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