A near miss (a.k.a. close call) is an unplanned event that did not result in injury to the patient. Only a fortunate break in the chain of events prevented injury. We use data from a large voluntary reporting system of 836,174 medication errors from 1999 to 2005 to provide evidence ...
In general, the Authority identified a considerable statewide increase of near-miss BCMA events over the 12-year period. BCMA events occurred during each point of the medication-management process. The majority of events involved administering medication, while the remaining events invol...
Near-miss error 来自 掌桥科研 喜欢 0 阅读量: 25 作者: DCF Green 摘要: We wish to share the learning from a"near miss"patient safety incident,which was contributed to by the layout and indexing of the Children's BNF 2007.In this near miss,a neonate was at risk because of confusion...
While Near Miss management is usually associated with error and safety management, there is a growing trend that organizations apply theories of knowledge management to assist the building of a safety culture. Therefore, theories and practices on error management, organizational learning, and safety ...
Medication management of pathological gambling. Minnesota Medicine 89: 44–48. Griffiths M (1991). Psychobiology of the near-miss in fruit machine gambling. J Psychol 125: 347–357. Habib R, Dixon MR (2010). Neurobehavioral evidence for the 'near-miss' effect in pathological gamblers. J Exp...
Barriers to the reporting of medication administration errors and near misses: an interview study of nurses at a psychiatric hospital We have not seen another study where nurses would not report an error or near miss because they thought there was a good excuse for it. Training ... C Haw,J...
But Harris didn’t want to miss his speech. Her plane circled in Chicago airspace for an extra 10 minutes so she could finish watching Emhoff’s remarks, according to a reporter on the plane. After he wrapped, he was met by cheers of “DOUG! DOUG! DOUG!” from the front cabin...
When your dog starts to lift their leg to urinate, urine will miss the pads and go over the nearest object. Also male dogs look for vertical surfaces to urinate on, and not flat pads. Not suitable for most intact dogs who are behavior marking. Don’t have outdoor space – If you ...
Furthermore, data collection from these investigations often lag in time and may miss an opportunity to report increased alcohol use during critical windows of time, when intervention may help prevent adverse health outcomes. In contrast, the clinical setting provides an opportunity for early ...
Medication errors are a threat to patient safety, yet near miss events are frequently underreported. At the Lexington Veterans Affairs Medical Center, medication errors are tracked utilizing the electronic patient event reporting system. Starting in August 2012, the pharmacy department initiated a more ...