Learning from the failures of others: stories, pls!

The heartbreaking failure of the missed diagnosis of sepis that resulted in the death of Rory Staunton is creating quite a stir: An infection, unnoticed, turns unstoppable. Dwyer J. New York Times. July 11, 2012. For links to the article and related stories click here: How has your organization used this story to identify, access, share and generate: >>Evidence (to understand the potential risks to patients) >>Information (through creating tools to educate and raise awareness of the failures inherent in this incident) >>Knowledge (opportunities to draw from the experience of personnel to support buy-in for change, shape solutions and enhance improvement efforts within the context of your organization). Do tell! We'll all learn from your experience and tactics --but only if you share them.