Publication of Taranaki DHB Learning from Adverse Events report

27 January 2021

The Learning from Adverse Events Report summarises serious adverse events reported to the Health Quality and Safety Commission for the 2019/20 year.

The intention behind the release of the report is to encourage an open culture of reporting, to learn from what happened, put in place systems to reduce the risk of it happening again and make care as safe as possible.

The report outlines what recommendations and actions the DHB has taken to prevent, where possible, further similar events.  All evidence suggests this process of reporting, analysis and discussion is one of the most effective single things we can do to improve patient safety.

Learning from Adverse Events Report (PDF 346 KB)
*DHBs are required to report all events which are classified as Severity Assessment Code (SAC) 1 or 2



Last updated: Wednesday, January 27, 2021

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