Anda di halaman 1dari 2

Root Cause Analysis Investigation

Action Plan - template (vertical)


See also ‘Types of Preventative Actions Planned’- tool at www.npsa.nhs.uk/rca

Action 1 Action 2 Action 3 Action 4 Action 5


Root CAUSE
EFFECT on Patient

Recommendation

Action to Address Root


Cause
Level for Action
(Org, Direct, Team)
Implementation by:

Target Date for


Implementation
Additional Resources
Required
(Time, money, other)
Evidence of Progress
and Completion
Monitoring & Evaluation
Arrangements
Sign off - action
completed date:
Sign off by:

National Patient Safety Agency - 2009


Root Cause Analysis Investigation
Action Plan – template (horizontal)
See also ‘Types of Preventative Actions Planned’ – tool at www.npsa.nhs.uk/rca

Act- Root EFFECT Recomm- Action to Level for Implemen Target Date Additional Evidence Monitoring Sign Sign
ions
CAUSE on endation Address Action -tation for Resources of & off – off
Patient Root (Org, by: Implemen- Required Progress Evaluation Action by:
Cause Direct, tation (Time, and Arrangeme compl-
Team) money etc) Complet- nts eted
ion date
1

10

National Patient Safety Agency - 2009

Anda mungkin juga menyukai