Home ›

Search Results

Programmes
Types

Search results for "open book"

Your search returned 46 results

Open Book: Extravasation injury during surgery

PUBLICATION: 11 Aug 2021, Adverse Events

This Open Book alerts providers to the key findings of a recent review of an incident where a patient suffered an extravasation injury that required skin grafts to repair.

Open Book: Learning Review (March 2021)

PUBLICATION: 5 Mar 2021, Adverse Events

This Open Book introduces the Learning Review, a process originally developed in the United States Forest Service.

April Falls update 2017

NEWS: 3 Apr 2017, Reducing Harm from Falls

An update on April Falls, a national initiative to promote falls reduction in health care settings.

Open Book: Lessons learnt from reviewing patient falls (March 2017)

PUBLICATION: 29 Mar 2017, Adverse Events

Falls are one of the most common causes of injury to patients in hospital. This Open Book was written in collaboration with the Health Quality & Safety Commission’s Reducing Harm from Falls programme. It summarises four falls events, review findings and r

Open Book: Incorrect assembly of surgical equipment (June 2016)

PUBLICATION: 30 Jun 2016, Adverse Events

This report alerts providers to key findings and actions following review of two incidents in different organisations where surgical equipment was assembled incorrectly resulting in patient harm in the operating theatre.

Open Book: Transmission of 'super-bug' in hospital (May 2016)

PUBLICATION: 20 May 2016, Adverse Events

This report alerts providers to key findings and actions following review of an outbreak of a multi-drug resistant organism (MDRO) which affected five patients. The aim is to learn from the changes implemented after the event to prevent future similar eve