Root Cause Analysis (Registered Nurse)

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Assignment_9.1b_handout.doc

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image1.jpg Professional Issues in Nursing

Handouts

Handout for Assignment 9.1: Root Cause Analysis Chart

Question

Response

Identify possible causal factors

List team members. (Include name, title, and rationale for inclusion on team)

Give a chronological description of the event

When did event happen?

Where did it happen?

What is the severity of the actual or potential of the harm?

What is the chance it will happen again?

What are the consequences?

What is the plan of action?

Professional Issues in Nursing Handout 9.1 V3.0 Page 1 of 1 11/9/2017

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