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

All of Them Could be Weak or Ineffective Actions

Changing “our” own behavior is biggest hurdle (we met the enemy and the enemy is us?)
Safety culture change is necessary condition
Most actions are easily worked around
Many RCAs find intervention being ignored, disabled
Nearly worthless steps to get “change”
Reminder systems
CME
Printed materials

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