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monahrq.ahrq.gov/questions/resources/research.html
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monahrq.ahrq.gov/teamstepps-program/curriculum/situation/overview/index.html
June 01, 2023 - Cross-Monitoring
A harm error reduction strategy that involves:
Monitoring actions of other team
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monahrq.ahrq.gov/sdoh/clas/index.html
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monahrq.ahrq.gov/sites/default/files/wysiwyg/teamstepps/instructor/onlinecourse/tsonlinemodule3.pptx
December 01, 2005 - I think we can all think of examples of where communication played a role in a patient error or medical … error. … To avoid making assumptions that can lead to error, you should verify in writing or orally any nonverbal … So there's huge opportunity for error to occur. … clarity who is responsible for care and decision making has often been a major contributor to medical error
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monahrq.ahrq.gov/research/findings/factsheets/errors-safety/simulproj15/index.html
August 01, 2018 - Such a situation could involve skill in error disclosure, for example, informing a loved one (portrayed … equipment come to market with certain improvements and efficiencies, but also introduce new forms of error … in rural settings, patient care hand-offs, virtual reality team training, and disclosure of medical error … new skills and reach a high standard of performance, it also takes practice and considerable trial-by-error
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monahrq.ahrq.gov/hai/tools/ambulatory-care/lab-testing-toolkit.html
January 01, 2018 - primary care offices consistently show that the process for managing tests is a significant source of error
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monahrq.ahrq.gov/news/newsroom/case-studies/index.html
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monahrq.ahrq.gov/sites/default/files/publications/files/simulation-brief.pdf
February 01, 2015 - Such
a situation could involve skill in error disclosure, for example, informing a loved one (portrayed … equipment come to market with certain improvements and efficiencies, but also
introduce new forms of error … in rural settings, patient care hand-offs,
virtual reality team training, and disclosure of medical error … skills and reach a high standard of performance, it also takes practice and considerable
trial-by-error
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monahrq.ahrq.gov/teamstepps/instructor/reference/teamattitude.html
April 01, 2017 - Skip to main content
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monahrq.ahrq.gov/news/newsroom/case-studies/201709.html
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monahrq.ahrq.gov/news/newsroom/case-studies/201511.html
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monahrq.ahrq.gov/coronavirus/practice-improvement.html
July 01, 2022 - Patient Safety
Technology Responses to COVID-19
Coronavirus Disease 2019 (COVID-19) and Diagnostic Error
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monahrq.ahrq.gov/news/newsletters/e-newsletter/index.html?page=1
April 18, 2023 - Skip to main content
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monahrq.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/perinatal-care/modules/strategies/medication/tool_safe-mgso4.docx
May 30, 2013 - pharmacy-prepared bags (e.g., 4 g/100 ml or 8 g/100 ml) should be used unitwide to reduce variability and risk of error … magnesium that can be delivered in the event of an accidental rapid infusion (e.g., pump programming error … sulfate use minimizes variability across providers and nursing staff in order to reduce the risk of error
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monahrq.ahrq.gov/health-literacy/publications/index.html
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monahrq.ahrq.gov/teamstepps/instructor/scenarios/operroom.html
March 01, 2014 - This error is discovered by the circulator immediately after the lens is inserted, and he promptly informs … Instructor Comments
This scenario demonstrates how cross-monitoring team members can help prevent error … Larry's team members fail to monitor his performance or check-back, which could have prevented the error
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monahrq.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/perinatal-care/modules/strategies/medication/tool_safe-oxytocin.docx
May 01, 2017 - Examples
Use a uniform mixed preparation unitwide for all patients to reduce variability and risk for error … and maintenance dose) should be used consistently for all patients to reduce variability and risk of error … oxytocin use minimizes variability across providers and nursing staff in order to reduce the risk of error … The use of standard NICHD nomenclature17,18,19 reduces confusion and risk of error.
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monahrq.ahrq.gov/sites/default/files/wysiwyg/teamstepps-program/tools/ts-team-performance-tool.pdf
May 31, 2023 - TeamSTEPPS Teamwork Performance Observation Tool
TeamSTEPPS Team Performance Observation Tool
Date:
Unit/Department:
Team:
Shift:
Rating Scale Please 1 = Very Poor
comment if 1 or 2. 2 = Poor
3 = Acceptable
4 = Good
5 = Excellent
1. Team Structure Rating
a. Assembles a team
b. Assigns or identifies te…
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monahrq.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/qitoolkit/combined/d4b_combo_psi05-foreignbody-bestpractices.pdf
November 01, 2012 - Human error in medicine. New Jersey Hove, UK: Lawrence Erlbaum Associates;
1994.
12. … Human error: models and management. BMJ 2000;320(7237):768-70.
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monahrq.ahrq.gov/teamstepps-program/resources/additional/index.html
September 01, 2023 - Skip to main content
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