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Risk Watch March/April 2007 – volume 5, issue 3 Lessons from the sentinel event casebook
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Document Date: 2015-02-25 15:51:23


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City

Melbourne / /

Company

IIS Project Advisory Group / Sentinel / /

/

Event

Product Issues / Force Majeure / /

IndustryTerm

faulty equipment / orthopaedic loan kit equipment / blood products / health services / loan equipment / maternity services / suspected faulty equipment / rural health services / instrument count protocol / haemodialysis equipment / equipment / /

MedicalCondition

endocarditis / /

MedicalTreatment

total hip replacement / catheter / elective surgery / resuscitation / surgery / /

Organization

Department of Human Services / Therapeutic Goods Administration / Central Sterilising Unit / Intensive Care Unit / /

Person

James H. West / Danielle Whiteman / Deane Wilks / Lisa Stevenson / Karen Botting / /

/

Position

appropriately trained technician / The company representative / Governor / Manager / surgeon / Technician / /

Product

equipment / /

Technology

x-ray / The instrument count protocol / MET protocol / /

URL

www.health.vic.gov.au/best / www.health.vic.gov.au / www.health.vic.gov.au/clinrisk / /

SocialTag