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Displaying 21 - 30 of 55 results
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Representing the consumer voice in an adverse event review
Sheila from Te Pukaea (Whanganui DHB's consumer council) talks about her experience as an independent consumer representative on adverse event review panels.
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E-learning module: Human Factors | Ngā Āhua Tangata
The e-learning module, Human Factors | Ngā Āhua Tangata in health care includes seven videos and is available free to all in health care professionals via the LearnOnline platform.
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Open4Results – June 2019
Our six-monthly report on the harm prevented, and money saved, in areas the Health Quality & Safety Commission focuses on or raises awareness about.
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Serious and Sentinel Events in New Zealand Hospitals 2008–2009
In this year three in 10,000 admissions to DHBs involved a potentially preventable serious or sentinel event. Of these 39 percent were a result of a clinical mismanagement problem
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Pressure injury review template 2024
This optional template is available to assist with reviews of pressure injuries.
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Policy and practice in the use of root cause analysis to investigate clinical adverse events: mind the gap
This paper (Social Science and Medicine 73 (2011) 217-225) examines the challenges of investigating clinical incidents through the use of Root Cause Analysis.
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Presentations from learning session one of the Te ako mai i ngā pāmamaetanga me te wheako tāngata whaiora me te whānau | Learning from adverse events and consumer, family and whānau experience project
Presentations from learning session one of the Te ako mai i ngā pāmamaetanga me te wheako tāngata whaiora me te whānau | Learning from adverse events and consumer, family and whānau experience project held on 12–13 February 2020.
- Review of the national reportable events policy 2012: Summary of stakeholder feedback
- Always Report and Review list
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Global trigger tool: Using data for improvement
This presentation given by global trigger tool clinical lead, Gillian Robb, provides an update on the use of trigger tools in New Zealand.