TapRooT® Patient Safety Causal Factor Worksheet

Review the sequence of events on your SnapCharT® and answer these questions:

1. INCIDENT: What was the Incident? (Describe fatality or patient harm)

2. RISKS: What was the Risk involved in treatment (What was the risk related to the incident)?

Could alternative options have eliminated or reduced the risk? Yes or No

How?

3. STARTING ERRORS: What mistakes, errors, or equipment failures started a sequence of events
that led to the Incident?

4. FAILED CATCH: What mistakes, errors, or equipment failures failed to catch or stop the
sequence of events that led to the Incident?

5. MISSED PATIENT REACTIONS: What errors led to a failure to notice or respond to an adverse
patient reaction prior to the Incident?

6. MISSING SAFEGUARDS: What mistakes, errors, or equipment failures caused a safeguard to be

missing or fail?

7. MADE OUTCOME WORSE: What mistakes, errors, or equipment failures made the outcome of
the Incident worse?

8. PATIENT RELATIONS: What error led to issues with patient / family relations that made the
outcome of the Incident worse.

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