CAUSAL AND CONTRIBUTING FACTORS (CCF) STATEMENTS
CCF = Causal and Contributing Factor
CCFs = Causal and Contributing Factor Statements
HFACS Pathway Statement = CCF Statement
CCF statements “clearly show the cause-and-effect relationship”…and “should use specific and accurate descriptors for what occurred in the event, rather than negative and vague words.” – Joint Commission.
Guidelines for Writing CCF Statements
- CCFs should not begin with the active failure or unsafe act
Correct: Working a double shift resulted in nurse fatigue, which led to programming an IV pump incorrectly, resulting in a medication overdose.
Incorrect: The nurse incorrectly programed the IV pump, which resulted in a medication overdose, because she was working a double shift and was fatigued.
- CCFs should begin with latent failures and present a logical order leading up to the active failure.
Correct: Working a double produced nurse fatigue, which led to the incorrect programming of an IV pump and the patient receiving a medication overdose.
Incorrect: While working a double shift, the nurse incorrectly programed the IV pump, because she was fatigued, which resulted in a medication overdose.
- CCFs should be summary statement that conveys the “gist” of your conclusions/findings.
Correct: Working a double shift resulted in nurse fatigue, which led to programming an IV pump incorrectly, resulting in a medication overdose.
Incorrect: The nurse had been working 15 hours across two shifts on the day of the event and as a result, he was feeling some fatigue, this resulted in him misprogramming the IV pump incorrectly, entering 2.0 rather than .20, resulting in the patient experiencing a medication overdose and requiring intervention.
- CCFs should not contain HFACS terminology.
Correct: In concordance with existing hospital policy, a nurse manager scheduled a nurse to work a double shift without rest, resulting in the nurse becoming fatigue, misprogramming an IV pump, and the patient receiving a medication overdose.
Incorrect: The organizational influence of having a policy which allows nurses to be scheduled double shifts without adequate time for rest, resulted in planned in appropriate operations, by the supervisor who scheduled the nurse to work a double shift, which resulted in a fatigued mental and physiological state of the nurse, which resulted in the nurse inadvertently performing a skill-based error by incorrectly programming the IV pump, which resulted in a medication overdose.
- CCFs should be a self-contained idea or statement.
Correct: Working a double shift resulted in nurse fatigue, which led to programming an IV pump incorrectly, resulting in a medication overdose.
Incorrect: The nurse had been working 15 hours across two shifts on the day of the event. The nurse was feeling some fatigue. As a result, he misprogrammed the IV pump incorrectly, entering 2.0 rather than .20. The patient then experienced a medication overdose and required intervention.
Note: A single sentence is NOT required; however, you may want to use semicolons rather than periods to keep the statement focused on a single finding.
Additional Tips:
- Think of as many different ways you can say “cause”…Resulted in, As a result, Lead to, Fostered, Perpetuated, Exacerbated, Impeded, Impacted, Effected, Due to, Because, Consequently, etc.
- Use these synonyms (and others) to keep your statements from being redundant or sounding awkward.