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Showing results for "error".
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421. Success Stories from the AHRQ Medical Office Survey on Patient Safety Culture (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patientsafetyculture/medical-office/mowebinar_2014/famolaro-0914slides.pdf
     January 01, 2014 - Communication About Error 7. Owner/Managing Partner/Leadership Support for Patient Safety 8. … Standardization Owner/ Managing Partner/ Leadership Support for Patient Safety Communication About Error … Position  Management had the most positive results  Largest differences:  Communication about error

422. Advances in Patient Safety: New Directions and Alternative Approaches | Agency for Healthcare Research and Quality
     www.ahrq.gov/patient-safety/reports/advances-new-directions/index.html
     July 01, 2022 - Improving Error Reporting in Ambulatory Pediatrics with Team Approach  (   PDF , 358 KB ) Daniel R. … Taxonomies and Measurement Development of a Comprehensive Medical Error Ontology (   PDF , 893 KB … A Visual Computer Interface Concept for Making Error Reporting Useful at the Point of Care (   PDF , … Risk Reduction and Systematic Error Management: Standardization of the Pediatric Chemotherapy Process … Error Producing Conditions in the Intensive Care Unit (   PDF , 475 KB ) Frank A.

423. Understanding SOPS® Surveys: A Primer for New Users - Gray (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/sops/events/webinar/sops_101_webcast-2022-gray.pdf
     January 01, 2022 - available 15 Areas of Patient Safety Culture Assessed Across SOPS Surveys • Communication About Error … Organizational Learning – Continuous Improvement • Overall Rating on Patient Safety • Response to Error

424. Final Progress Report: Consumer-Led Workshop To Advance Patient Safety (pdf file)
     www.ahrq.gov/sites/default/files/2024-07/peck-report.pdf
     January 01, 2024 - The commitment arising from people who have suffered from medical error, who are determined to help … We are the lifeline for patients, their families, and healers who suffer medical error. … depends on learning from medical error. … Consumers who have experienced medical error or systems failure often move into -- or are distanced … I can’t tell you the number of discussions I’ve participated in to discuss medical error reporting

425. Slide Presentation - Workforce Safety and Well-Being Webinar Series (Session 3): Resolving Workforce Turnover Crisis (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/action-alliance/workforce-turnover-crisis.pdf
     April 01, 2025 - (P17) Contributors to error Patient complexity Interface design CPOE guardrails Safety culture … burden Interruptions Sleep-related impairment Task-switching Well-being Fatigue Methods of error … other physicians Nurse and staff turnover affect everyone Turnover affects patients Contributors to error … Methods of error correction Question &Answers Let us know!

426. Work System Analysis: The Key to Understanding Health Care Systems (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol2/Karsh.pdf
     April 22, 2004 - Human error: models and management. Br Med J 2000;320:768–70. 2. Nolan TW. … A systems analysis approach to medical error. J Eval Clin Pract 1997;3(3):213–22. 5. Leape LL. … Error, stress, and teamwork in medicine and aviation: cross sectional surveys. … Design elements for a primary care medical error reporting system. … Medical error reporting system design: multiple user considerations and their implications.

427. P-HIP Excel Tool Guidance (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/pqmp/toolkits/phip-mrabstraction-tool-guidance.pdf
     June 02, 2025 - following the data warning indicates that you cannot move forward through the tool until you correct the error … P-HIP Export errors If you get an error message similar to the one below, the Excel file had trouble … P-HIP Other data export/import options In case of an error, or when using a new copy of the tool, you

428. AHRQ Webcast Introducing the New SOPS Hospital Survey 2.0 - Sorra (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/sops/surveys/3-sorra-sops-hospital-survey-2-0-webcast.pdf
     July 20, 2020 - Shifting to a “Just Culture” framework to assess Response to Error; 4. … Communication about error 2. Communication openness 3. Handoffs and information exchange 4. … Response to error 8. Staffing and work pace 9. … Difference HSOPS 2.0- HSOPS 1.0 Reporting Patient Safety Events Communication Openness Response to Error … - HSOPS 1.0 Hospita l Management Support for Patient Safety 70 Teamwork Communication About Error

429. Tool: Briefing and Debriefing Tool (doc file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/surgery/tools/applying-cusp/briefing_debriefing.docx
     December 01, 2017 - Specimens labeled correctly · Clean/dirty instrument separation · Equipment issues/review Operator error … versus posting error: ________________________________________________________________ _____________

430. Briefing and Debriefing Tool | Agency for Healthcare Research and Quality
     www.ahrq.gov/hai/tools/surgery/tools/applying-cusp/briefing-debriefing.html
     December 01, 2017 - Specimens labeled correctly Clean/dirty instrument separation Equipment issues/review Operator error … versus posting error: ________________________________________________________________________

431. Survey on Patient Safety (facility version) (doc file)
     www.ahrq.gov/sites/default/files/wysiwyg/sops/surveys/hospital/facilscanform.doc
     June 02, 2025 - Patient Safety Instructions This survey asks for your opinions about patient safety issues, medical error … question does not apply to you, you may leave your answer blank. · An “event” is defined as any type of error … years or more SECTION I: Your Comments Please feel free to write any comments about patient safety, error

432. Connecting the Dots: Improving Unit Safety Culture to Stop HAI (October 8, 2013) | Agency for Healthcare Research and Quality
     www.ahrq.gov/hai/cauti-tools/archived-webinars/connecting-dots-transcript.html
     December 01, 2017 - The NICK MERCK taxonomy for categorizing errors gives us a common language for talking about error. … 11 - James Reason is an industrial organizational psychologist that's taught us a huge amount about error … With just culture then, we just have the non-punitive response to error dimension. … So, those would be two concerns as well as non-punitive response to error. … In the dimension, non-punitive response to error.

433. Paul Tedrick (doc file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/cauti-tools/archived-webinars/connecting-dots-transcript.doc
     October 08, 2013 - The NICK MERCK taxonomy for categorizing errors gives us a common language for talking about error. … 11 - James Reason is an industrial organizational psychologist that's taught us a huge amount about error … With just culture then, we just have the non-punitive response to error dimension. … So, those would be two concerns as well as non-punitive response to error. … In the dimension, non-punitive response to error.

434. Survey on Patient Safety (facility version) (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/sops/surveys/hospital/facilscanform.pdf
     June 02, 2025 - Patient Safety Instructions This survey asks for your opinions about patient safety issues, medical error … • An “event” is defined as any type of error, mistake, incident, accident, or deviation, regardless … or more SECTION I: Your Comments Please feel free to write any comments about patient safety, error

435. Appendix, MATCH Resources for Patients | Agency for Healthcare Research and Quality
     www.ahrq.gov/patient-safety/settings/hospital/match/appendix/app-12.html
     July 01, 2022 - Medication Practices (ISMP) is the Nation's only nonprofit organization devoted entirely to medication error … resources including tips for using medications wisely and suggestions on what to do if you think an error

436. Appendix, MATCH Resources for Patients | Agency for Healthcare Research and Quality
     www.ahrq.gov/es/patient-safety/settings/hospital/match/appendix/app-12.html
     July 01, 2022 - Medication Practices (ISMP) is the Nation's only nonprofit organization devoted entirely to medication error … resources including tips for using medications wisely and suggestions on what to do if you think an error

437. Shadowing (doc file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/education/curriculum-tools/cusptoolkit/toolkit/shadowing.doc
     June 02, 2025 - Did you observe any error in transcription of orders by the provider you shadowed? 4. … Did you observe any error in the interpretation or delivery of an order? 5.

438. Leveraging Existing Assessments of Risk Now (LEARN) Safety Analysis: A Method for Extending Patient Safety Learning (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol1/Advances-woods_79.pdf
     May 30, 2008 - Document correct patient and blood type Incorrect or illegible handwritten label Human error … If info is wrong, the Fenwal armband on patient will catch the error. … These additional steps in the medication ordering process can result in increased risk of error. … minor misplacement of a decimal point in calculating the medication dose can result in a 10-fold error … Medication error prevention “toolbox.” Medication safety alert. June 2, 1999.

439. Development of a Computerized Adverse Drug Event (ADE) Monitor in the Outpatient Setting (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol2/Seger.pdf
     January 01, 2003 - and medication list, and applies a set of logical rules to determine a possible ADE or medication error … (ME), medication error that leads to an adverse drug event (ADE/ME), or no event. … A medication error was defined as any error that occurred in the medication use process (including ordering … The medication has a low adverse reaction profile, but the therapy is redundant and thus an error. … Increase in US medication-error deaths between 1983 and 1993. The Lancet 1998;351:643–44. 2.

440. Final Progress Report: Training Doctors To Disclose Unanticipated Outcomes to Patients: Randomized Trial (pdf file)
     www.ahrq.gov/sites/default/files/2024-07/gallagher3-report.pdf
     January 01, 2024 - Key Words: error disclosure, patient safety, patient-provider communication, ethics, medical malpractice … with patients about unanticipated outcomes is difficult, especially when the outcome was due to an error … To explore whether characteristics of the event (severity of harm, presence of error), the physician … Talking with patients and families about medical error: A guide for education and practice. 2010. … Accountability for medical error: Moving beyond blame to advocacy. CHEST 2011;140:519-526. 9.