What happened? Sentinel Event What are the details of the event? (Brief description) When did the event occur? (Date, day of week, time) What area/service was impacted? Why did it The process or What are the steps in the happen? activity in the process, as designed? (A event occurred. flow diagram may be helpful here) What were the What steps were involved most proximate in (contributed to) the factors? event? Human factors What human factors were (Typically “special cause” variation) relevant to the outcome? Equipment factors How did the equipment performance affect the outcome? Controllable What factors directly environmental affected the outcome? factors
What happened? Sentinel Event What are the details of the event? (Brief description) When did the event occur? (Date, day of week, time) What area/service was impacted? Why did it happen? The process or activity in the event occurred. What are the steps in the process, as designed? (A flow diagram may be helpful here) What were the most proximate factors? What steps were involved in (contributed to) the event? (Typically “special cause” variation) Human factors What human factors were relevant to the outcome? Equipment factors How did the equipment performance affect the outcome? Controllable environmental factors What factors directly affected the outcome?
RCA_worksheet.docx