September 12, 2016 | Mark Paradies

Monday Accident & Lessons Learned: Baby Dies After Oxygen Mix-Up at Hospital in Australia


Here’s a link to the story:

An Oxygen line had been improperly installed in 2015. It fed nitrous oxide to a neonatal resuscitation unit rather than oxygen.

The Ministry of Health representative said that all lines in all hospitals in New South Wales installed since the Liberal government took over in 2011 will be checked for correct function. 

What can you learn from this?

Think about your installation and testing of new systems. How many Safeguards are in place to protect the targets?

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