Medical Errors

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To Err Is Human

Author : Institute of Medicine,Committee on Quality of Health Care in America
Publisher : National Academies Press
Page : 312 pages
File Size : 52,8 Mb
Release : 2000-03-01
Category : Medical
ISBN : 9780309068376

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To Err Is Human by Institute of Medicine,Committee on Quality of Health Care in America Pdf

Experts estimate that as many as 98,000 people die in any given year from medical errors that occur in hospitals. That's more than die from motor vehicle accidents, breast cancer, or AIDSâ€"three causes that receive far more public attention. Indeed, more people die annually from medication errors than from workplace injuries. Add the financial cost to the human tragedy, and medical error easily rises to the top ranks of urgent, widespread public problems. To Err Is Human breaks the silence that has surrounded medical errors and their consequenceâ€"but not by pointing fingers at caring health care professionals who make honest mistakes. After all, to err is human. Instead, this book sets forth a national agendaâ€"with state and local implicationsâ€"for reducing medical errors and improving patient safety through the design of a safer health system. This volume reveals the often startling statistics of medical error and the disparity between the incidence of error and public perception of it, given many patients' expectations that the medical profession always performs perfectly. A careful examination is made of how the surrounding forces of legislation, regulation, and market activity influence the quality of care provided by health care organizations and then looks at their handling of medical mistakes. Using a detailed case study, the book reviews the current understanding of why these mistakes happen. A key theme is that legitimate liability concerns discourage reporting of errorsâ€"which begs the question, "How can we learn from our mistakes?" Balancing regulatory versus market-based initiatives and public versus private efforts, the Institute of Medicine presents wide-ranging recommendations for improving patient safety, in the areas of leadership, improved data collection and analysis, and development of effective systems at the level of direct patient care. To Err Is Human asserts that the problem is not bad people in health careâ€"it is that good people are working in bad systems that need to be made safer. Comprehensive and straightforward, this book offers a clear prescription for raising the level of patient safety in American health care. It also explains how patients themselves can influence the quality of care that they receive once they check into the hospital. This book will be vitally important to federal, state, and local health policy makers and regulators, health professional licensing officials, hospital administrators, medical educators and students, health caregivers, health journalists, patient advocatesâ€"as well as patients themselves. First in a series of publications from the Quality of Health Care in America, a project initiated by the Institute of Medicine

Advances in Patient Safety

Author : Kerm Henriksen
Publisher : Unknown
Page : 526 pages
File Size : 44,9 Mb
Release : 2005
Category : Medical
ISBN : CHI:70548902

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Advances in Patient Safety by Kerm Henriksen Pdf

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

When We Do Harm

Author : Danielle Ofri, MD
Publisher : Beacon Press
Page : 274 pages
File Size : 53,6 Mb
Release : 2020-03-23
Category : Medical
ISBN : 9780807037881

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When We Do Harm by Danielle Ofri, MD Pdf

Medical mistakes are more pervasive than we think. How can we improve outcomes? An acclaimed MD’s rich stories and research explore patient safety. Patients enter the medical system with faith that they will receive the best care possible, so when things go wrong, it’s a profound and painful breach. Medical science has made enormous strides in decreasing mortality and suffering, but there’s no doubt that treatment can also cause harm, a significant portion of which is preventable. In When We Do Harm, practicing physician and acclaimed author Danielle Ofri places the issues of medical error and patient safety front and center in our national healthcare conversation. Drawing on current research, professional experience, and extensive interviews with nurses, physicians, administrators, researchers, patients, and families, Dr. Ofri explores the diagnostic, systemic, and cognitive causes of medical error. She advocates for strategic use of concrete safety interventions such as checklists and improvements to the electronic medical record, but focuses on the full-scale cultural and cognitive shifts required to make a meaningful dent in medical error. Woven throughout the book are the powerfully human stories that Dr. Ofri is renowned for. The errors she dissects range from the hardly noticeable missteps to the harrowing medical cataclysms. While our healthcare system is—and always will be—imperfect, Dr. Ofri argues that it is possible to minimize preventable harms, and that this should be the galvanizing issue of current medical discourse.

Improving Diagnosis in Health Care

Author : National Academies of Sciences, Engineering, and Medicine,Institute of Medicine,Board on Health Care Services,Committee on Diagnostic Error in Health Care
Publisher : National Academies Press
Page : 473 pages
File Size : 47,5 Mb
Release : 2015-12-29
Category : Medical
ISBN : 9780309377720

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Improving Diagnosis in Health Care by National Academies of Sciences, Engineering, and Medicine,Institute of Medicine,Board on Health Care Services,Committee on Diagnostic Error in Health Care Pdf

Getting the right diagnosis is a key aspect of health care - it provides an explanation of a patient's health problem and informs subsequent health care decisions. The diagnostic process is a complex, collaborative activity that involves clinical reasoning and information gathering to determine a patient's health problem. According to Improving Diagnosis in Health Care, diagnostic errors-inaccurate or delayed diagnoses-persist throughout all settings of care and continue to harm an unacceptable number of patients. It is likely that most people will experience at least one diagnostic error in their lifetime, sometimes with devastating consequences. Diagnostic errors may cause harm to patients by preventing or delaying appropriate treatment, providing unnecessary or harmful treatment, or resulting in psychological or financial repercussions. The committee concluded that improving the diagnostic process is not only possible, but also represents a moral, professional, and public health imperative. Improving Diagnosis in Health Care, a continuation of the landmark Institute of Medicine reports To Err Is Human (2000) and Crossing the Quality Chasm (2001), finds that diagnosis-and, in particular, the occurrence of diagnostic errorsâ€"has been largely unappreciated in efforts to improve the quality and safety of health care. Without a dedicated focus on improving diagnosis, diagnostic errors will likely worsen as the delivery of health care and the diagnostic process continue to increase in complexity. Just as the diagnostic process is a collaborative activity, improving diagnosis will require collaboration and a widespread commitment to change among health care professionals, health care organizations, patients and their families, researchers, and policy makers. The recommendations of Improving Diagnosis in Health Care contribute to the growing momentum for change in this crucial area of health care quality and safety.

Avoiding Medical Errors

Author : Robert M. Fox,Chris Landon
Publisher : Rowman & Littlefield Publishers
Page : 206 pages
File Size : 51,9 Mb
Release : 2020-04-08
Category : Health & Fitness
ISBN : 9781538135723

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Avoiding Medical Errors by Robert M. Fox,Chris Landon Pdf

This book, written by a doctor and a lawyer, explains to everyday readers ways in which they can avoid death and injury caused by medical mistakes. It may be shocking to learn that preventable errors by doctor and hospital personnel are a leading cause of death and injury in the United States—perhaps even exceeding the annual deaths caused by heart disease and cancer. But avoiding these mistakes is possible, and the rules found in this book will arm readers against the careless errors that lead to such deaths and injuries. From hospitals to doctors’ offices, medical professionals are overwhelmed, overtired, even overworked and mistakes are sometimes unavoidable even with the best safety measures in place. A resident at the end of a 36-hour on-call stint may forget to wash her hands before performing a surgical procedure. A chart may be mismarked. Medications may be inaccurately listed. Test results may be inaccurately interpreted. But patients are in a position to help themselves and their medical caregivers to avoid these mistakes by taking more active and attentive part in their own healthcare. By being aware of the most common errors, patients can look for ways to ask questions, review information, even examine test results with a critical eye toward their own health and specific situations. Chris Landon and Robert Fox show them how.

Preventing Medication Errors

Author : Institute of Medicine,Board on Health Care Services,Committee on Identifying and Preventing Medication Errors
Publisher : National Academies Press
Page : 481 pages
File Size : 48,8 Mb
Release : 2007-01-11
Category : Medical
ISBN : 9780309101479

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Preventing Medication Errors by Institute of Medicine,Board on Health Care Services,Committee on Identifying and Preventing Medication Errors Pdf

In 1996 the Institute of Medicine launched the Quality Chasm Series, a series of reports focused on assessing and improving the nation's quality of health care. Preventing Medication Errors is the newest volume in the series. Responding to the key messages in earlier volumes of the seriesâ€"To Err Is Human (2000), Crossing the Quality Chasm (2001), and Patient Safety (2004)â€"this book sets forth an agenda for improving the safety of medication use. It begins by providing an overview of the system for drug development, regulation, distribution, and use. Preventing Medication Errors also examines the peer-reviewed literature on the incidence and the cost of medication errors and the effectiveness of error prevention strategies. Presenting data that will foster the reduction of medication errors, the book provides action agendas detailing the measures needed to improve the safety of medication use in both the short- and long-term. Patients, primary health care providers, health care organizations, purchasers of group health care, legislators, and those affiliated with providing medications and medication- related products and services will benefit from this guide to reducing medication errors.

Patient Safety and Quality

Author : Ronda Hughes
Publisher : Department of Health and Human Services
Page : 592 pages
File Size : 55,6 Mb
Release : 2008
Category : Medical
ISBN : IOWA:31858055672798

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Patient Safety and Quality by Ronda Hughes Pdf

"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/

Medical Errors and Medical Narcissism

Author : John D. Banja
Publisher : Jones & Bartlett Learning
Page : 246 pages
File Size : 45,9 Mb
Release : 2004
Category : Medical errors
ISBN : 0763783617

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Medical Errors and Medical Narcissism by John D. Banja Pdf

Using the concept of medical narcissism the author examines both the psychological and biological factors involved when a physician decides not to disclose when a medical error has occurred.

Talking with Patients and Families about Medical Error

Author : Robert D. Truog,David M. Browning,Judith A. Johnson,Thomas H. Gallagher
Publisher : JHU Press
Page : 198 pages
File Size : 51,8 Mb
Release : 2011-01-17
Category : Medical
ISBN : 9781421401027

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Talking with Patients and Families about Medical Error by Robert D. Truog,David M. Browning,Judith A. Johnson,Thomas H. Gallagher Pdf

More than a million patient safety incidents occur every year, and medical error is the third leading cause of death in the United States. Illuminating the experiences of those affected by medical error—patients, their loved ones, and physicians and other medical professionals—Talking with Patients and Families about Medical Error delves deeply into the challenges of communicating honestly and openly about mistakes in medical practice. cc Based on guidelines from the Institute for Professional and Ethical Practice and the authors' own experiences, the practice-based approaches outlined here offer concrete guidance on • initiating discussions • dealing professionally and compassionately with patients' reactions • who should be included in the conversation • what information should be documented in the medical record • how to respond to questions about financial compensation Aimed at promoting resolution and healing, this book stresses the importance of clear, empathetic communication that will improve clinical and organizational responses to medical missteps and mismanagement. It emphasizes five features of the physician-patient relationship deserving of special attention: transparency, respect, accountability, continuity, and kindness (TRACK). Narrative examples of common situations demonstrate how conversations about medical error can lead to healing.

Medication Errors

Author : Michael Richard Cohen
Publisher : American Pharmacist Associa
Page : 707 pages
File Size : 50,5 Mb
Release : 2007
Category : Medical
ISBN : 9781582120928

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Medication Errors by Michael Richard Cohen Pdf

In this expanded 600+ page edition, Dr. Cohen brings together some 30 experts from pharmacy, medicine, nursing, and risk management to provide the most current thinking about the causes of medication errors and strategies to prevent them.

Impact of Medical Errors and Malpractice on Health Economics, Quality, and Patient Safety

Author : Riga, Marina
Publisher : IGI Global
Page : 334 pages
File Size : 45,8 Mb
Release : 2017-01-30
Category : Medical
ISBN : 9781522523383

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Impact of Medical Errors and Malpractice on Health Economics, Quality, and Patient Safety by Riga, Marina Pdf

Precise and flawless medical practice is imperative due to the delicate nature of patient lives and health. Without methods and technologies to detect medical mistakes, many lives would be compromised. Impact of Medical Errors and Malpractice on Health Economics, Quality, and Patient Safety is an essential reference source for the latest research on the detection and analysis of the various implications of medical errors and addresses the hidden malpractices that exist in healthcare systems globally. Featuring extensive coverage on a broad range of topics such as clinical pathways, decision-making techniques, and health information technology, this book is ideally designed for practitioners, professionals, and researchers seeking current research on various issues in healthcare provision.

The Patient's Guide to Preventing Medical Errors

Author : Karin J. Berntsen
Publisher : Bloomsbury Publishing USA
Page : 285 pages
File Size : 43,8 Mb
Release : 2004-10-30
Category : Health & Fitness
ISBN : 9780313013676

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The Patient's Guide to Preventing Medical Errors by Karin J. Berntsen Pdf

A nation watched in horror as 17-year-old Jessica Santillian died needlessly after a heart-lung transplant in 2003. She had been given organs with the wrong blood type. That error killed her. It is just one among tens of thousands of less publicized errors that occur in U.S. hospitals each year. Author Karin Berntsen, a veteran of the hospital and health care industry, takes us through the headlines, and the events never publicized, into hospital wards and surgical rooms to see how errors are made causing disability or death. She gives graphic examples of actual events that illustrate the problems cited in a federal Institute of Medicine report showing medical errors in the hospital cause 44,000 to 98,000 deaths each year. Those errors include medication mistakes, wrong site or side surgery, and botched transfusions. Berntsen explains why these are not just human errors with one or two people responsible; they are systems failures that require a major culture change to remedy. And that change, she argues, may not come without action by the very people the medical system is designed to help: patients. She offers clear actions consumers can take to assure they are not on the receiving end of a medical error. The book details over 200 tips for improving patient safety. U.S. hospitals have countless stories of miraculous healing and recovery; the greatest technology, most advanced medicines, and best research in the world. On the other hand, we have a system where medical errors bring more than 120 fatalities each day across the country in hospitals. An airline crash causing that many deaths daily would paralyze that industry. But because the deaths and harm are diluted across and deep within the silence of hospitals, it is easier to be complacent. There is, says Berntsen, an urgent need to pause and take inventory, a need for clinicians and consumers to come together as partners for change.

Medical Error and Harm

Author : Milos Jenicek
Publisher : CRC Press
Page : 384 pages
File Size : 44,5 Mb
Release : 2010-07-02
Category : Business & Economics
ISBN : 1439836957

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Medical Error and Harm by Milos Jenicek Pdf

Recent debate over healthcare and its spiraling costs has brought medical error into the spotlight as an indicator of everything that is ineffective, inhumane, and wasteful about modern medicine. But while the tendency is to blame it all on human error, it is a much more complex problem that involves overburdened systems, constantly changing technology, increasing specialization, and a cycle of continual funding shortfalls made even more acute by resource-wasting inefficiencies. Medical Error and Harm: Understanding, Prevention and Control, presents the work of long time physician and teacher Milos Jenicek, a pioneering expert on epidemiology, evidence-based medicine, and critical thinking and decision making in the health sciences. Providing an extraordinarily comprehensive overview of the subject that is as thorough and scientifically organized as it is accessible and free of rhetoric, Dr. Jenicek — Presents a short history of error in general across various domains of human activity and endeavor, including concepts, methodologies of study, and management applications Provides semantic and taxonomic classifications of challenges in medical error and harm, two distinct domains Explores approaches used to investigate and ameliorate challenges in medicine and other health sciences Explains why, when, and how studies and decisions regarding errors should be carried out, such as whether risk assessment should be undertaken in the diagnosis, treatment, or prognosis stage Covers essential strategies for mitigating errors in the broader framework of medical care, specifically in community medicine and public health Considers the ever-growing role of physicians in tort law and litigation The book also discusses whether dealing with errors is a learned skill and looks at how much of the problem with medical error is caused by the medical community’s failure to teach, learn, and understand everything there is to know about medical error, including the often neglected importance of critical thinking skills. Understanding and correcting this shortfall is a primary responsibility of every health professional, one they can begin to realize with the study of these pages.

Medication Errors

Author : Robert Naylor
Publisher : Radcliffe Publishing
Page : 356 pages
File Size : 55,8 Mb
Release : 2002
Category : Chemotherapy
ISBN : 1857759567

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Medication Errors by Robert Naylor Pdf

This text looks at the incidence of adverse drug reactions and medication errors in hospitals and primary care, when such errors occur, the cost of medical errors, how to reduce errors, and the implications of error reduction.

Internal Bleeding

Author : Robert M. Wachter,Kaveh G. Shojania
Publisher : Unknown
Page : 464 pages
File Size : 53,5 Mb
Release : 2004
Category : Medical
ISBN : UOM:39015061145010

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Internal Bleeding by Robert M. Wachter,Kaveh G. Shojania Pdf

Imagine an epidemic that kills over one hundred Americans every day. Now stop imagining. Each year doctors and nurses kill nearly one hundred thousand Americans. By mistake. They operate on the wrong patients, prescribe the wrong drugs, and leave instruments inside body cavities after surgery. Meanwhile, hospitals spend billions on new gadgets, marble lobbies, and slick billboards even as safety continues to be ignored. Until now. Internal Bleeding exposes the dark secrets behind the glistening facade of modern medicine. Doctors Robert Wachter and Kaveh Shojania, professors at one of America's leading medical schools and two of the world's foremost authorities on medical mistakes, shatter the silence to tell the dramatic and compelling stories of real patients betrayed by a system they trusted to save them. Through these stories, the authors reveal the inner workings, gut-wrenching dilemmas, and heartbreaking tragedies of our overburdened, understaffed health care system. Internal Bleeding provides an insider's view of how professional caregivers think, feel, and operate-facts that every patient and family must know to avoid becoming just another "mistake." In the groundbreaking tradition of Fast Food Nation , Internal Bleeding paints a vivid and unforgettable picture of a system gone terribly wrong, and what doctors, nurses, hospital CEOs, and policy makers must do to make it right.