A multi-faceted quality improvement initiative effectively eliminated incorrect central line placements and near-miss events in pediatric cancer patients. By redefining responsibilities, adding staff, and modifying processes, the team achieved zero errors over 1,018 consecutive days. This comprehensive approach demonstrates significant improvements in surgical safety and patient care, highlighting the critical importance of systematic changes in healthcare settings to prevent sentinel events.
Journal Article by Roach JP, Linton A (…) Anstett TJ et 5 al. in J Am Coll Surg
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