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Identifying systems failures in the pathway to a catastrophic event: an analysis of national incident report data relating to vinca alkaloids
BACKGROUND: Catastrophic errors in healthcare are rare, yet the consequences are so serious that where possible, special procedures are put in place to prevent them. As systems become safer, it becomes progressively more difficult to detect the remaining vulnerabilities. Using inadvertent intratheca...
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| Main Authors: | , , , |
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| Formato: | Artigo |
| Idioma: | Inglês |
| Publicado em: |
BMJ Publishing Group
2014
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| Assuntos: | |
| Acesso em linha: | https://ncbi.nlm.nih.gov/pmc/articles/PMC4145437/ https://ncbi.nlm.nih.gov/pubmed/24643293 https://ncbi.nlm.nih.govhttp://dx.doi.org/10.1136/bmjqs-2013-002572 |
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