Errors that have been a catalyst for change”
Analyse and critically evaluate the literature surrounding the clinical course and death of Ryan Saunders.
This death changed nursing and medical clinical practice. What were the main factors the coroner acknowledged contributed to the death of this child?
What part did communication play in the outcome?
What can be learned from the circumstances of this death? What actions can you implement in your nursing practice to ensure this is not repeated?
TO BE WRITTEN IN THIRD PERSON.
TOPICS TO BE USED FOR DISCUSSION ARE:
COMMUNICATION
DOCUMENTATION
PATIENT SAFETY
LISTENING TO THE PARENTS
REASON’S SWISS CHEESE THEORY MUST BE USED
CLINICAL HANDOVER
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