1. Read Case 13: Silence of the Hospital: Lessons on Supporting Patients and Staff following an Adverse Event.
What went wrong n Linda’s case? What is your opinion of the non disclosure policy? Of the MACRMI disclosure model?
2. A Cascade of Small Events: Learning from an Unexpected Postsurgical Death ” in CASE STUDIES
Discuss what went wrong with Nick’s care? What remedies would you consider?
2. Read Case 18 in CASE STUDIES: Not for IV Use: The story of an Enteral Tubing Misconnection.
Discuss Question 1. What chain of events and mistakes led to the Death of Robin and Allison Lowe, Robin’s baby? At what point in the chain could the pending disaster have been stopped? What processes could be put in place to prevent such an event from occurring?