errors

An invitation to error

What happens when you’re short staffed and there isn’t anyone to help?

Déjà vu all over again

Some people simply can’t learn from the past—even the fairly recent and painful past.

ECRI announces top technology hazards for 2015

The ECRI Institute has announced its Top 10 Health Technology Hazards for 2015, which include alarm hazards, mix-up of IV lines, lack of data integrity, and inadequate reprocessing…

Improving health care with systems thinking

We strive to reach the theoretical goal of perfect patient care. But is defect-free health care possible? Or are avoidable deaths from preventable errors inevitable? Sociologist and organizational theorist Charles Perrow describes…

Learning from mistakes

Today’s healthcare organizations need to improve patient safety, which includes effectively communicating information to nurses about safety incidents and how to address them. After all, frontline nurses are…

New report calls for improvement in diagnosing

“Improving Diagnosis in Health Care,” a new report from the Institute of Medicine states “most people will experience at least one diagnostic error in their lifetime, sometimes with…

Our “knowing-doing” gap

Something as simple and low – tech as the checklist can help healthcare providers close the knowing – doing gap.

PA catheter controversy

Standard of care in the ICU – or object of overuse, abuse, and misuse? The authors explain why they believe PA catheter use may harm more critically ill…

Quality: A moral primer

Research reports that one in three deaths in the United States is due to medical error, much of which is due to sloppy, hasty, or inept care and…
Dealing with difficult people

Responding to a sentinel event

Sentinel events happen even in the best hospitals. Do you know what these events are and how to handle them?
insulin notes therapy shot

Take Note – March 2008

Updated guidelines on end-of-life care To improve the quality of palliative end-of-life care, the American College of Physicians has revised its guidelines. According to the new recommendations, clinicians…

The high cost of medical errors

According to “The Economic Measurement of Medical Errors,” medical errors cost the US $19.5 billion in 2008. Read more here.

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The rash from Rocky Mountain spotted fever usually begins to develop on which parts of the body?