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Latest articles and information - Tag :: Adverse events

Access a range of articles and resources written by clinical governance experts and search our carefully curated list of safety and quality journal articles and reports.

AICG articles, resources and curated journals and reports are available to all AICG members. Members must be logged in, in order to access all content. Users who are not AICG members will only be able to access publicly available articles. 

AICG Articles

Showing 1–9 of 9 articles
Why Root Cause Analysis is not working
Why Root Cause Analysis is not working

James Reason once characterised the goal of error investigations as ‘draining the swamp, not swatting mosquitoes’. Critical incidents arise from the interplay between active failures (eg. not double-checking for allergies before administering a medication) and latent conditions (eg. workload).

Adverse events
Clinical leadership
Clinical risk management
Incident reporting
Don’t rely on your incident reporting systems to count incidents
Don’t rely on your incident reporting systems to count incidents

Many hospitals continue to use incident reporting systems (IRSs) as their primary patient safety data source. The information IRSs collect on the frequency of harm to patients [adverse events (AEs)] is generally of poor quality, and some incident types (e.g. diagnostic errors) are under-reported. Other methods of collecting patient safety information using medical record review, such as the Global Trigger Tool (GTT), have been developed. The aim of this study was to undertake a systematic review to empirically quantify the gap between the percentage of AEs detected using the GTT to those that are also detected via IRSs.

Adverse events
Audit
Clinical risk management
Incident reporting
Using systems thinking to reduce incidents
Using systems thinking to reduce incidents

SystemsThinking - A New Direction in Healthcare Incident Investigation.

Adverse events
Risk management
Safety Culture
Systems Thinking
Managing clinical risk in Primary Health care
Managing clinical risk in Primary Health care

The Managing Clinical Risk in Primary Health Care document is designed as a resource for staff in primary health care services. The document has been developed after consultation with practitioners, managers, risk specialists and with reference to the conceptual framework provided by the Victorian Quality Council.

Adverse events
Risk management
Safety Culture
Systems Thinking
What is dignity of risk? A poster
What is dignity of risk? A poster

Dignity of risk is another way of saying you have the right to live the life you choose, even if your choices involve some risk.

Adverse events
Risk management
Safety Culture
Systems Thinking
Exploring the concept of ‘Dignity of Risk’
Exploring the concept of ‘Dignity of Risk’

This 'Dignity of Risk' research project aims to determine policy and decision-makers perceptions of ‘Dignity of Risk’ as it applies to vulnerable older persons living in residential aged care services.

Adverse events
Risk management
Safety Culture
Systems Thinking
What are the core components of managing clinical risk?
What are the core components of managing clinical risk?

In this No Harm Done podcast, Dr Cathy Balding and Cathy Jones delve into the clinical risk management depths.

Adverse events
Risk management
Safety Culture
Systems Thinking
Best practice guide to clinical incident management
Best practice guide to clinical incident management

This guide is a resource to help support individual and organisational learning and to drive quality improvement, in response to patient safety incidents. Organisations may also choose to use the guide to support quality assurance processes.

Adverse events
Risk management
Safety Culture
Systems Thinking
Cross-sector learnings from an adverse event
Cross-sector learnings from an adverse event

Hear from individuals within different sectors about their own experience with adverse events, how they were managed and the learnings that have resulted from these. Facilitated by Michael Gorton, Chairman of the Board, Alfred Health.
 

Adverse events
Showing 1–9 of 9 articles

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