Page 5 - covid19_M

For mortality review committee use only

Avoidability of death

☐ Definitely avoidable ☐ Probably avoidable (more than 50:50)

☐ Possibly avoidable but not very likely
☐ Strong evidence of avoidability
(less than 50:50)
☐ Slight evidence of avoidability ☐ Definitely not avoidable

Analysis

Categorisation of contributing factors:
☐ Human factors ☐ Patient factors
☐ System factors ☐ Insufficient data
Other:

Standard of care grading by mortality review committee:

☐ Good practice ☐ Less than satisfactory
☐ Insufficient data ☐ Room for improvement
Preventable harm ? ☐ Yes ☐ No
Further investigation required ? ☐ Yes ☐ No

Agreed actions

List of actions Individual(s) responsible for
implementation

5 Mortality review committee for COVID 19 19 June 2020