Identifying a list of healthcare “never events” to effect system change: A systematic review and narrative synthesis

This systematic review aims to identify the most serious and preventable “never events” to support efforts to improve patient safety.

Identifying a list of healthcare “never events” to effect system change: A systematic review and narrative synthesis

Abstract

Never events (NEs) are patient safety incidents that are preventable and so serious they should never happen. To reduce NEs, several frameworks have been introduced over the past two decades; however, NEs and their harms continue to occur. These frameworks have varying events, terminology and preventability, which hinders collaboration. This systematic review aims to identify the most serious and preventable events for targeted improvement efforts by answering the following questions: Which patient safety events are most frequently classified as never events? Which ones are most commonly described as entirely preventable?

Reference

Bowman CL, de Gorter R, Zaslow J, Fortier JH, Garber G. Identifying a list of healthcare “never events” to effect system change: A systematic review and narrative synthesis. British Medical Journal (BMJ) Open Quality [Internet]. 2023 June 26;12:e002264. doi: 10.1136/bmjoq-2023-002264