Using multiclass classification to automate the identification of patient safety incident reports by type and severity | BMC...
Approximately 10% of admissions to acute-care hospitals are associated with an adverse event. Analysis of incident reports helps to understand how and why incidents occur and can inform policy and practice for safer care. Unfortunately our capacity to monitor and respond to incident reports in a timely manner is limited by the sheer volumes of data collected. In this study, we aim to evaluate the feasibility of using multiclass classification to automate the identification of patient safety incidents in hospitals. Text based classifiers were applied to identify 10 incident types and 4 severity levels. Using the one-versus-one (OvsO) and one-versus-all (OvsA) ensemble strategies, we evaluated regularized logistic regression, linear support vector machine (SVM) and SVM with a radial-basis function (RBF) kernel. Classifiers were trained and tested with
How effective are patient safety initiatives? A retrospective patient record review study of changes to patient safety over...
Baines, R., Langelaan, M., Bruijne, M. de, Spreeuwenberg, P., Wagner, C. How effective are patient safety initiatives? A retrospective patient record review study of changes to patient safety over time. BMJ Quality & Safety: 2015, 24(9), 561- ...
Medical Errors in US Pediatric Inpatients With Chronic Conditions | Articles | Pediatrics
RESULTS: In the 2006 KID, 22.3% of pediatric inpatients had 1 chronic condition, 9.8% had 2 chronic conditions, and 12.0% had ≥3 chronic conditions. The overall medical error rate per 100 discharges was 3.0 (95% confidence interval [CI]: 2.8-3.3); it was 5.3 (95% CI: 4.9-5.7) in children with chronic conditions and 1.3 (95% CI: 1.2-1.3) in children without chronic conditions. The medical error rate per 1000 inpatient days was also higher in children with chronic conditions. The association between chronic conditions and medical errors remained statistically significant in logistic regression models adjusting for patient characteristics, hospital characteristics, disease severity, and length of stay. In the adjusted model, the odds ratio of medical errors for children with 1 chronic condition was 1.40 (95% CI: 1.32-1.48); for children with 2 conditions, the OR was 1.55 (95% CI: 1.45-1.66); and for children with 3 conditions, the OR was 1.66 (95% CI: 1.53-1.81). ...
Hospital-Reported Medical Errors in Children | American Academy of Pediatrics
These data from a nationally representative dataset provide some of the first data regarding the general problem of hospital-reported medical errors in pediatric inpatients. By using a nationally representative inpatient sample, it is possible to discuss patterns in the broad group of pediatric patients. We now have an understanding that hospital-reported medical error in hospitalized children is a relatively rare event occurring in ,3% of hospital discharges. This rate has increased from 1988 to 1991, but remained stable from 1991 to 1997. Furthermore, children with increasingly complex medical care have higher medical error rates, which is consistent with data derived from studies on adult patients. Children with medical errors also had higher associated LOS and mortality rates throughout the years studied. Therefore, this work primarily provides an important reference point for subsequent and more specialized studies of specific patient groups such as children with chronic illnesses who may ...
For Most States, Medical Error Reporting Is Uncertain Science | Managed Care magazine
Both the IOM and QuIC reports emphasize the importance of collaboration between federal, state, and private-sector stakeholders. According to the National Academy for State Health Policy (NASHP), states responded to the IOM report with 45 bills related to medical errors, of which eight had been enacted by July. Only 20 states, however, have mandatory reporting programs related to patient safety.. States are looking for guidance, says Jill Rosenthal, an NASHP policy analyst. Theyre interested in standardization, but they dont want to see that developed at the federal level without state input. Standardization, both in collecting data on medical errors and in promulgating best practices, is a prerequisite for preventing errors from reoccurring.. Even states with relatively robust mandatory reporting systems are struggling to define for providers what constitutes a medical error. The Pennsylvania Department of Health, for example, sent licensed health care facilities a list of questions and ...
Medical Mistakes May be a Leading Cause of Death - Flora Templeton Stuart Injury lawyer
According to some observers, the CDC instructs doctors to only list medical conditions as the cause of death, and its coding system does not account for medical mistakes whether diagnostic errors, poor judgment or communication breakdowns. However, the CDC notes that complications arising from medical treatment are listed on death certificate, but only the condition that was being treated is listed as the underlying cause of death.. As a result, the public is not aware of the impact of medical errors, and the authors of the study are calling for death certificates to specifically ask if a complication that could have been prevented contributed to the death. The failure to report medical errors ultimately hinders research that could be helpful in reducing the number of deaths by providing more resources aimed at patient safety.. Ultimately, whether the study will prompt the CDC to include medical errors on its annual list of the leading causes of death remains to be seen. In the meantime, ...
Patient-reported safety incidents in older patients with long-term conditions: a large cross-sectional study | BMJ Open
Patient safety is defined as the avoidance, prevention, and amelioration of adverse outcomes or injuries stemming from the processes of healthcare,1 while a patient safety incident is defined as any unintended event or hazardous condition resulting from the process of care, rather than due to the patients underlying disease, that led or could have led to unintended health consequences for the patient or healthcare processes linked to safety outcomes.2Patient safety research has traditionally focused on hospital-based specialist settings, but there is growing evidence that patient safety in primary care can also be problematic.3-5 Patient safety incidents related to prescription of medication, diagnostic errors and communication failures are frequently encountered in primary and secondary care (ranging from 2% to 10% of consultations).6-9 These safety incidents might be more common or severe in vulnerable patient groups such as older patients with two or more long-term conditions (known as ...
Medical Error Surpasses Respiratory Disease As Third Leading Cause Of Death In The US - Xtalks
Using medical data collected over an eight-year period, patient safety experts at Johns Hopkins have calculated that medical errors are now the third leading cause of death in the US. At more than 250,000 deaths per year attributed to medical mistakes, this number exceeds the Center for Disease Control and Preventions (CDC) third most common cause of death - respiratory disease - which is responsible for almost 150,000 deaths each year.. According to the researchers, the CDCs data does not reflect medical errors, which are often not listed on the death certificate. The authors of the paper - which was published in The BMJ - are urging regulators to update the system used to classify cause of death on these documents.. Incidence rates for deaths directly attributable to medical care gone awry havent been recognized in any standardized method for collecting national statistics, said Dr. Martin Makary, professor of surgery at the Johns Hopkins University School of Medicine and an authority on ...
Healthcare Quality and Patient Safety - National Patient Safety Goals, Quality of Care, and Medical Error Reduction - www.hcpro...
The quality/patient safety department assists hospitals with meeting The Joint Commissions National Patient Safety Goals, addressing CMS patient safety-related regulations, ensuring patient satisfaction, and improving the overall quality of care.
Healthcare Quality and Patient Safety - National Patient Safety Goals, Quality of Care, and Medical Error Reduction -...
The quality/patient safety department assists hospitals with meeting The Joint Commissions National Patient Safety Goals, addressing CMS patient safety-related regulations, ensuring patient satisfaction, and improving the overall quality of care.
How effective are patient safety initiatives? A retrospective patient record review study of changes to patient safety over...
This retrospective study in the Netherlands encompasses three national major adverse event studies. These authors previously reported that the adverse event rate in the Netherlands had increased between 2004 and 2008. In this current study, there was no change in overall adverse event rates in 2011/2012 compared to 2008, while preventable adverse events were markedly reduced by 45%.
UCSF Study Shows Better Provider Communication Reduces Medical Errors, Improves Patient Safety | California Healthline
|p|A study conducted by UC-San Francisco and eight other institutions found that improving verbal and written communication between providers resulted in a 30% decline in patient harm from medical errors. According to researchers, medical errors are the third leading cause of death in the U.S. |/p|
Depression in doctors linked to increase in medical errors, study finds | Anesthesia Experts
For physicians, the combination of long hours, often grueling medical procedures and lives on the line can create an enormous amount of stress. That can take a toll on mental health, and many doctors say they suffer from depression. A Medscape survey from last year indicated 71% of doctors are suffering from some form of burnout, depression or both.. Up to 400 doctors in the U.S. kill themselves every year, according to a study on that topic. And given depression can dull mental acuity, that puts clinicians at risk for committing medical errors.. Researchers from the University of Michigan School of Medicine, Federal University of So Paulo, the University of Sao Paulo and Memorial Sloan Kettering Cancer Center undertook a survey of prior studies linking medical errors to depression among physicians.. For the most part, the studies showed a fairly consistent link between physician depression and medical errors. Altogether, they showed that physicians who were depressed were nearly twice as likely ...
How To Repair Medical Error Form Tutorial
The alerts provide clinicians the opportunity to learn about root causes of errors. To effectively avoid future errors that can cause patient harm, improvements must be made on the underlying, more-common and less-harmful systems problems5 most often associated with near misses. Disclosure of medical error. Near Miss Error Hebert PC, Levin AV, Robertson G. How to handle apologies effectively is a key issue for error disclosure. Previously, it was assumed that most medical errors were due to providers who were either incompetent or lazy. The system returned: (22) Invalid argument The remote host or network may be down. news Multiple barriers inhibit disclosure, ranging from fear of malpractice to shame and embarrassment from admitting to a patient that one has made an error. In most cases, disclosure does not appear to stimulate lawsuits, and may in fact make lawsuits less likely. Mandatory and voluntary reporting systems differ in relation to the details required in the information that is ...
Helpful Ways to Avoid Medical Errors - Lee Kirksey, MDs Blog - MedHelp
I sit on an advisory board for our state that focuses on medical errors. Medical errors can occur in many forms including prescribing medications in people with allergies, wrong dosages, wrong site su...
Preventable Medical Errors
Patient safety at US hospitals not getting better despite efforts to improve patient care reduce infection rates and decrease occurrence of preventable medical errors
Talking to Patients After a Medical Mistake - The New York Times
After a medical error, hospitals often prevent doctors from talking to patient families. Now new research shows that everybody - patients, doctors and the hospital - benefits when communication is encouraged after a medical mistake.
The Incidence and Nature of Adverse Medical Device Events in Dutch Hospitals. A Retrospective Patient Record Review Study. |...
Porte, P.J., Smits, M., Verweij, L.M., Bruyne, M.C. de, Vleuten, C.P.M. van der, Wagner, C. The Incidence and Nature of Adverse Medical Device Events in Dutch Hospitals. A Retrospective Patient Record Review Study. Journal of Patient Safety: ...
Impact of extended-duration shifts on medical errors, adverse events, and attentional failures
In our survey, extended-duration work shifts were associated with an increased risk of significant medical errors, adverse events, and attentional failures in interns across the United States. These results have important public policy implications for postgraduate medical education.
Overview of medical errors and adverse events | Annals of Intensive Care | Full Text
Safety is a global concept that encompasses efficiency, security of care, reactivity of caregivers, and satisfaction of patients and relatives. Patient safety has emerged as a major target for healthcare improvement. Quality assurance is a complex task, and patients in the intensive care unit (ICU) are more likely than other hospitalized patients to experience medical errors, due to the complexity of their conditions, need for urgent interventions, and considerable workload fluctuation. Medication errors are the most common medical errors and can induce adverse events. Two approaches are available for evaluating and improving quality-of-care: the room-for-improvement model, in which problems are identified, plans are made to resolve them, and the results of the plans are measured; and the monitoring model, in which quality indicators are defined as relevant to potential problems and then monitored periodically. Indicators that reflect structures, processes, or outcomes have been developed by medical
MERCI Joins NPSF Patient Safety Coalition - National Patient Safety Foundation
MERCI (Medical Error Reduction and Certification, Inc.) is a patient safety training enterprise designed specifically to serve hospitals in need of methodology, validation, and ongoing auditing to reduce procedural medical errors and improve patient safety. Achieving these objectives not only improves patients lives and health, but also has a major positive financial impact on the bottom line in todays health care system. When thorough training, maintenance of skills, and adherence to industry best practices are rigorously implemented, a dramatic reduction in preventable errors can be achieved. To learn more about MERCI, visit www.merciprogram.com ...
Medical errors in primary care clinics - a cross sectional study | BMC Family Practice | Full Text
Patient safety is vital in patient care. There is a lack of studies on medical errors in primary care settings. The aim of the study is to determine the extent of diagnostic inaccuracies and management errors in public funded primary care clinics. This was a cross-sectional study conducted in twelve public funded primary care clinics in Malaysia. A total of 1753 medical records were randomly selected in 12 primary care clinics in 2007 and were reviewed by trained family physicians for diagnostic, management and documentation errors, potential errors causing serious harm and likelihood of preventability of such errors. The majority of patient encounters (81%) were with medical assistants. Diagnostic errors were present in 3.6% (95% CI: 2.2, 5.0) of medical records and management errors in 53.2% (95% CI: 46.3, 60.2). For management errors, medication errors were present in 41.1% (95% CI: 35.8, 46.4) of records, investigation errors in 21.7% (95% CI: 16.5, 26.8) and decision making errors in 14.5% (95% CI:
Evidence on interventions to reduce medical errors: an overview and recommendations for future research
Medical errors were very frequent in the studies we identified, arising sometimes in more than half of the cases where there is an opportunity for error. Relatively simple interventions may achieve large reductions in error rates. Evidence on reduction of medical errors needs to be better categorize …
Print Exam | Medical Errors CEUs | CE for Florida PT, RN, PTA, RT, Dietitians
2 CE hrs of Medical Errors approved in Florida only $6. Medical Errors CE course is approved in Florida for PT, RN, LPN, PTA, RT, Dietitians and Nutrition Counselors. Immediate reporting of CE hours to CEBroker.
The Devastating Effects of Silence - Patient Safety & Quality Healthcare
By Megan Headley. During her early research on patient safety over a decade ago, focusing on medical error disclosure and ways to improve communication with patients and families after harmful events, Sigall K. Bell, MD, director of patient safety and quality initiatives for the Raskin Fellow in Medical Education at Beth Israel Deaconess Medical Center, began to notice a pattern.. I started noticing that some of the stories of harmed patients and families shared a common narrative: I knew something was wrong, but I couldnt say anything or, I didnt know how or who to tell or, I tried to say something, but it didnt work. This resonated with themes we heard from interviewed patients and families who experienced medical error, which included a sense of guilt: If only I had been there, or, If only I had said something, Bell recalls.. As it turns out, clinicians may be overlooking, if not actively discouraging, input from a significant patient safety resource: patient ...
Medical Errors and Patient Safety Research Reports Two - Program Services Continuing Education For Mental Health Professionals
Program Services: Online Continuing Education and Home Study, Florida Behavioral Health Laws and Rules,Issues In Supervision,Approved CE Provider with American Psychological Association, and National Board for Certified Counselors and provider of US DOT Substance Abuse Qualification Training and National examination for substance abuse professionals, AAMFT 30 Hour approved clinical supervision training. Home Study, Online Courses and Live Florida Seminars. Found at: http://www.programservices.org
Preventable Medical Error Is Canadian Healthcares Silent Killer | HuffPost null
While our hospitals save lives every day, they are also the third leading cause of avoidable death every year. In Canada, medical errors and hospital-acquired infections claim between 30,000 and 60,000 lives annually. Thousands more are injured. But to the public, these incidents are largely invisible.
Alliance for Continuing Education in the Health Professions : 2017 Quality and Innovation Summit : QIS 2017 Session Details
Since the Institute of Medicine (IOM) report To Err is Human in 1999, patient safety and education to prevent medical errors has been critical to healthcare. Additionally, regulatory and accreditation bodies have set standards to improve the quality of health care organizations to help provide safe patient care across all settings. Despite numerous efforts, medical error rates do not seem to be improving. For example, in 2000, the IOM report stated that up to 98,000 deaths occur as a result of medical errors.1 More recently, Makary and Daniel state that the numbers were actually underestimated and report a mean rate of death from medical error of 251,454 a year. This would make medical errors the 3rd most common cause of death in the United States for 2013.2 ...
Fumbled handoffs can lead to medical errors
Since the researchers looked retrospectively at the discharge summaries, they were able to see if test results reported after discharge called for a change in the patient treatment plan or management. We found that a huge number -- 72 percent -- of test results requiring treatment change were not mentioned in discharge summaries. So an outpatient provider likely would not even have known that the results of these tests needed to be followed up. In the patient safety arena, this is what you call a fumbled handoff - and it leads to medical errors. said Martin Were, M.D., MS., first author of the study. Dr. Were is a Regenstrief Institute investigator and an assistant professor of medicine at the IU School of Medicine.. While it is easy to blame busy health-care providers for poor quality of discharge summaries, the problem largely reflects a failure in the system, according to Dr. Were. Similarly, in its seminal report To Err is Human, the Institute of Medicine advocates for changes in ...
Comparison of traditional trigger tool to data warehouse based screening for identifying hospital adverse events | BMJ Quality ...
We found relatively poor agreement between traditional trigger tool and EDW based screening with only approximately a third of all AEs detected by both methods. Our results were consistent across designations of preventability and severity of AEs. Prior studies similarly revealed poor agreement between computerised and trigger tool based strategies to detect AEs. In a study focusing on ADEs, Jha and colleagues reported that a computer based method detected 45% of events, trigger tool based screening detected 65% and only 12% were detected by both methods.14 More recently, Tinoco and colleagues reported that a computerised surveillance system detected more hospital acquired infections than trigger tool based screening, but a similar number of ADEs.19 Importantly, the study found that only 26% of hospital acquired infections and 3% of ADEs were detected by both methods.19 Our study provides additional support that computer facilitated screening may complement the traditional trigger tool approach ...
Fumbled Handoffs May Lead To Medical Errors - Redorbit
We found that a huge number -- 72 percent -- of test results requiring treatment change were not mentioned in discharge summaries. So an outpatient provider likely would not even have known that the results of these tests needed to be followed up. In the patient safety arena, this is what you call a fumbled handoff - and it leads to medical errors. said Martin Were, M.D., MS., first author of the study. Dr. Were is a Regenstrief Institute investigator and an assistant professor of medicine at the IU School of Medicine ...
Researchers: Medical errors now third leading cause of death in United States - California Hospital Association
Nightmare stories of nurses giving potent drugs meant for one patient to another and surgeons removing the wrong body parts have dominated recent headlines about medical care. Lest you assume those cases are the exceptions, a new study by patient safety researchers provides some context.. Their analysis, published in the BMJ on Tuesday, shows that medical errors in hospitals and other health care facilities are incredibly common and may now be the third leading cause of death in the United States - claiming 251,000 lives every year, more than respiratory disease, accidents, stroke and Alzheimers.. ...
5 hospitals in the spotlight for medical errors - and how theyre fixing them
A number of hospitals are working to improve patient safety and curb medical errors after recent reports found lapses in patient care.
PROMPT Flex Birthing Simulator
Patient safety initiatives aimed at addressing the potential for adverse events and medical errors are being implemented in many labor and delivery departments. PROMPT Flex is ideal for addressing high risk, low frequency events and reducing complications. The versatile and modular design provide the user with a comprehensive experience in all stages of birth and complexity. Suited for all learners in both professional education and healthcare providers ...
PROMPT Flex Birthing Simulator
Patient safety initiatives aimed at addressing the potential for adverse events and medical errors are being implemented in many labor and delivery departments. PROMPT Flex is ideal for addressing high risk, low frequency events and reducing complications. The versatile and modular design provide the user with a comprehensive experience in all stages of birth and complexity. Suited for all learners in both professional education and healthcare providers ...
Medical Error: The High Cost to Lives and Health Care
Alex Christgen, executive director for the Center for Patient Safety, joins Quality Talk host Jodie Jackson Jr. to talk about eliminating medical errors.
Mistake Reduction Tools to Be Disseminated
CHICAGO, ILL-Hospital administrators will begin to receive information about reducing medical errors from the American Hospital Association (AHA) and their state hospital associations. AHA News reported that a video titled Beyond Blame and the report Reducing Medical Errors and Improving Patient Safety: Success Stories from the Front Lines of Medicine have been sent to hospitals across the country. The video presents a series of errors from the viewpoint of the providers involved, and the report presents profiles of institutions that have made commitments to patient safety and medical error reduction. The profiles reflect some of the more innovative efforts currently in this area. ...
Fix Nurses Medical Error Gov (Solved)
It is not intended as a substitute for professional healthcare. J Med Ethic Hist. 2009;3(Suppl 1):60-9.10. State legislatures can also provide for safer care through laws designed to improve the nursing workplace environment. Medication Errors Articles Implement protocols for vulnerable populations (elderly, pediatric, obese patients). These results have been shared to prevent similar sentinel events from occurring and to protect patients. SPSS software version 16 (SPSS Inc., Chicago, IL, USA) was used for statistical analysis and P values less than 0.05 were considered significant.ResultsAll questionnaires were returned to the researchers after being Generated Sat, 22 Oct 2016 05:13:31 GMT by s_wx1157 (squid/3.5.20) click site The key to reducing medical errors is to focus on improving the systems of delivering care and not to blame individuals. Department of Health and Human Services National Institutes of Health Page last updated: 05 October 2016 ANA HomeAbout OJINFAQsAuthor ...
Doctor-Patient Bond Frays After Medical Mistake - Drugs.com MedNews
Serious medical errors don t just affect the health of the patient, they can quickly destroy the patient s relationship with his or her doctor, too, experts say
Real-Life Medical Mistakes That Will Make You Cringe | Readers Digest
Research shows that medical errors may cause 250,000 deaths in the United States every year. Here are some errors that had lasting effects.
Preventable deaths due to problems in care in English acute hospitals: a retrospective case record review study | BMJ Quality &...
Our study has a number of strengths: the large, representative sample drawn from Trusts in different regions and of different size and teaching status; our use of problem in care rather than the commonly used adverse event to minimise the risk of overlooking errors of omission; and the various measures to standardise data collection and ensure high quality record review.. Nonetheless, several limitations need to be considered. First, medical records may not document all problems in care, though this limitation applies to all RCRR studies, including ones that have generated previous estimates of preventable hospital deaths. Second, the estimates of life expectancy were dependent on reviewers judgement, a notoriously difficult task. Third, RCRR studies are often criticised because of the poor reliability of the reviewers judgements. We used a number of approaches to improve reliability and obtained a moderately strong inter-rater agreement that compared favourably with previous studies. Some ...
Preventing Medical Errors for Physical Therapists | ContinuingEducation.com
Despite the efforts of healthcare providers, medical error rates in communities, hospitals, and homes remain high. Patients and families pay for errors through
Medical Errors Education: A Prospective Study of a New Educational Tool
AbstractMedical errors training is an important yet often overlooked aspect of medical education. A medical errors educational session was developed for rotating medical students (MSs) with prospective analysis of the educational tool. Students completed the same 12-question test before and after th
How to protect your child from medical errors
SheKnows Parenting shares advice from an expert on how to ensure your child does not become a statistic of a hospital medical error.
THE EFFECTS OF COMPUTER SIMULATION ON REDUCING THE INCIDENCE OF MEDICAL ERRORS ASSOCIATED WITH MASS DISTRIBUTION OF...
THE EFFECTS OF COMPUTER SIMULATION ON REDUCING THE INCIDENCE OF MEDICAL ERRORS ASSOCIATED WITH MASS DISTRIBUTION OF CHEMOPROPHYLAXIS AS A RESULT OF A BIOTERRORISM EVENT
Medical Errors: STILL the Third Leading Cause of Death | Wake Up World
According to a recent study, medical errors kill an estimated 250,000 Americans each year, making it the third leading cause of death in the U.S.
Medical Error Kills Hopkins Cancer Patient - Parker Waichman LLP
A Young Cancer Patient Recovering At Home From Medical Error. A young cancer patient recovering at home from a bone marrow transplant died.
Sensitivity of routine system for reporting patient safety incidents in an NHS hospital: retrospective patient case note review...
Objective To evaluate the performance of a routine incident reporting system in identifying patient safety incidents. Design Two stage retrospective review of patients case notes and analysis of data submitted to the routine incident reporting system on the same patients. Setting A large NHS hospital in England. Population 1006 hospital admissions between January and May 2004: surgery (n=311), general medicine (n=251), elderly care (n=184), orthopaedics (n=131), urology (n=61), and three other specialties (n=68). Main outcome measures Proportion of admissions with at least one patient safety incident; proportion and type of patient safety incidents missed by routine incident reporting and case note review methods. Results 324 patient safety incidents were identified in 230/1006 admissions (22.9%; 95% confidence interval 20.3% to 25.5%). 270 (83%) patient safety incidents were identified by case note review only, 21 (7%) by the routine reporting system only, and 33 (10%) by both methods. 110 ...
Leadership Award presented for fostering a patient safety culture
The Credit Valley Hospital and Trillium Health Centre is the recipient of the 2012 Patient Safety Education Program - Canada (PSEP - Canada) Innovations in Patient Safety Education Award, recognizing their work in fostering a culture of patient safety.The PSEP - Canada Innovations in Patient Safety Education Award was Credit Valley Hospital and Trillium Health Centre on November 1, 2012. The Innovations in Patient Safety Education Award recognizes organizations that demonstrate best practices in patient safety and quality improvement, says Hugh MacLeod, CEO of the Canadian Patient Safety Institute. Credit Valley Hospital and Trillium Health Centre have effectively adapted the PSEP - Canada program to foster peer-to-peer spread in advancing a patient safety culture throughout their organization. They are truly a deserving recipient of this award.. This award is a further validation and confirmation that we are on the right track in making patients a priority in everything that we do, says ...
Detection of medical errors in kidney transplantation: A pilot study comparing proactive clinician debriefings to a hospital...
TY - JOUR. T1 - Detection of medical errors in kidney transplantation. T2 - A pilot study comparing proactive clinician debriefings to a hospital-wide incident reporting system. AU - McElroy, Lisa M.. AU - Daud, Amna. AU - Lapin, Brittany. AU - Ross, Olivia. AU - Woods, Donna M.. AU - Skaro, Anton I.. AU - Holl, Jane L.. AU - Ladner, Daniela P.. N1 - Publisher Copyright: © 2014 Elsevier Inc. All rights reserved. Copyright: Copyright 2014 Elsevier B.V., All rights reserved.. PY - 2014/11/1. Y1 - 2014/11/1. N2 - Background Rates of medical errors and adverse events remain high for patients who undergo kidney transplantation; they are particularly vulnerable because of the complexity of their disease and the kidney transplantation procedure. Although institutional incident-reporting systems are used in hospitals around the country, they often fail to capture a substantial proportion of medical errors. The goal of this study was to assess the ability of a proactive, web-based clinician safety ...
Interventions
For the past five years healthcare organizations across the country have been preventing patient safety incidents though the use of Safer Healthcare Now! interventions - a series of customizable, reliable, tested, and practical tools for improving quality and patient safety.. Safe Healthcare Now! interventions combine clinical and patient safety improvement expertise. They are designed to give you everything you need to implement, measure, and evaluate your patient safety initiatives.. We recommend you download the Getting Started Kit for the following intervention you are interested in using. The kits are comprehensive practical resources that engage healthcare teams and clinicians in a dynamic approach to quality improvement and give you a solid foundation for getting started.. ...
Recent Developments in Patient Safety and Scope of Patient Safety Special Interest Group Recent Developments in Patient Safety...
Even when using the lower estimate, deaths due to medical errors exceed the number attributable to the 8th leading cause of death. Death: Final data for CDC-National Vital Statistics Reports. 47(19):27, More people die in a given year as a result of medical errors than from motor vehicle accidents (~44,000), breast cancer (~43,000) or AIDS(~16,500). Births and Deaths: Preliminary data for CDC, National Vital Statistics Reports. 47(25):6, Medication error along, occurring either in or out of hospitals, are estimated to account for 7000 deaths annually. Phillips DP et al. Increase in US medication error deaths between 1983 and The Lancet, 351:643-44, Total national cost of preventable adverse events are estimated between 17 billion of which health care costs represent one half. Thomas EJ et al. Cost of Medical Injuries in Utah and Colorado. Inquiry 36: , 1999 and Johnson WJ et al. The economic consequences of medical injuries, JAMA. 267: , The Quality in Australian Health Care Study (Wilson RM et al. The
Patient safety - Wikipedia
Patient safety is a discipline that emphasizes safety in health care through the prevention, reduction, reporting, and analysis of medical error that often leads to adverse effects. The frequency and magnitude of avoidable adverse events experienced by patients was not well known until the 1990s, when multiple countries reported staggering numbers of patients harmed and killed by medical errors. Recognizing that healthcare errors impact 1 in every 10 patients around the world, the World Health Organization calls patient safety an endemic concern. Indeed, patient safety has emerged as a distinct healthcare discipline supported by an immature yet developing scientific framework. There is a significant transdisciplinary body of theoretical and research literature that informs the science of patient safety. The resulting patient safety knowledge continually informs improvement efforts such as: applying lessons learned from business and industry, adopting innovative technologies, educating providers ...
No One is Immune: Even Celebrities are Victims of Medical Errors
A law group has released a list of the top 22 cases of celebrities harmed by medical malpractice. If you or someone you love has been the victim of medical error, call the attorneys of Levin & Perconti for a FREE consultation (312) 332-2872.
System Failure Sound Effects ~ System Failure Sounds | Pond5
Download System Failure sounds ... 547 stock sound clips starting at $2. Download and buy high quality System Failure sound effects. BROWSE NOW |||
Medical Error, Malpractice - Unexpected Pet Death
Questions after dogs death - was there medical error Q: I lost a diabetic cushings dog 4 days after surgery for hind leg parlysis due to disk injury (not known if from natural circumstances or injury). I am looking for info on dopamine loss and adverse reaction drugs. Has anyone done any scientific research on any of the following drugs which were given together(at the same time): Reglan(a dopamine antagonist), Ranitidine(HCL), Sulcralfate, Baytril ,Valium and increased insulin(dog wasnt eating,but there was vomiting and diarrhea after drug medications).After the first drug combination the dog also experienced seizure like activity and later at night what appeared to be a grand mal seizure and was given valium.The following morning all drugs (except Valium) and increased insulin were given again.The dog became comatose and remained so until I arrived and asked for corn syrup (approx.1.00 -1.30 p.m. I brought him around and asked for water .He was extremely thirsty but had difficulty getting it ...
Fix Medical Error Cases Tutorial
Key Facts to Know Conditions 5 Signs You Could Have Esophageal Cancer Conditions 8 Foods That Could Make Your Arthritis Worse Everyday Wellness 7 Clear Signs You Have an Unhealthy Gut Latest Stories in this Project Doctor Confesses: I Lied to Protect Colleague in Malpractice Suit New Report: Problem Care Harms Almost One-Third of Rehab Hospital Patients Study Urges CDC to Revise Furthermore, without an emergency, the doctor and the nurses never informed my Dad or me (his medical power of attorney at the hospital 24/7) about the drug being a sulfa drug, Another reason that nothing was done was the prohibitive cost to treat severe infections like C. Defend and Deny vs. Six cardioversions, a stay in the intensive care unit, and multiple consultations and tests later, Tootsie was exhausted. Moved by Chriss story and motivated by the cause, Al immediately began working with Chris to restructure the Emily Jerry Foundation. As a seasoned entrepreneur, Al knew how to start, build Medical Error Stories ...
New Journal Series Will Educate Physicians About Medical Errors | MeetingsNet
A new journal series, Quality Grand Rounds, will harness the power of individual case presentations to educate health care providers about medical errors. The first article in a series of eight appears in the June 4, 2002 issue of the Annals of Internal Medicine. Click here to go to the Annals website. The 1999 Institute of Medicine (IOM) report, To Err is Human, shocked people and catalyzed
In-House Specialty Pharmacy at Cancer Center Improves Quality of Care, Reduces Medical Errors | ASCO
ALEXANDRIA, Va. - An influx of new oral cancer drugs provides patients with a more convenient and less invasive way to take medication, but such treatments are often associated with adherence challenges and medical errors. New research shows that the addition of an in-house specialty pharmacy at a cancer center in New Haven, Connecticut, improved overall quality of care for
CME Linkages: California Department of Public Health fines hospitals for medical errors
State officials have fined 13 California hospitals for medical errors that in some cases killed or seriously injured patients, according to a report made public Wednesday ...
24 CE Hour Opt 2- Prevention of Medical Errors 2nd Ed., Hepatitis A, B, C 2nd Ed., Occupational Skin Exposures & Effects,...
24 CE Hour Opt 2- Prevention of Medical Errors 2nd Ed., Hepatitis A, B, C 2nd Ed., Occupational Skin Exposures & Effects, Patient Health Communication
Commissioner - Open Disclosure
1] See R Lamb, Open disclosure: the only approach to medical error (2004) 14 Quality and Safety in Health Care 3.. [2] Ministry of Health, New Zealand Standard Health and Disability Services Standards, NZS 8134:2008.. [3] See C Vincent and A Coulter, Patient safety: what about the patient? (2002) Quality and Safety in Healthcare 11(1): 76-80.. [4] M Bismark, E Dauer, R Paterson and D Studdert, Accountability sought by patients following adverse events from medical care: the New Zealand experience (2006) 175 CMAJ 889; M Bismark and R Paterson, Doing the right thing after an adverse event (2005) 1219 NZMJ 55; A Witman, D Park and S Hardin, How do patients want physicians to handle mistakes? A survey of internal medicine patients in an academic setting (1996) 156 Archives of Internal Medicine 2565; M Higorai, T Wong and G Vafidis, Patients and doctors attitudes to amount of information given after unintended injury during treatment: cross-sectional, questionnaire survey (1994) 318 ...
Wrong-side thoracentesis: lessons learned from root cause analysis. | PSNet
Wrong-site procedures result in significant patient harm, and prior studies have shown that-contrary to traditional assumptions-many of these errors occur outside the operating room. This analysis of 14 cases of wrong-site thoracenteses, a procedure to remove fluid from around the lung, identified several common themes in these errors. The majority of errors resulted in serious patient injury.
Patient safety incident review: a rare occurrence of central anesthesia from a local anesthetic block during an ophthalmology...
The College of Physicians and Surgeons of British Columbia regulates the practice of medicine under the authority of provincial law. All physicians who practise medicine in the province must be registrants of the College.
Psychological impact and recovery after involvement in a patient safety incident: a repeated measures analysis | BMJ Open
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The incidence of adverse events in Swedish hospitals: a retrospective medical record review study. - PubMed - NCBI
PubMed comprises more than 30 million citations for biomedical literature from MEDLINE, life science journals, and online books. Citations may include links to full-text content from PubMed Central and publisher web sites.
Diagnostic Errors Top ECRIs Patient Safety List - MedicallyPrime.Com
For the second consecutive year, diagnostic error and managing test results were ranked number 1 among the Top 10 Patient Safety Concerns for 2019 identified by the ECRI Institute.. Medical errors are the third leading cause of death in the country, said Marcus Schabacker, MD, president and CEO, ECRI Institute. This guidance can help healthcare leaders and clinicians save lives.Healthcare providers rely on EHRs to help with clinical decision support and tracking test results. But that technology is just one tool in the diagnostic process, said William Marella, executive director of operations and analytics, at the ECRI Institute PSO.. We have to recognize the limits of current technology and ensure that we have processes in place to close the loop on diagnostic tests, Marella said. This safety issue cuts across acute and ambulatory settings, requiring teamwork across the health system.. ECRI Institutes 2019 list of concerns addresses systemic issues facing health systems, such as ...
November 2017 - Law Firm of Targan & Pender, P.C.
Dentists are medical practitioners who are also obligated to provide an acceptable standard of care to their patients. Medical mistakes at the dentists office can kill patients or leave them with permanent injuries. For instance, there is currently a case in Houston where a dentist is accused of causing severe brain damage to a 4-year-old girl. The dentist allegedly failed to monitor the girl during a procedure and gave her too many sedatives. As a result, the girl can no longer speak, walk, eat or see. There are other types of medical mistakes that may occur at a dentists office. Examples of medical malpractice at the dentists office might include: Anesthesia mistakes: Some dental procedures require patients to undergo general anesthesia. Mistakes made during general anesthesia could lead to traumatic brain injuries or death. Patients may also not receive enough anesthesia, which could lead to anesthesia awareness. This is where ...
Donate to the Patient Safety Education & Research Fund | SPA
The SPA is pleased to announce the availability of young investigator research grants through the Patient Safety, Education and Research Fund (PSERF).
Phoenix Medical Malpractice Attorney Blog
There is an epidemic that is killing almost half-a-million Americas and injuring millions of others every year. This epidemic is as bad as the top two killers of Americans, cancer and heart disease (each claiming over 550,000 lives each year), and is far worse than accidents (claiming over 120,000 lives each year). What makes this epidemic more tragic than the most common causes of death in the U.S. is that these deaths are 100% preventable.. Preventable medical errors kill and injure Americans at an alarming rate. A new study printed in the Journal of Patient Safety, as reported by Scientific American, reports that the true number of premature deaths associated with preventable harm to patients was estimated at more than 400,000 per year. Serious harm seems to be 10- to 20-fold more common than lethal harm. This is a problem of epidemic proportions that must be fixed.. When was the last time you heard politicians or lobbyists address how to prevent medical errors? Probably never. Rather than ...
Solved) Medication Error Prevention For Nurses Tutorial
Is there a naked decimal point that changes the meaning of the prescription? In a recent error reported to the ISMP, a technician filled an automated dispensing cabinet with the wrong concentration of a premixed potassium chloride I.V. Your browser does not support cookies. Medication Error Prevention For Healthcare Providers healthcare system more than $21 billion annually, according to the National Priorities Partnership and National Quality Forum. Consider having a drug guide available at all times. The only difference is that you could be the one causing the error. Article Outline The big seven Prevent patient falls Keep away infections No more medication errors Steer clear of documenting errors Evade equipment injury This way for positive patient outcomes Error proof http://slmpds.net/medication-error/medication-error-nurses.php She crushes an extended-release calcium channel blocker and administers it through the NG tube. In general, only the information that you provide, or the choices ...
Institute for Clinical Simulation and Patient Safety | Lewis Katz School of Medicine
Provide excellence in the training of the art and science of medicine and surgery, using a traditional laboratory setting, state-of-the-art virtual reality, and simulation for learners including practicing physicians and residents, emergency response personnel, and allied health students and professionals.. Facilitate maintenance of clinical and procedural skills for all levels of learners in order to promote patient safety.. Enable high quality research in medical and surgical education including the development of innovative technologies for teaching clinical procedural and cognitive skills.. ICS uses multiple modalities including high- and low-fidelity, virtual reality simulators, and a robust Standardized Patient program to fulfill the mission to become a leader in medical and surgery education and patient safety initiatives. ICS received the initial American College of Surgeons Comprehensive Accreditation for Education Institutes in 2006 and most recent reaccreditation in 2015.. For ...
Rock-Bottom Discount on May 1 Infection Prevention Event Offered to Members of the Public - ePRNews
Wantagh, NY /ePRNews/ Patient safety education group Pulse Center for Patient Safety Education and Advocacy (formerly PULSE of NY) announces an unbeatable offer on tickets for its May 1 Symposium, Infection Prevention: It…
Clinical incidents and risk management-a public health issue | Journal of Epidemiology & Community Health
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A String of Mistakes: The Importance of Cascade Analysis in Describing, Counting, and Preventing Medical Errors | Annals of...
The patient safety movement currently focuses on errors for which there are available solutions,23, 24 such as automated prescription entry,25, 26 and on other errors that are assumed to be most common or harmful. There is, however, limited epidemiologic research with which to determine the latter. High-quality, generalizable data are lacking,27 and the definition of error itself is argued.28, 29. Most efforts to quantify errors focus on downstream events, predominantly errors in diagnosis and treatment. Such mistakes, viewed in isolation from their causal origins, appear as clinical misjudgments30, 31 and inspire interventions designed around skill building,32, 33 yet the underlying issue may not be misjudgment but the quality of the data on which the judgments are based. The policy importance of overlooking proximal causes is great, because physicians, health care systems, and policy makers, operating from inadequate evidence and the misperceptions it creates may be inattentive to the errors ...
Case Study: Wrong Site Surgery
Despite focused attention and protocols, preventable patient harm continues to be a problem. Read this case study on wrong site surgery for recommendations.
Lisa Goodman-Helfand | MVP Seminars
Healthcare.. Whats it like being confined to a bed, vulnerable, disoriented, and stripped of basic human dignity? Having spent over 200 consecutive days in the hospital and three decades entrenched in the medical system, Lisa offers a unique glimpse into the patient experience. Beyond the Medical Chart: Empathy in Patient Care.. An honest, and interactive course that lends insight into a system often saturated in statistics and bottom lines. As healthcare becomes increasingly digital, Lisas personal patient perspective reminds professionals that behind every number, there is a person. br, After the Mistake: Examining Medical Error.. With a balanced perspective and respect, Lisa offers an up-close look at the 218 days she spent in the hospital. Through highly engaging interactions, the audience evaluates what might have changed if medical mistakes had been openly disclosed and examined, rather than hidden. The benefits of collaboration, open communication, and patient empathyare demonstrated in ...
UNH prof weighs in on Lance Armstrongs apology - *GJ FOSTERS NEWS - fosters.com - Dover, NH
DURHAM - Nick Smith, associate professor of philosophy at the University of New Hampshire and author of a book about apologies, has some insights to share on Lance Armstrongs anticipated public apology and apologies by public figures in general.
How To Fix Nurse Medication Error Case Study (Solved)
However, the health care system as a whole and on an individual institute basis has been working to create a safer environment for patients. The patient was placed on supplemental oxygen and a 0.5 mg (1:1000) dose of epinephrine was ordered. Medication Error Case Report To fix this, set the correct time and date on your computer. Real Life Case Study Involving Medication Error Institute of Medicine: Washington, DC; 2000. A subsequent ECG indicated her ST levels had returned to baseline. http://dlldesigner.com/medication-error/nurse-error-medication.php References Kohn LT, Corrigan JM, Donaldson MS (eds). In: Cohen RM, ed. Medical errors are responsible for injury in 1 out of every 25 hospital patients and result in more deaths than those caused by car accidents, breast cancer, or AIDS individually.1 Consequences Medication Errors Case Reports Allowing a website to create a cookie does not give that or any other site access to the rest of your computer, and only the site that created the cookie ...
NewYork-Presbyterian Queens - Electronic Medical Records Boost Diabetes Care
Proponents of EMRs say they make it easier for doctors to communicate with patients and with one another. The records are also supposed to cut down on medical errors by doing things like providing warnings about medication allergies.. Dr. Cebul acknowledged that his study didnt prove that electronic records directly improved patient care; other factors could explain the difference. Its possible, for instance, that the clinics with paper records simply provided worse care in general -- their decision to not move to electronic records could be a sign that theyre behind the times in other ways.. And clinics often failed to fully follow guidelines about care for people with diabetes even when they used electronic records.. ...
Skeptical Scalpel: Lack of sleep prompted pilots breakdown. System error?
I say this because it seems more likely to me [disclaimer: Im not a forensic neuropsychologist] that the pilot might just have gone nuts for no good reason. That does happen occasionally. The problem with the sleep deprivation argument is that JetBlue said the pilot did not fly March 24 or March 25, and worked a round-trip flight March 26 that gave him 17 hours of off time leading into the flight March 27. Also if sleep deprivation can make one psychotic, just about every doctor I know must be crazy ...
Dollmore.net :: Everything for Doll & more
1. If you find out damage to our dolls and doll stuffs, contact us within 1 week after receiving the packet.. 2. We provide free shipping service by Fedex if a buyer buy more than 1500 us dollar at one time. But if you want to receive order by ems because of customs tax issue in your country, you should pay extra shipping fee to repeat fedex shipping method to ems shipping method.. 3. If you buy many doll stands or doll furniture, then it is impossible to provide free shipping service.. 4. We can ship order by Fedex, EMS, SF Express( Rincos), Standard air mail (Rincos), EE-packet and boat.. 5. When you buy less than 1500 us dollar but did not pay shipping fee, it means that it happened system error. We are trying our best to fix system error now. Very sorry to make you confused. We will tell you shipping fee of your order.. 6. When you are in Europe and USA, we suggest you select fedex shipping method. 7. EMS, Fedex and Standard air mail shipping fee is charged based on box size. So when you buy ...
Dollmore.net :: Everything for Doll & more
1. If you find out damage to our dolls and doll stuffs, contact us within 1 week after receiving the packet.. 2. We provide free shipping service by Fedex if a buyer buy more than 1500 us dollar at one time. But if you want to receive order by ems because of customs tax issue in your country, you should pay extra shipping fee to repeat fedex shipping method to ems shipping method.. 3. If you buy many doll stands or doll furniture, then it is impossible to provide free shipping service.. 4. We can ship order by Fedex, EMS, SF Express( Rincos), Standard air mail (Rincos), EE-packet and boat.. 5. When you buy less than 1500 us dollar but did not pay shipping fee, it means that it happened system error. We are trying our best to fix system error now. Very sorry to make you confused. We will tell you shipping fee of your order.. 6. When you are in Europe and USA, we suggest you select fedex shipping method. 7. EMS, Fedex and Standard air mail shipping fee is charged based on box size. So when you buy ...
Incident Reports - Informal Investigations
This page lists all incident report (informal investigations) available on this website. The BHPA supports a network of recreational clubs and registered schools throughout the UK, and provides the infrastructure within which hang gliding and paragliding thrive.
Incident Reports - Informal Investigations
This page lists all incident report (informal investigations) available on this website. The BHPA supports a network of recreational clubs and registered schools throughout the UK, and provides the infrastructure within which hang gliding and paragliding thrive.