Staff members are often trained to report a potential medical error, or near-miss event. However, more often than not, these events go unreported. In 2003, The University of Texas (UT) System, made up of six health institutions, developed a system that allowed the anonymous reporting of close...
When Barbara Wilson, PhD, RNC, begins any new patient safety project, she first examines the principles of human factors engineering (HFE). Wilson, assistant professor at Arizona State University’s College of Nursing and Health Innovation, Center for Improving Health Outcomes in Children, Teens...
Identifying patients at risk for suicide has been a requirement of the National Patient Safety Goals since 2007. Since that time, inpatient suicide remains the second most frequently reported sentinel event to The Joint Commission, after wrong-site surgery.
Over the past five years, rapid response teams (RRT) have been brought to the forefront of American hospitals. In 2004, the Institute for Healthcare Improvement (IHI) launched its 100,000 Lives Campaign of which RRTs were a focal point, and in 2008, The Joint Commission added a National Patient...
Innovation and design thinking is a fascinating methodology that holds much promise for healthcare. Although other industries, such as manufacturing and telecommunications, have harnessed the power that design thinking can hold, healthcare is just beginning to truly embrace and apply some of the...
One of the most vital parts of providing adequate healthcare is the exchange of information between patient and caregiver. Without clear communication, it can be difficult, and even dangerous, to treat a patient. For patients who have limited English proficiency (LEP), as well as providers, the...
Since 2002, the National Patient Safety Foundation (NPSF) has sponsored Patient Safety Awareness Week (PSAW) as a means of making caregivers, other types of hospital staff, and community members more aware of patient safety issues. This year, the event is being observed from March 7 to March 13...
As we move further into 2010, I’m excited about the opportunities for growth and improvement we have in store for our patient safety programs. The projects, improvement initiatives, and measures of success are neatly described on paper and await skillful execution. However, the sense of...
In 2007, The Joint Commission made an addition to Goal #8 regarding medication reconciliation: Along with compiling a list of medications upon admission, each patient must receive a list of his or her medications upon discharge. (This National Patient Safety Goal is set to be revamped this year...