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psnet.ahrq.gov/web-mm/palliative-care-comfort-vs-harm
April 27, 2016 - SPOTLIGHT CASE
Palliative Care: Comfort vs. … Harm
PPT
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Twitter … While he was still hospitalized, comfort measures were initiated. … about the balance between providing adequate pain control at or near the end of life and minimizing harm … obfuscate the fact that health care professionals also have the obligation to minimize unnecessary harm
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psnet.ahrq.gov/web-mm/untimely-end-despite-end-life-care-planning
February 01, 2012 - We now consider care inconsistent with patients' goals in the ICU a preventable harm, in the same way … Giovanni Elia, MD Associate Chief of Inpatient Palliative Care Services Division of Palliative Medicine … Preventing harm in the ICU—building a culture of safety and engaging patients and families. … Right Drug, Wrong Formulation
January 1, 2018
Building a Memory: Preventing Harm … January 27, 2021
Potential harm caused by physicians' a-priori beliefs in the clinical
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psnet.ahrq.gov/web-mm/too-hot-comfort
September 01, 2018 - Too Hot For Comfort
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Facebook … Before we address the appropriate use of thermal therapies and the harm they can cause, it is important … beneficial.( 1 ) Below, we review a number of indications for thermal therapy, then discuss the potential harm … Cases
Culture Clash No More: Integration and Coordination of Disease Treatment and Palliative
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psnet.ahrq.gov/web-mm/culture-clash-no-more-integration-and-coordination-disease-treatment-and-palliative-care
December 23, 2020 - Further discussions of the goals of care revealed that the patient desired to focus on comfort and on … He was discharged to an inpatient hospice for comfort care. … Although the regulation was written to focus care on the “goals of hospice”, emphasizing comfort at the … August 18, 2010
Measuring harm and informing quality improvement in the Welsh NHS: the … Giving back the pen: disclosure, apology and early compensation discussions after harm
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psnet.ahrq.gov/issue/errors-palliative-care-kinds-causes-and-consequences-pilot-survey-experiences-and-attitudes
January 05, 2011 - of palliative care professionals. … December 13, 2023
Occurrence of no-harm incidents and adverse events in hospitalized … November 22, 2017
WebM&M Cases
Palliative Care: Comfort … Harm
November 1, 2017
Lessons learned for reducing the negative impact of adverse … October 11, 2017
Use of standard risk screening and assessment forms to prevent harm
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psnet.ahrq.gov/issue/safety-pediatric-hospice-and-palliative-care-qualitative-study
September 02, 2020 - Safety in pediatric hospice and palliative care: a qualitative study. … patients, including an emphasis on the safety of the physical environment, medication safety, maintaining comfort … and preventing harm , and trust in the HBHPC caregivers. … December 9, 2020
Incidence, nature and causes of avoidable significant harm in primary … Patient-related factors associated with an increased risk of being a reported case of preventable harm
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psnet.ahrq.gov/issue/pediatric-faculty-knowledge-and-comfort-discussing-diagnostic-errors-pilot-survey-understand
July 06, 2022 - Study
Pediatric faculty knowledge and comfort discussing diagnostic errors: a pilot … Pediatric faculty knowledge and comfort discussing diagnostic errors: a pilot survey to understand barriers … Pediatric faculty knowledge and comfort discussing diagnostic errors: a pilot survey to understand barriers … March 26, 2014
What is preventable harm in healthcare? … Patient Care and Meeting Workforce Challenges
August 30, 2023
Patient safety in palliative
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psnet.ahrq.gov/issue/no-one-coming-hospice-patients-abandoned-deaths-door
June 29, 2016 - June 9, 2010
‘Fear of falling’: how hospitals do even more harm by keeping patients in … April 14, 2017
Balancing safety, comfort, and fall risk: an intervention to limit opioid … reliability organization and eliminating avoidable harm. … Patients' perception of safety while receiving specialist community palliative care. … October 7, 2020
Safety in pediatric hospice and palliative care: a qualitative study.
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psnet.ahrq.gov/issue/patient-controlled-analgesia-proxy
March 27, 2024 - October 10, 2018
WebM&M Cases
Palliative Care: Comfort … Harm
November 1, 2017
Carers' medication administration errors in the domiciliary
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psnet.ahrq.gov/issue/modern-palliative-radiation-treatment-do-complexity-and-workload-contribute-medical-errors
January 12, 2022 - Study
Modern palliative radiation treatment: do complexity and workload contribute … Modern palliative radiation treatment: do complexity and workload contribute to medical errors? … Predictors of warfarin-associated adverse events in hospitalized patients: opportunities to prevent patient harm … August 15, 2018
WebM&M Cases
Palliative Care: Comfort … Harm
November 1, 2017
Improving Diagnosis in Radiology—Progress and Proposals
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psnet.ahrq.gov/issue/lost-art-doctoring-reflections-pediatric-resident
March 03, 2017 - A recent WebM&M commentary explores the balance between comfort and harm in palliative care. … September 23, 2020
Incidence, nature and causes of avoidable significant harm in primary … October 4, 2023
Preventing potential patient harm through clinical content interventions … June 15, 2022
A dynamic risk management approach for reducing harm from invasive bedside … April 17, 2019
Quality improvement priorities for safer out-of-hours palliative care:
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psnet.ahrq.gov/issue/hospital-reputation-and-perceptions-patient-safety
October 11, 2017 - survey of experiences and attitudes of palliative care professionals. … patient and practice characteristics associated with patient-reported experiences of safety problems and harm … August 24, 2022
Identifying hot spots for harm and blind spots across the care pathway … February 13, 2019
We want to know: patient comfort speaking up about breakdowns in care … The association between patient-reported incidents in hospitals and estimated rates of patient harm
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psnet.ahrq.gov/issue/how-safe-do-dying-people-feel-home-patients-perception-safety-while-receiving-specialist
November 10, 2021 - Patients' perception of safety while receiving specialist community palliative care. … Patients' perception of safety while receiving specialist community palliative care. … August 12, 2020
Keeping patients at risk for self-harm safe in the emergency department … February 1, 2023
Balancing safety, comfort, and fall risk: an intervention to limit opioid … Care
November 30, 2021
Identifying hot spots for harm and blind spots across
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psnet.ahrq.gov/web-mm/code-status-vs-care-status
September 30, 2020 - DNR/comfort care or restorative vs supportive care path are not polar opposites. … If your mental model was that home with hospice meant “discontinue everything, except comfort focused … analysis or other quality improvement models, to create clearer policies and protocols for supportive and comfort … Care inconsistent with a patient’s goals of care is a preventable harm. … March 18, 2009
Do no harm: promoting patient safety.
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psnet.ahrq.gov/sites/default/files/2020-12/final_dec_spotlight_code_status_vs_care_status.pdf
January 01, 2020 - CARE STATUS
A case describing how care inconsistent with patient
goals can lead to preventable harm … — However, if the mental model was that “home with hospice”
meant “discontinue everything, except comfort … health care worker fatigue and burnout.
— The repurposed functionality of the EHR also leads to patient harm … in this case once he left the ICU
— The repurposed functionality of the EHR also leads to patient harm … • Care inconsistent with a patient’s goals of care is a preventable
harm.
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www.ahrq.gov/sites/default/files/wysiwyg/antibiotic-use/long-term-care/family-facilitator-guide.docx
June 01, 2021 - antibiotics are necessary to treat many bacterial infections, antibiotics can also be associated with harm … This could lead to her getting a medicine she does not need—which may cause harm.” … decision to start antibiotics in someone who is approaching the end of life may be associated with harm … Her goal is comfort care. … Slide 23
Solutions and Reassurance
SAY:
It is helpful to provide alternative palliative or comfort
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www.qualitymeasures.ahrq.gov/sites/default/files/wysiwyg/antibiotic-use/long-term-care/family-facilitator-guide.docx
June 01, 2021 - antibiotics are necessary to treat many bacterial infections, antibiotics can also be associated with harm … This could lead to her getting a medicine she does not need—which may cause harm.” … decision to start antibiotics in someone who is approaching the end of life may be associated with harm … Her goal is comfort care. … Slide 23
Solutions and Reassurance
SAY:
It is helpful to provide alternative palliative or comfort
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ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/antibiotic-use/long-term-care/family-facilitator-guide.docx
June 01, 2021 - antibiotics are necessary to treat many bacterial infections, antibiotics can also be associated with harm … This could lead to her getting a medicine she does not need—which may cause harm.” … decision to start antibiotics in someone who is approaching the end of life may be associated with harm … Her goal is comfort care. … Slide 23
Solutions and Reassurance
SAY:
It is helpful to provide alternative palliative or comfort
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psnet.ahrq.gov/web-mm/framework-assessing-reasoning-about-controversial-end-life-clinical-decisions
November 30, 2023 - Following his wishes, he transitioned to comfort-focused end-of-life care but remained in an inpatient … inconsistent with well-established and widely recognized standards of care, 7,8 resulting in significant harm … The complexity of health care can be a source of risk or harm to patients in other ways as well. … Comfort Care Guidelines for Providers -- Penn Medicine. 2018. … A New Generation of Comfort Care Order Sets: Aligning Protocols with Current Principles.
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psnet.ahrq.gov/cme
May 26, 2021 - developed signs of stroke and required ongoing resuscitation overnight before being transitioned to comfort … Upon consultation with the palliative care team about goals of care, the patient with telephonic support … of his long time caregiver, expressed his wish to go home and the palliative care team, discharge planner … Unfortunately, the patient was transferred out of the ICU after the palliative care team left for the … associated commentary describes how care inconsistent with patient goals and wishes is a form of preventable harm