214 pages | 9 Color Illus.
At a time of increasing regulatory scrutiny and medico-legal risk, managing serious clinical incidents within primary care has never been more important. Failure to manage appropriately can have serious consequences both for service organisations and for individuals involved.
This is the first book to provide detailed guidance on how to conduct incident investigations in primary care. The concise guide
This book offers a master class for anyone performing RCA and aiming to demonstrate learning and service improvement in response to serious clinical incidents. It is essential reading for any clinical or governance leads in primary care, including GP practices, 'out-of-hours', urgent care centres, prison health and NHS 111. It also offers valuable insights to any clinician who is in training or working at the coal face who wishes to understand how serious clinical are investigated and managed.
"This is a well organised, well written, and absorbing book offers a real masterclass for anyone performing Root Analysis and aiming to demonstrate learning and service improvement in response to serious clinical incidents. It should be essential reading for any clinical or governance leads in primary care, including GP practices, out-of-hours, urgent care centres, prison health and NHS 111."
Jacky Steemson, OS&H Journal, July 2017
1 Introduction. 2 What is a clinical incident and what makes an incident serious? 3 Recognising serious incidents. 4 Root cause analysis. 5 Humans and heuristics – why do we make errors? 6 What can we learn? 7 Writing reports. 8 Preventing clinical errors - The Sixth sense and the wisdom of Dr Pepper. 9 Creating a no blame culture - Coroners courts and Litigation. 10 Case studies. 5 cases demonstrating human factors in primary care. When Humans and systems interact.