Healthcare Risk Management – January 1, 2005
January 1, 2005
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The science of safety: Duke moves in a new direction to improve patient safety
In the aftermath of a tragic sentinel event traced back to poor processes, the appointment of a new patient safety officer at Duke University Hospital System in Durham, NC, raises several immediate questions. -
Assumptions and a lack of redundancy led to trouble
The 2003 transplant error at Duke University Hospital in Durham, NC, that led to the appointment of a new patient safety officer at Duke University Hospital System in Durham, NC, was traced to a lack of redundancy in the system that ensured donor organs matched the patient. -
Check the slip resistance of floors to prevent falls
Liquids on floors represent the biggest risk for falls in health care facilities, but risk managers often overlook the need to assess the fall risk of a particular area with wet surfaces, not dry ones, says an expert. -
New research shows brain injuries stem from infection
New research continues to dispel the once widely accepted belief that premature infants suffer brain injury from a lack of oxygen usually attributed to obstetrician error. In fact, infection plays a larger role, according to a high-risk obstetrician and assistant professor at The Johns Hopkins University School of Medicine in Baltimore. -
Stolen ambulance tragedy: $12.5 million payout
Health care providers in Texas have agreed to pay $12.5 million to settle a lawsuit stemming from the theft of an unattended ambulance, which was then involved in an accident that killed a father and seriously injured the rest of his family. The plaintiffs attorney says the settlement underscores the need for hospitals to secure ambulances and other vehicles. -
Flu shortage caused by liability fears? Maybe not
When risk managers first heard that there wouldnt be enough flu vaccine from the two manufacturers still providing it, many probably reacted with the same thought: Thats what you get when money-hungry trial lawyers run health care companies out of business. But is that really the cause of the flu vaccine shortage? -
Respond to the shortage by encouraging sick days
If the flu season hits your community hard, will your health care staff suffer because they didnt get enough flu shots? Quite possibly. But there is something risk managers can do. -
AHRQ offers a tool for measuring patient safety
Patient safety is on everyones minds these days, but how do you know how well your organization already is doing on this topic? One way is a tool offered by the Agency for Health-care Research and Quality (AHRQ), an arm of the Department of Health and Human Services in Washington, DC. -
ISMP: Med errors demand a more focused response
Five years after the landmark Institute of Medicine report, To Err is Human: Building a Safer Health System, not enough is being done to address medication errors, warns the Institute for Safe Medication Practices (ISMP) in Huntingdon Valley, PA. -
Legal Review & Commentary - Negligent treatment of epileptic seizures results in death: $1.5 million settlement in New York
This case involves several issues related to standard of care and possibly to causation, which are subject to review by the facilitys risk manager. -
Patient Safety Alert Supplement