Wrong Site Failure
Wrong site surgery is the second most reported sentinel event according to reported sentinel event statistics to The Joint Commission. Lack of communication and human error have been directly linked to wrong site, wrong procedure, and wrong patient surgical mistakes. National Patient Safety Goals were established by The Joint Commission to enhance patient outcomes in numerous strategic areas. The purpose of this research poster presentation is to provide background information on the National Patient Safety Goal: Prevent Mistakes in Surgery, the evidence-based guideline of time out, clinical application of time out and its impact on nursing, and identify methods to disseminate related information. A literature review was conducted that includes
Accidental Link Case Study
157 Words | 1 PagesIn the case of "accidental link", a deaf lady formed an innocent amity with another woman, however, she had a highly territorial, jealous ex. As the case unfolded the forensic pathologist determined the cause of death proved to be blunt force injury, Combined Deoxyribonucleic acid index system, also known as "CODIS" allowed forensic scientist to take samples from the garment found in the dumpster, (the exact place they found her lifeless remains), and compare the blood spatter found on the outside of the garment, forensic scientist were able to link that to the victims Deoxyribonucleic acid, then they to samples from the inside of the garment, in addition, scientist linked the Deoxyribonucleic acid to the perpetrator. The primary crime scene,
Jane Medical Abbreviations
415 Words | 2 PagesMedical professionals are liable for malpractice and could face consequences such as a lawsuit against them or being fired. These errors can be minimized by being more
Sun Country Health Mission Statement
718 Words | 3 PagesBetter Care: Transform the Patient Experience through sooner, safer, smarter Surgical Care. Safety Culture: focus on Patient and Staff
Kaiser Permanente: Nurse-Physician Collaboration And Communication
521 Words | 3 PagesCommunication in the operating room is very important. If surgeons and nurses are not communicating effectively it can directly affect the quality of patient care and safety. In 1999, the Institute of Medicine (IOM) issued a report, To Err is Human: Building a Safer Health System, which estimated the fifth leading cause of death in hospitals in the United States was due to health care errors (Mason, Gardner, Outlaw, Freida, 2016). To help reduce these errors, effective communication needs to be exercised throughout health care.
Charlie Jones Wrongberight Case Study
99 Words | 1 PagesWhen the residents of the rural farming community of Wrongberight, Virginia, want an accurate weather report, they call one of their neighbors, Charlie Jones, since he has never been wrong once, in forty years. On Monday he forecast intermittent summer rainstorms throughout the week and a ten-hour deluge for Friday, that would dump eight addition inches of rain, to the already, saturated farmer’s fields and woodlands. In addition, he suggest that the residents cancel their plans for Saturday and stay home since the storm on Friday was a prelude to the tempest that would strike Wrongberight, early Saturday night
Errors In Into Thin Air
721 Words | 3 PagesThroughout the novel Into Thin Air, written by Jon Krakauer, the Everest climbers constantly faced with challenges that came along with their expedition; whether it be lack of oxygen, inability to keep pace with time schedule, weather conditions, etcetera. Every year, every expedition will be unpredictable meaning the outcome of people’s survival is based on the individual’s ability to react appropriately to danger. Since each expedition’s results are uncertain, the guides and clients will be forced to make decisions under pressure when an obstacle obstructs their path. Under pressure, the margin for error begins to decrease. Unfortunately, in circumstances like these, humans are bound to make a mistake since it is a part of human nature.
Bedside Reporting Paper
1981 Words | 8 PagesBedside reporting has been shown to improve communication and quality of handoff between nurses. It is also credited to promote patient safety and improve patient satisfaction. Patient satisfaction, patient safety and nursing communication and quality of report from a 32 bed surgical hospital in Dallas, Texas is to be evaluated using various surveys, HCAHPS scores, incident reports, and call light logs. Data will be collected 2 months prior and 6 months following the implementation of bedside report. Scores and communication survey results will be reviewed in this time period to determine increases or decreases from pre-implementation results using traditional nurse-to-nurse report..
Nursing Bedside Report
476 Words | 2 PagesHospitals frequently enhance their quality of care by improving their best practices. Bedside reporting is a best practice that has numerous benefits including a decrease in the potential for mistakes, increased patient involvement and understanding of their care, increased teamwork among nurses, and an increased accountability of nurses (AHRQ, 2013). A review of the literature was run and showed several studies and literature reviews on bedside reporting. The majority of these articles were conducted on adult medical-surgical
Examples Of Iom's Six Aims Of Improvement In Healthcare
573 Words | 3 PagesEach year, the goals are analyzed and if necessary, updated. The 2016 National Patient Safety Goals aim to: 1) Improve the accuracy of patient and resident identification; 2) Improve the effective communication of caregivers; 3) Improve the safety of medication use; 4) Improve the safety of clinical alarm systems; 5) Reduce the risk of health care associated infections; 6) Organize identification of safety risks evident in patient populations; and 7) Set universal protocol for preventing wrong site/procedure/person surgeries (TJC, 2016). These safety goals are mandated so that medical errors are reduced and patients are given the best quality care possible. Some of the steps nurses can take in association with these goals include: using at least two patient identifiers to ensure correct patient treatment and reduce patient misidentification; making timely reports of critical test and diagnostic results; maintaining accurate patient medication information, and labeling all medications and containers removed from original containers; quickly responding to medical equipment alarms, and maintaining their upkeep; following hand hygiene guidelines, and using evidence-based practices to prevent infections due to multi drug-resistant organisms, surgical sites, or indwelling catheters; identifying patients at risk for suicide; and ensuring that sites are correctly marked for surgery through marking the procedure site and undergoing a verification process (Cherry & Jacobs,
Concussions In Health Care Research Paper
88 Words | 1 Pages- Safety provi¬sions are interpreted to protect patients from illnesses caused in the course of medical treatment as well as to provide hygienic and injury-free experience in the health care setting. Special provisions exist for safety in pharmaceuticals, blood supply, infectious disease treatment and diagnostics, and mental health services, among others. Ethical codes for doctors, nurses, and other health care workers contain provisions applicable to the patients’ right to safety. Medical errors and other actions that fail to meet safety standards can carry civil, criminal and administrative penalties
Chasing Zero Documentary Analysis
398 Words | 2 PagesPatient safety experts have demonstrated that “patient safety increases when teamwork and collaboration skills are taught and empowered; when teamwork and collaboration are not present, medical errors will result” (Creasia & Friberg, 201, p. 348). As a nurse, it is imperative to collaborate with other interdisciplinary members in health care and also strive to research and implement evidence-based practices. Evidence-based practice is necessary to “ensure the highest quality of cost-effective care and the best patient outcomes” (Fineout-Overholt, 2011, para. 16). With a collaborative and innovative attitude on safe health care practices, an increase in patient safety and effectiveness of care will
Reflection On Interprofessional Learning
1500 Words | 6 PagesUnfortunately, human error is a large contributor to patient death, and these actions can be avoided if interprofessionals were to collaborate
Why History Failed Summary
198 Words | 1 PagesHistory Derailed not only describes Berend’s argument, but also the semi-glaring, problematic perspective from which he seems to have written the monograph. Berend’s perspective is heavily influenced by a semi-fatalistic idea of the rise of nationalism and history in general. He places Western Europe’s experiences and developments during the “long century” as the pinnacle of positive changes possible. Central and Eastern Europe on the other hand, according to Berend, was striving and failing to mimic Europe’s success. The very argument that the reason for what he calls the region’s partial modernization and incomplete nationalistic development lies in its failure to follow the historical legacy of Western Europe is a very Eurocentric historical
The Food And Drug Administration (FDA)
1156 Words | 5 PagesEven more important is the fact that the reports of the Institute of Medicine have a huge impact on how to evaluate the outcomes of health care the workers themselves. In 1999, the Institute of Medicine published a landmark report, " To Err is Human : creating a safe health care system. " The outcome of the report is the statement about the necessity of measures to create safer health system. Since that time, the safety of patients - a problem that primarily was not clearly understood and rarely been the subject of discussion – began to strongly attract the attention of the government.
Reflection On Preoperative Experience
1217 Words | 5 PagesThe circulating nurse also initiated the time-out. During the time-out, the circulating nurse said the patient’s name, the surgery that the patient was getting, and the limb in which the surgery was being performed on. The other health care professionals agreed that it was the right patient, right site, and right procedure. Throughout the surgery the circulating nurse continued to ensure the safety of the patient by watching the surgical staff and making sure that the sterile field was not contaminated. This nurse’s role also included gathering materials for the surgeon, throwing away trash, and keeping the environment comfortable for the staff.
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