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Initial Build

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SE, 9/2

Staff Review

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Suzanne Wood

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titleunresolved comments

Approval Status

Description

Determination of which contributing factor(s) related to devices, equipment, or supplies are known.

On-Screen Instructions

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Check all that apply excerpt

Field Type

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Checkbox excerpt

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Responses

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excludeDescription|On-Screen Instructions|Field Type|Responses|Response Codes|OPSC Staff Notes|History|Guide for Use|Additional Support

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availability
availability
Availability

The availability, or lack thereof, of a device, equipment, or supply contributed to the event.

Includes

Device, equipment or supply:

  • Not adequately stocked

  • Not available when needed

  • Not accessible when needed

  • Not available

  • Available when it should not have been

Excludes

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design
design
Design

The design of a device, equipment, or supply, regardless of how it functions, contributed to the event.

Includes

  • Device or equipment display or controls not well-designed, difficult to read, or difficult to program

  • Device, equipment or supply awkward to use correctly

  • Device, equipment, or supply did not have built in safety features

Excludes

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function
function
Function (e.g., defective, non-working)

The function of a device, equipment, or supply, regardless of how it is designed, contributed to the event. Function includes devices or supplies that are defective, non-working, or do not meet code.

Includes

  • Defective or non-working device, equipment, or supply (including defective or dysfunctional alerts)

  • Device display or controls not functioning;

  • Broken or defective device, equipment, or supply that was awaiting repair contributed to the event

Excludes

  • Device, equipment, or supply that functioned as intended, but whose design contributed to the event (select “Design”)

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maintenance
maintenance
Maintenance

Routine maintenance, or lack thereof, of a device, equipment, or supply contributed to the event.

Includes

  • Device, equipment, or supply did not meet code, specifications, or regulations

  • Inadequate maintenance log

  • Inadequate or delayed maintenance

  • Inadequate cleaning or sterilization

Excludes

  • Broken or defective device, equipment, or supply that was awaiting repair contributed to the event (select “Function”)

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shortage
shortage
Shortage

Manufacturer shortage of a device, equipment, or supply contributed to the event.

Includes

  • Device, equipment, or supply not readily available due to a manufacturer shortage

  • Medication supply shortages

Excludes

  • Failure to properly stock supplies (select “Availability”)

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healthcareUse
healthcareUse
Use or selection by healthcare provider or staff

The incorrect use or inappropriate selection of a device, equipment, or supply by a healthcare provider or staff member contributed to the event.

Includes

  • Provider or staff member did not use the device, equipment, or supply correctly

  • Provider or staff member did not select the correct device, equipment, or supply for the task at hand

Excludes

  • Device, equipment, or supply did not function properly (select “Function”)

  • Design of the device, equipment, or supply prohibited the provider or staff from using the device correctly (select “Design”)

  • Device, equipment, or supply was used incorrectly by a patient (select “Use by patient”)

  • Wrong device, equipment, or supply was selected for use by a patient (select “Use by patient”)

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patientUse
patientUse
Use by patient

The selection of a device, equipment, or supply for use by a patient was incorrect or the patient used the device incorrectly.

Includes

  • Device, equipment, or supply was used incorrectly by a patient

  • Wrong device, equipment, or supply was selected for use by a patient

Excludes

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other
other
Other (please describe)

Any other factor related to the device, equipment, or supply, not included in the list above, contributed to the event.

Includes

  • Recalls

Excludes

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No additional guidance excerpt

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Guide for Use

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Other selection text excerpt

History

Start Date

Spring 2012

End Date

n/a

Change History

January 2016: Changed “Function” and “Function (including device failure)” to “Function (e.g., defective, non-working)”; added “Shortage”, “Use or selection by healthcare provider or staff”