Citation

Elliott M, Page K, Worrall-Carter L. Contemp. Nurse 2012; ePub(ePub): ePub.

Affiliation

St Vincent's Centre for Nursing Research Melbourne, Australia. S00072102@myacu.edu.au.

Copyright

(Copyright © 2012, Informa - Taylor and Francis Group)

DOI

10.5172/conu.2012.2464

PMID

22888967

Abstract

Adverse events are unintended harm to a patient caused by the health care provided; more than half of all these events have been deemed avoidable. Adverse events are a common problem in acute care and represent a breach in care quality and safety. They are generally not caused by a single mistake or error and although safety barriers exist in health care, patients today are still harmed. Using an accident causation model is a constructive way of identifying the underlying causes of adverse events and to strengthen a study's theoretical underpinnings. Reason's model (sometimes called the "Swiss cheese" or "cumulative act effect" model) is recommended as a useful framework for adverse event analysis as it promotes a focus on the conditions or situation in which the clinician was trying to perform, rather than apportioning blame.

Language: en