What we should know about errors


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We can learn from errors

The best people can sometimes make the worst mistakes

Errors are predictable

Once a person becomes skilled at their job, they are more likely to be affected by absent mindedness

Highly trained staff make errors but can respond quickly

Changing the system to prevent errors from happening will have a more lasting impact than blaming a person

What contributes to errors occurring?

Human factors
Fatigue/stress
Distraction
Forgetfulness
Tunnel vision / focus
New learner
Fear
Information overload
Missing or incorrect information

Organisational factors
Workload
Limited training
Staffing mix
Experience
Skill level
A culture of not following the rules eg turning off the alarms without checking what is happening

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Contents | Page 8 of 26

Last updated: 14 August, 2009
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