Sentinel Events Should Result In A Blameless Society — Not Make The Employee The Scapegoat
The Happy PharmD
OCTOBER 26, 2022
When my pharmacy staff was involved in a sentinel event, we conducted a root cause analysis and action plan. These documents focused on why the sentinel event occurred. In this particular case, the physician folded the medication order when he placed it in the nurse’s bin. I obtained the help of three pharmacy technicians.
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