Toxic Cascades

Current thinking about patient safety is primarily focused on the immediate consequences of mistakes that affect care, such as medication errors. Some mistakes become apparent only after a lapse of time from when they were committed.

The toxic cascade model presents an approach to patient safety that locates “upstream sources and downstream consequences of errors” (AFP 2001). It is conceptualized as a tiered diagram, presenting four levels that are potential threats to patients’ safety. Click on each of the boxes for an explanation. If the diagram seems counter-intuitive, think of rapids in a river: as the river narrows, the water goes faster and the flow becomes more powerful.