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