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Learning from adverse events report 2016–17

24 Nov 2017, Adverse Events

This is the annual adverse events report published by the Health Quality & Safety Commission. The report covers adverse events reported by New Zealand's 20 district health boards (DHBs) and other providers.

Always report and review list 2018–19

9 May 2018, Adverse Events

The always report and review list is a subset of adverse events that should be reported and reviewed in the same way as SAC 1 and 2 rated events, irrespective of whether or not there was harm to the consumer/patient.

Learning from adverse events report 2017–18

7 Dec 2018, Adverse Events

This is the annual learning from adverse events report for 2017–18, published by the Health Quality & Safety Commission. The report covers adverse events reported by New Zealand's 20 district health boards (DHBs) and other providers.

Severity Assessment Criteria tables

1 Oct 2012, Adverse Events

The likelihood and consequences tables are used by district health boards (DHBs) to assist with the classification of incidents by DHB quality and risk managers.

RCA
Root Cause Analysis For Clinical Incidents

22 Feb 2013, Adverse Events

This document provides advice on how to manage the Root Cause Analysis (RCA) process for Severity Assessment Code 1 and 2 incidents to assist RCA Teams.

The Global Trigger Tool: A review of the evidence

1 Feb 2016, Adverse Events

This report reviews the literature associated with the development and use of trigger tools to determine rates of harm in health care settings, with particular attention on the Institute of Healthcare Improvement's Global Trigger Tool.

Revised Global Trigger Tool Implementation Guide 2014

12 Nov 2014, Adverse Events

The Global Trigger Tool Guide and appendices provide useful information about using the GTT, including managing data, standard operating procedures, reporting, triggers, performance indicators, and identifying opportunities for improvement.