The Value of Close Calls in Improving Patient Safety

The Value of Close Calls in Improving Patient Safety
Author: Joint Commission Resources, Inc
Publisher: Joint Commission Resources
Total Pages: 206
Release: 2011
Genre: Health & Fitness
ISBN: 159940415X

Because close calls, often termed near misses, don't raise the same concerns about malpractice liability and may be less emotionally charged than errors that cause serious harm, they are a unique source of learning for individuals and organizations striving to keep patients safe. This book tells how to take advantage of these lessons to prevent today's close call from turning into tomorrow's catastrophic event. Special Features: * Foreword by human error expert James Reason, Ph.D. * Authoritative tutorials on what the literature tells us about the concept of close calls and their identification, relationship with errors, and use in assessing and improving the safety and reliability of health care. * 15 detailed case studies from a variety of clinical disciplines and specialties to show how health care organizations use close calls to identify and solve patient safety problems

Patient Safety and Quality

Patient Safety and Quality
Author: Ronda Hughes
Publisher: Department of Health and Human Services
Total Pages: 592
Release: 2008
Genre: Medical
ISBN:

"Nurses play a vital role in improving the safety and quality of patient car -- not only in the hospital or ambulatory treatment facility, but also of community-based care and the care performed by family members. Nurses need know what proven techniques and interventions they can use to enhance patient outcomes. To address this need, the Agency for Healthcare Research and Quality (AHRQ), with additional funding from the Robert Wood Johnson Foundation, has prepared this comprehensive, 1,400-page, handbook for nurses on patient safety and quality -- Patient Safety and Quality: An Evidence-Based Handbook for Nurses. (AHRQ Publication No. 08-0043)." - online AHRQ blurb, http://www.ahrq.gov/qual/nurseshdbk/

Advances in Patient Safety

Advances in Patient Safety
Author: Kerm Henriksen
Publisher:
Total Pages: 526
Release: 2005
Genre: Medical
ISBN:

v. 1. Research findings -- v. 2. Concepts and methodology -- v. 3. Implementation issues -- v. 4. Programs, tools and products.

Patient Safety

Patient Safety
Author: Institute of Medicine
Publisher: National Academies Press
Total Pages: 551
Release: 2003-12-20
Genre: Medical
ISBN: 0309090776

Americans should be able to count on receiving health care that is safe. To achieve this, a new health care delivery system is needed â€" a system that both prevents errors from occurring, and learns from them when they do occur. The development of such a system requires a commitment by all stakeholders to a culture of safety and to the development of improved information systems for the delivery of health care. This national health information infrastructure is needed to provide immediate access to complete patient information and decision-support tools for clinicians and their patients. In addition, this infrastructure must capture patient safety information as a by-product of care and use this information to design even safer delivery systems. Health data standards are both a critical and time-sensitive building block of the national health information infrastructure. Building on the Institute of Medicine reports To Err Is Human and Crossing the Quality Chasm, Patient Safety puts forward a road map for the development and adoption of key health care data standards to support both information exchange and the reporting and analysis of patient safety data.

Crossing the Quality Chasm

Crossing the Quality Chasm
Author: Institute of Medicine
Publisher: National Academies Press
Total Pages: 359
Release: 2001-07-19
Genre: Medical
ISBN: 0309132967

Second in a series of publications from the Institute of Medicine's Quality of Health Care in America project Today's health care providers have more research findings and more technology available to them than ever before. Yet recent reports have raised serious doubts about the quality of health care in America. Crossing the Quality Chasm makes an urgent call for fundamental change to close the quality gap. This book recommends a sweeping redesign of the American health care system and provides overarching principles for specific direction for policymakers, health care leaders, clinicians, regulators, purchasers, and others. In this comprehensive volume the committee offers: A set of performance expectations for the 21st century health care system. A set of 10 new rules to guide patient-clinician relationships. A suggested organizing framework to better align the incentives inherent in payment and accountability with improvements in quality. Key steps to promote evidence-based practice and strengthen clinical information systems. Analyzing health care organizations as complex systems, Crossing the Quality Chasm also documents the causes of the quality gap, identifies current practices that impede quality care, and explores how systems approaches can be used to implement change.

Principles of Perioperative Safety and Efficiency

Principles of Perioperative Safety and Efficiency
Author: Jamal J. Hoballah
Publisher: Springer Nature
Total Pages: 421
Release: 2024
Genre: Operating room nursing
ISBN: 3031410890

Perioperative safety continues to be a global challenge. It is estimated that approximately 200 million surgical procedures are performed annually worldwide, and despite various national and global safety initiatives, perioperative adverse event rates remain alarmingly high. Although hospitals and governmental agencies impose safety standards and certification by organizations such as the Joint Commission, which can address issues of perioperative safety, many hospitals in developed, developing or underdeveloped countries lack the resources or knowhow to decrease perioperative adverse events. There is a great opportunity for improving perioperative safety worldwide especially in underdeveloped or developing countries. Filling a gap in the literature, this book teaches healthcare providers the basic principles of perioperative safety and efficiency, including checklists and processes to reduce adverse events. Presented here are the basics of intraoperative monitoring and safety measures to reduce patient adverse events, including wrong site surgery, electric burn injury, deep venous thrombosis, surgical site infection and foreign body retention. Emphasis is given toward developing awareness into measures preventing occupational injuries, such as sharp injury, radiation exposure, laser exposure and smoke hazard. It also addresses dealing and reporting adverse events and disruptive behaviors in the operating rooms as well as new measures for enhanced recovery following surgery and anesthesia. Principles of Perioperative Safety and Efficiency is a valuable resource and reference for all operating room personnel including surgeons, surgical residents, medical students and nurses.

Close Calls

Close Calls
Author: C. Macrae
Publisher: Springer
Total Pages: 217
Release: 2014-03-05
Genre: Business & Economics
ISBN: 1137376120

Drawing on extensive and detailed fieldwork within airlines-an industry that pioneered near-miss analysis- this book develops a clear set of practical implications and theoretical propositions regarding how all organizations can learn from 'near-miss' events and better manage risk and resilience.

Keeping Patients Safe

Keeping Patients Safe
Author: Institute of Medicine
Publisher: National Academies Press
Total Pages: 485
Release: 2004-03-27
Genre: Medical
ISBN: 0309187362

Building on the revolutionary Institute of Medicine reports To Err is Human and Crossing the Quality Chasm, Keeping Patients Safe lays out guidelines for improving patient safety by changing nurses' working conditions and demands. Licensed nurses and unlicensed nursing assistants are critical participants in our national effort to protect patients from health care errors. The nature of the activities nurses typically perform â€" monitoring patients, educating home caretakers, performing treatments, and rescuing patients who are in crisis â€" provides an indispensable resource in detecting and remedying error-producing defects in the U.S. health care system. During the past two decades, substantial changes have been made in the organization and delivery of health care â€" and consequently in the job description and work environment of nurses. As patients are increasingly cared for as outpatients, nurses in hospitals and nursing homes deal with greater severity of illness. Problems in management practices, employee deployment, work and workspace design, and the basic safety culture of health care organizations place patients at further risk. This newest edition in the groundbreaking Institute of Medicine Quality Chasm series discusses the key aspects of the work environment for nurses and reviews the potential improvements in working conditions that are likely to have an impact on patient safety.

Resident Duty Hours

Resident Duty Hours
Author: Institute of Medicine
Publisher: National Academies Press
Total Pages: 427
Release: 2009-04-27
Genre: Medical
ISBN: 0309131529

Medical residents in hospitals are often required to be on duty for long hours. In 2003 the organization overseeing graduate medical education adopted common program requirements to restrict resident workweeks, including limits to an average of 80 hours over 4 weeks and the longest consecutive period of work to 30 hours in order to protect patients and residents from unsafe conditions resulting from excessive fatigue. Resident Duty Hours provides a timely examination of how those requirements were implemented and their impact on safety, education, and the training institutions. An in-depth review of the evidence on sleep and human performance indicated a need to increase opportunities for sleep during residency training to prevent acute and chronic sleep deprivation and minimize the risk of fatigue-related errors. In addition to recommending opportunities for on-duty sleep during long duty periods and breaks for sleep of appropriate lengths between work periods, the committee also recommends enhancements of supervision, appropriate workload, and changes in the work environment to improve conditions for safety and learning. All residents, medical educators, those involved with academic training institutions, specialty societies, professional groups, and consumer/patient safety organizations will find this book useful to advocate for an improved culture of safety.

Handbook of Human Factors and Ergonomics in Health Care and Patient Safety

Handbook of Human Factors and Ergonomics in Health Care and Patient Safety
Author: Pascale Carayon
Publisher: CRC Press
Total Pages: 855
Release: 2016-04-19
Genre: Technology & Engineering
ISBN: 1439830347

The first edition of Handbook of Human Factors and Ergonomics in Health Care and Patient Safety took the medical and ergonomics communities by storm with in-depth coverage of human factors and ergonomics research, concepts, theories, models, methods, and interventions and how they can be applied in health care. Other books focus on particular human