We are attempting to hardwire feedback of errors across our system (or at least within our department). One aspect is when/how we communicate back about a specific error. Regardless of if we had human error and system-level influences, the person who made or at least contributed to an error needs to be made aware. During these feedback sessions, system-level contributions that can be worked on are uncovered. While this occurs with the vast majority of errors that have some sort of Pharmacy contribution, we cannot verify that it happens 100% of the time.

Is there anyone that has a standardized rounding-tool, or a formalized note to be filed after that session. We are attempting to have this be attached to the incident report, so that it isn't yet another system. We would like to have a system that is based in Just Culture that other departments can mimic to ensure that there is a closed loop on errors.

Thank you,
Joel