standard of Care
Primary Physician Cannot Be Reached
Making Excuses for Medical Errors
Failure to Share Important Information
Wrong Dose of Electricity
Something Really Good: __________
__________
__________
Bad Ergonomics
Closed Loop Communication
Absent
Overconfident Physician
Poor Operating Room Set-Up
Early Cessation of Resuscitation Efforts
Inappropriate Surgical Setting
Wrong Dose of Medication
Lack of Physician Follow-Through
Ineffective Defibrillation
Needlessly Removing Caregiver/
Family
Unlisted Error: __________
__________
__________
Inadequate PPE
Unsafe Foreign Objects in Operating Room
Performing Procedure Beyond Level of Skill/Training
Scrub in Incorrectly
Failure to Fixate Equipment
Talking About the Patient Like They Aren't There
Prolonged Interruption of Compressions
Procedure Performed Incorrectly
External Pressure/ Rushing a Procedure
Excessive Outside Distractions
Ineffective CPR
Failure to Provide Oxygen
Failure to Provide Ventilation
Wrong Defibrillator Setting
Illegal Declaration of Death
Unnecessarily
Delaying Procedure
Unstructured Sign-Out
Incorrect Equipment
Breaking Sterile Field (Gloves/ Hands)
