Patient Safety and Quality Improvement

Modules

Module 4: The “Analysis” of Medical Error, and Implementation

1. Introduction to Course

2. History of Patient Safety

3. The Science of Human Error

4. The Analysis of Medical Error

5. Evidence-Based Medical Practice

6. Communication and Information Transfer

7. Adverse Patient Outcomes

8. The Role of the Patient and Family

9. Environmental Safety in the Medical Setting

10. Safe Medical Practice In Ambulatory Settings

Rule 3: Identify the Preceding Cause(s), Not the Human Error.

WRONG: The resident made a dosage error.
CORRECT: Due to no automated software to check the dosage limits and no cognitive aids on dosing, there was a likelihood of this dosing error, which resulted in three times the appropriate level of insulin being ordered and administered.

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