Workbook for Designing, Implementing, and Evaluating a Sharps Injury Prevention Program

Contents:

A-9 Sample Form for Performing a Simple Root Cause Analysis of a Sharps Injury or "Near Miss" Event

This form was developed to assist healthcare organizations determine the factors that may have contributed to a reported sharps injury (A-7) or a situation where a sharps injury could have occurred (“near miss”) (A-8-2). The methods for performing a root cause analysis are discussed in operational process Implement Procedures for Reporting and Examining Sharps Injuries and Injury Hazards . Use of this form will assist healthcare organizations identify whether one factor or a combination of factors contributed to the problem. Healthcare organizations may adapt this form as needed.

The key to the RCA process is asking the question “why?” as many times as it takes to get down to the “root” cause(s) of an event.

• What happened?
• How did it happen?
• Why did it happen?
• What can be done to prevent it from happening in the future?

Use of this form and the trigger questions provided will help determine whether and how one or more of the following was a contributing factor: patient action, patient assessment, training or competency, equipment, lack of or misinterpretation of information, communication, availability and use of specific policies or procedures, healthcare worker issues, and/or supervisory issues.