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Showing results for "mistakes".

  1. ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/sops/quality-patient-safety/patientsafetyculture/pharmsops-composites.pdf
    June 19, 2018 - Staff in this pharmacy discuss mistakes. B13. … Staff are treated fairly when they make mistakes. C4. … Staff feel like their mistakes are held against them. … This pharmacy is good at preventing mistakes. C9. … Communication About Mistakes 9. Response to Mistakes 10.
  2. ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patientsafetyculture/pharmacy/pharmwebinar/sorraslides.pdf
    January 01, 2014 - Communication about mistakes 8. Response to mistakes 9. Staff training and skills 10. … Documenting mistakes Patient safety “grade” (Excellent to Poor) Underlined dimensions were later … Communication about mistakes Communication about presciptions across shifts % Positive Response … that reach the patient and could cause harm but do not Mistakes that reach the patient but have no … potential to harm Mistakes that could have harmed the patient but were corrected BEFORE the medication
  3. ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/sops/surveys/2019-pharmacy-sops-database-report-appendix.pdf
    January 01, 2019 - Response to Mistakes 1. Staff are treated fairly when they make mistakes. … Communication About Mistakes 1. Staff in this pharmacy discuss mistakes. … Response to Mistakes 1. Staff are treated fairly when they make mistakes. … Communication About Mistakes 1. Staff in this pharmacy discuss mistakes. … Communication About Mistakes 1. Staff in this pharmacy discuss mistakes.
  4. ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol1/Hoff.pdf
    January 01, 2003 - Watching medical work to understand medical mistakes Comprehending failure and mistakes in any line … which were then categorized using labels from the medical mistakes literature, such as mistakes of … Two-thirds of the surgery mistakes and near misses involved mistakes of commission. … “I develop a hierarchy of mistakes in my head. … Another reason might be the nature of the mistakes themselves (i.e., more mistakes of omission that
  5. ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patientsafetyculture/asc/ascwebinar/brownslides.pdf
    August 13, 2015 - 89% 81% Teamwork 86% 81% 40 40 Survey Results Staff Training 78% 79% Response to Mistakes …  Communication Openness  Staffing, Work Pressure and Pace  Staff Training  Response to Mistakes … • 78% positive for DHC vs 82% for pilot ASCs Staff are treated fairly when they make mistakes. … 81% 89% Learning, rather than blame, is emphasized when mistakes are made. 78% 70% Staff … : Continued treating mistakes as learning opportunities 49 49 Going Forward • Continue to collaborate
  6. ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patientsafetyculture/pharmacy/toolkit/PharmSOPSform.pdf
    June 06, 2018 - Staff in this pharmacy discuss mistakes ..................... 1 2 3 4 5 9 9. … Staff are treated fairly when they make mistakes ..... 1 2 3 4 5 9 2. … This pharmacy is good at preventing mistakes ......... 1 2 3 4 5 9 7. … Staff feel like their mistakes are held against them .. 1 2 3 4 5 9 9. … are the following types of mistakes documented (in writing OR tracked electronically)?
  7. ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patientsafetyculture/pharmacy/2015/pharmsops15pt2.pdf
    January 01, 2015 - Communication About Mistakes 92% 86% 81% 4. … (B10) 91% 88% 89% Communication About Mistakes 1. Staff in this pharmacy discuss mistakes. … (B14) 91% 82% 71% Response to Mistakes 1. Staff are treated fairly when they make mistakes. … Communication About Mistakes 87% 86% 85% 88% 4. … Communication About Mistakes 89% 83% 84% 84% 4.
  8. ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/sops/surveys/2019-pharmacy-sops-database-report-parti-rev091721.pdf
    January 01, 2019 - Staff discuss mistakes that happen and can talk about ways to prevent mistakes. … Response to Mistakes The pharmacy examines why mistakes happen, helps staff learn from mistakes, and … Response to Mistakes Staff are treated fa irly when they make mistakes (Cl) 82 This pharmacy helps … Communication About Mistakes 1. Staff in this pharmacy discuss mistakes. … Response to Mistakes 1. Staff are treated fairly when they make mistakes.
  9. ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patientsafetyculture/pharmacy/toolkit/PharmSOPSform.doc
    June 09, 2016 - Mistakes may be related to, or include: · Prescribing, transcribing, dispensing, administering, monitoring … Staff are treated fairly when they make mistakes FORMCHECKBOX 1 FORMCHECKBOX 2 FORMCHECKBOX … This pharmacy is good at preventing mistakes FORMCHECKBOX 1 FORMCHECKBOX 2 FORMCHECKBOX 3 … We look at staff actions and the way we do things to understand why mistakes happen in this pharmacy … 3 FORMCHECKBOX 4 FORMCHECKBOX 5 FORMCHECKBOX 9 SECTION D: Documenting Mistakes In this
  10. ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patientsafetyculture/hospital/hospwebinar/just-culture-webcast-1-intro.pdf
    November 09, 2016 - hosp-reports.html Defining Nonpunitive Response to Error 11 The extent to which staff feel that their mistakes … and event reports are not held against them and that mistakes are not kept in their personnel file … Nonpunitive Response to Error Survey Items – Staff feel like their mistakes are held against them. … event is reported, it feels like the person is being written up, not the problem. – Staff worry that mistakes
  11. ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/sops/surveys/2019-nhsops-dbreport-partii.pdf
    January 01, 2019 - Staff are afraid to report their mistakes. (A12R) 51% 58% 3. … This nursing home lets the same mistakes happen again and again. … Staff are afraid to report their mistakes. (A12R) 55% 56% 3. … Staff are afraid to report their mistakes. (A12R) 56% 57% 55% 3. … Nonpunitive Response to Mistakes 60% 56% 54% 55% 60% 11.
  12. ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patientsafetyculture/pharmacy/2015/pharmsops15pt1.pdf
    January 01, 2015 - Communication About Mistakes Staff discuss mistakes that happen and can talk about ways to prevent mistakes … Response to Mistakes The pharmacy examines why mistakes happen, helps staff learn from mistakes, and … Communication About Mistakes 1. Staff in this pharmacy discuss mistakes. … Response to Mistakes 1. Staff are treated fairly when they make mistakes. … Staff feel like their mistakes are held against them.
  13. Facilitator-Notes (doc file)

    ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/quality-resources/tools/cauti-ltc/modules/implementation/long-term-modules/module3/facilitator-notes.docx
    March 01, 2017 - A Just Culture is one that allows teams to learn from mistakes in a safe environment. … In failure, you are given an opportunity to learn from your mistakes and continue to improve processes … System design Humans are not perfect and occasionally make mistakes, either through unintentional errors … All humans make mistakes, and it is important to differentiate between human error and at-risk behavior … SLIDE 24 SAY: A system of Just Culture recognizes that people make mistakes.
  14. ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/sops/surveys/hospital/facilscanform.doc
    November 15, 2019 - Staff feel like their mistakes are held against them (1 (2 (3 (4 (5 9. … Mistakes have led to positive changes here (1 (2 (3 (4 (5 10. … It is just by chance that more serious mistakes don’t happen around here (1 (2 (3 (4 (5 11. … Staff worry that mistakes they make are kept in their personnel file (1 (2 (3 (4 (5 17. … 2 (3 (4 (5 SECTION D: Frequency of Events Reported In your work area/unit, when the following mistakes
  15. ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/sops/surveys/hospital/hsops-items-composites.pdf
    February 16, 2021 - Mistakes have led to positive changes here. A13. … It is just by chance that more serious mistakes don't happen around here. (negatively worded) A17. … Staff feel like their mistakes are held against them. (negatively worded) A12. … Staff worry that mistakes they make are kept in their personnel file.
  16. ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patientsafetyculture/nursing-home/2016/nhsurv16-pt2.pdf
    January 01, 2016 - Nonpunitive Response to Mistakes 55% 54% 54% 47% 12. … Nonpunitive Response to Mistakes 54% 54% 12. … Nonpunitive Response to Mistakes 54% 54% 12. … Nonpunitive Response to Mistakes 53% 57% 12. … Nonpunitive Response to Mistakes 56% 53% 48% 12.
  17. ce.effectivehealthcare.ahrq.gov/sops/international/hospital/translators.html
    October 01, 2014 - Mistakes have led to positive changes here. A13. … It is just by chance that more serious mistakes don't happen around here. … Staff feel like their mistakes are held against them. (negatively worded) A12. … Staff worry that mistakes they make are kept in their personnel file. … (negatively worded) ( More about this item: Staff worry that their mistakes are being documented, are
  18. ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patientsafetyculture/asc/ascwebinar/smith2slides.pdf
    August 13, 2015 - Response to Mistakes 8. … 23 23 ASC Composite Results % Positive Response Communication Openness 85% Response to Mistakes … affiliated ASCs were more positive (86%) than Not hospital affiliated ASCs (80%) on Response to Mistakes … safety problems, learning rather than blame is emphasized, and staff are treated fairly when they make mistakes … Smaller ASCs (1 or 2 Rooms) were more positive than larger ASCs (6 Rooms or More) on Response to Mistakes
  19. ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/sops/surveys/hospital/facilscanform.pdf
    November 18, 2019 - Staff feel like their mistakes are held against them ................................... 1 2 3 4 … Mistakes have led to positive changes here .............................................. 1 2 3 4 … It is just by chance that more serious mistakes don’t happen around here .......................... … Staff worry that mistakes they make are kept in their personnel file ......... 1 2 3 4 5 17. … SECTION D: Frequency of Events Reported In your work area/unit, when the following mistakes
  20. ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patientsafetyculture/hospital/resources/infotranshsops.pdf
    September 01, 2009 - Mistakes have led to positive changes here. A13. … It is just by chance that more serious mistakes don't happen around here. … In other words, the reason mistakes do not happen more often is good luck, NOT because procedures or … Staff feel like their mistakes are held against them. (negatively worded) A12. … Staff worry that mistakes they make are kept in their personnel file.

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