Resource library

Presentations from learning session one of the Te ako mai i ngā pāmamaetanga me te wheako tāngata whaiora me te whānau | Learning from adverse events and consumer, family and whānau experience project held on 12–13 February 2020.

Commentary on serious and sentinel events reported by District Health Boards in 2006–2007.

Serious and Sentinel Events in New Zealand Hospitals 2007–2008.

In this year three in 10,000 admissions to DHBs involved a potentially preventable serious or sentinel event. Of these 39 percent were a result of a clinical mismanagement problem

The Global Trigger Tool (GTT) is a methodology developed by the Institute for Healthcare Improvement to identify patient harm that occurs in health care organisations.

This presentation given by global trigger tool clinical lead, Gillian Robb, provides an update on the use of trigger tools in New Zealand.

This report aims to alert providers to the key findings of a recent adverse event review. The emphasis is on the changes implemented by the provider involved to stop the event happening again.

This report aims to alert providers to the key findings of two recent reviews, with emphasis on the changes implemented to prevent recurrence.

This report aims to alert providers to the key findings of a recent review, with emphasis on the changes implemented by that provider to prevent recurrence.

This report aims to alert providers to the key findings of a recent review, with emphasis on the changes implemented to prevent recurrence.