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IHI Safety and Harm

Across
Errors whose effects are seen and felt immediately, example is when a nurse grabs the wrong medication
Incident of harm directly resulting from patient care
Is the model that shows the that harm is caused by a series of systemic failures in the presence of a hazard.
Central Line Associated Infection
A close call, in which an event or situation could have resulted in an adverse event but did not
Characterized as slips, lapses, and mistakes
Down
Caregivers who suffer and experience trauma when they make a medical error
Care that is respectful to and responsive to individualized patient's preferences, needs, and values.
Is a life-saving drug, but excessive use has caused an "epidemic of resistance."
"An unintended physical injury resulting from or contributed to by medical care that required additional monitoring, treatment, or hospitalization, or that results in death."
These are conditions that are defects in the design and organization of process and systems, example is inadequate training of employees
Is a type of error that occurs when a health care provider did that results in harm