Synopsis:
According to World Health Organization statistics, adverse events in health care affect 1 in 300 patients, resulting in tragedy for patients and their families and taxing an already overburdened health care system. To address and prevent reoccurrences of such errors, The Joint Commission's Sentinel Event Policy requires accredited health care organizations to identify and examine the system failures or defects that contributed to the adverse or sentinel event. Root cause analysis (RCA) provides a systematic approach to identifying these contributing factors. And in the interest of identifying potential safety problems before they occur, proactive risk assessment, of which one type is failure mode and effects analysis (FMEA), uses a prospective approach to improve the likelihood of favorable outcomes and to prevent harm to patients. Root Cause Analysis in Health Care: A Joint Commission Guide to Analysis and Corrective Action of Sentinel and Adverse Events will take readers step by step through the process of conducting RCA in their organizations. It will also offer strategies and suggestions for implementing FMEA. Featuring a newly streamlined, approachable design, this 7th edition of our best-selling Root Cause Analysis in Health Care will guide health care organizations through the Joint Commission requirements, outlining steps to prevent sentinel events such as medication errors, patient suicide, wrong-site surgery, patient elopement, and more. Refreshed tools and examples will help organizations collect the data they need and demonstrate how to use that data to learn from previous experience.
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