部门RCA报告分析用表参考

Category of Modification

Root Cau /
Contributing Factor

Improvement Action

Personnel Responsible

Target Date of Completion

Review of action taken (Date, Outcome and/or effectiveness)

更新时间:2023-06-12 05:38:41 阅读：评论：0

TEMPLATE

Departmental Review Report

[for Local Root Cau Analysis]

Part I - Basic Information

Part II – RCA Process

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5.	Understanding of Events & Causal Issues– What Happen & Why Happen
Date & Time		Sequence of Event	Problem / Area of Concern	Cau & Effect Analysis * (Why? Why? Why?)

		定冠词







		quite的意思

* Plea refer to the Fishbone Diagram attached to facilitate the identification of root cau / contributory factor.

Part III – Risk Reduction Strategies

	6.		RCA Action Plan
Item no.		Root Cau / Contributing Factor		Improvement Action	Personnel Responsible	Target Date of Completion	Review of action taken (Date, Outcome and/or effectiveness)
				-xcs
				-

7	Post-CIRP recommendation

S = Superde R = Revi D = Deletion A = Addition

Root Cau Analysis -- Contributory Factors

Process Factors
Protocol-related	Information & Documentation	Task design / plan	Medication- related	Transfusion- related	Service delivery	Supervision & eking help	Education & Training	Workload / hours of work	Miscellaneous
♦Unavailable christmas carol ♦Inaccessible ♦Inappropriate u ♦Poor quality of information ♦Procedure for reviewing and updating ♦Others	♦Unavailable ♦Unreliable ♦Inaccessible ♦Misinterpretation ♦Disagreements regarding the interpretation ♦Incomplete/Abnt information ♦Inadequately flagged information/alert ♦Others	♦Inappropriate ♦Others	♦Miscalculation ♦Complicated dosage design ♦Mislabelling ♦Incorrect computer entry ♦Others	♦Miscalculation雅思培训班重庆 ♦Incorrect computer entry ♦Mislabelling ♦Technical error ♦Others	♦Decision ♦Delay ♦Misd ♦Inappropriate ♦Others	♦Decision/Willing to ek help ♦Unavailability of staff to help ♦Responsiveness of staff to help ♦Others	♦Induction/ orientation ♦Provision of education/ training ♦Others	tko♦Long working hours ♦Heavy workload ♦Others	♦Others ♦Cannot be identified

Organizational & Management Factors						Work Environment Factors
四级贴吧Organizational Structure	Policy, standards & goals		Resources & constraints	Leadership	Miscellaneous	Building & design	Environment	Equipment / supplies	Information Technology	Miscellaneous
♦Hierarchical arrangement of staff within the organizational context ♦Span of control ♦Unclear roles/ responsibility ♦Others		♦Management arrangements (function) ♦Operation (e.g. Facilities/Materials/ Contract Mgt) ♦Human resources ♦Finance ♦Information ♦Risk management (e.g. reporting, investigation, analysis, safety culture) ♦OSH ♦Others	♦Human resources ♦Finance ♦Others	♦Ineffective leadership ♦Others	♦vegetable是可数名词吗Others ♦Cannot be identified	♦Maintenance management ♦Functionality (ergonomic asssment) (e.g. lighting, space) ♦Others	♦Houkeeping ♦Control of physical environment (e.g. temp, light) ♦Movement of patients between wards/sites ♦Storage ♦Others	♦Malfunction/ failure/ reliability (Suspected) ♦Malfunction/ failure/ reliability (Confirmed) ♦Infusion pump ♦Unavailable ♦Maintenance Mgt ♦Functionality ♦System design ♦Reu of single-u device ♦Others	♦Malfunction/ failure/ reliability (Confirmed) ♦Unavailable ♦Maintenance management ♦Functionality (e.g. ergonomic design, fail-safe, standardization) ♦System design ♦Others	♦Others ♦Cannot be identified

Communication Factors					Staff Factors
Staff-patient communication	Staff-relative communication	Communication between staff / agencies	Product	Miscellaneous	Competence	Compliance	Personal	Miscellaneous
♦Language barrier ♦Poor staff-patient relation ♦Misinterpretation ♦Others	♦Language barrier ♦Poor staff-patient relation ♦Misinterpretation ♦Others	♦Incomplete/ Abnt information ♦Discrepancies in the notes/ documentation ♦Illegible ♦Missing signature ♦Poor quality of information in notes/ documentation ♦Inter-department communication ♦Communication with HAHO/ other hospitals/ agencies ♦Fail to communicate ♦Misinterpretation ♦Unclear prescription/ written order ♦Transcription error ♦Others	♦Poor/ Similar packaging and labeling ♦Similar looking or sounding names ♦Others	♦空位Others ♦Cannot be identified	♦Inadequate knowledge and/ or skill ♦Inadequate experience ♦Others	♦Failure to comply with policies and procedures ♦Fail to identify patient ♦Violation ♦Others	♦Stress ♦Fatigue ♦Distraction ♦Attitude ♦Inadequate motivation ♦Lap of concentration ♦Others	♦Others ♦Cannot be identified

Persons other than Staff / Patient Factors				Patient Factors
Personal	Compliance	Competence	Miscellaneous	Clinical	Personal	Miscellaneous
♦Stress ♦Fatigue ♦Distraction ♦Decision ♦Attitude ♦Lap of concentration ♦Emotional outburst	♦Failure to comply with policies and procedures ♦Fail to identify patient	♦Inadequate knowledge and/ or skill ♦Inadequate experience ♦Others	♦Others ♦Cannot be identified	♦Known risks associated with treatment ♦Complexity of condition ♦Difficulty of diagnosis ♦Severity of condition ♦Unexplained/ Unknown ♦Others	♦Personality ♦Decision ♦Social and family circumstances ♦Provision of health history ♦Fail to follow instructions ♦Others	♦Others ♦Cannot be identified

August 2005

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