The Truax Group         Patient Safety Solutions

   Healthcare Consulting Services 

471 Fort Gray Drive
Lewiston, NY 14092

ph: 1-866-9PSAFETY
fax: 716-285-4327
alt: 716-285-0012

Patient Safety Tip of the Week Archive

Click on the "Contact Us" button at the left to send us your comments on our "Patient Safety Tip of the Week" cases.

 

To get "Patient Safety Tip of the Week " emailed to you, click here and enter "subscribe" in the subject field.

 

 

 

March 9, 2010

Communication of Urgent or Unexpected Radiology Findings

 

March 2, 2010

Alarm Sensitivity: Early Detection vs. Alarm Fatigue

 

February 23, 2010

Alarm Issues in the News Again

 

February 16, 2010

Spin/Hype…Knowing It When You See It

 

February 9, 2010

More on Preventing Inpatient Suicides

 

February 2, 2010

The Hazards of Radiation

 

January 26, 2010

Preventing Postoperative Delirium

 

January 19, 2010

Timeouts and Safe Surgery

 

January 12, 2010

Patient Photos in Patient Safety

 

January 5, 2010

How’s Your Hand Hygiene?

 

December 29, 2009

Recognizing Deteriorating Patients

 

December 22, 2009

Falls on Toileting Activities

 

December 15, 2009

The Weekend Effect

 

 

December 8, 2009

Prescribing Errors

 

December 1, 2009

Patient Safety Doesn’t End at Discharge

 

 

November 24, 2009

Another Rough Month for Healthcare IT

 

November 17, 2009

Switched Babies

 

November 10, 2009

Conserving Resources…But Maintaining Patient Safety

 

November 3, 2009

Medication Safety: Frontline to the Rescue Again!

 

October 27, 2009

Co-Managing Patients: The Good, The Bad, and The Ugly

 

October 20, 2009

Radiology Again…But This Time It’s Really Radiology!

 

October 13, 2009

Slipping Through the Cracks

 

October 6, 2009

Oxygen Safety: More Lessons from the UK

 

September 29, 2009

Perioperative Peripheral Nerve Injuries

 

September 22, 2009

Psychotropic Drugs and Falls in the SNF

 

September 15, 2009

ETTO’s: Efficiency-Thoroughness Trade-Offs

 

September 8, 2009

Barriers to Medication Reconciliation

 

September 1, 2009

The Real Root Causes of Medical Helicopter Crashes

 

August 25, 2009

Interruptions, Distractions, Inattention…Oops!

 

August 18, 2009

Obstructive Sleep Apnea in the Perioperative Period

 

August 11, 2009

The Radiology Suite…Again!

 

August 4, 2009

Faulty Fall Risk Assessments?

 

July 28, 2009

Wandering, Elopements, and Missing Patients

 

July 21, 2009

Medication Errors in Long Term-Care

 

July 14, 2009

Is Your “Do Not Use” Abbreviations List Adequate?

 

July 7, 2009

Nudge: Small Changes, Big Impacts

 

June 30, 2009

iSoBAR: Australian Clinical Handoffs/Handovers

 

June 23, 2009

More on Delirium in the ICU

 

June 16, 2009

Disclosing Errors That Affect Multiple Patients

 

June 9, 2009

CDC Update to the Guideline for Prevention of CAUTI

 

June 2, 2009

Why Hospitals Should Fly…John Nance Nails It!

 

May 26, 2009

Learning from Tragedies. Part II

 

May 19, 2009

Learning from Tragedies

 

May 12, 2009

Errors With PCA Pumps

 

May 5, 2009

Adverse Drug Events in the ICU

 

April 28, 2009

Ticket Home and Other Tools to Facilitate Discharge

 

April 21, 2009

Still Futzing with Foleys?

 

April 14, 2009

More on Rehospitalization After Discharge

 

April 7, 2009

Project RED

 

March 31, 2009

Screening Patients for Risk of Delirium

 

March 24, 2009

Medication Errors in the OR

 

March 17, 2009

More on MRI Safety

 

March 10, 2009

Prolonged Surgical Duration and Time Awareness

 

March 3, 2009

Overriding Alerts…Like Surfin’ the Web

 

February 24, 2009

Discharge Planning: Finally Something That Works!

 

February 17, 2009

Reducing Risk of Overdose with Midazolam Injection

 

February 10, 2009

Sedation in the ICU: The Dexmedetomidine Study

 

February 3, 2009

NTSB Medical Helicopter Crash Reports: Missing the Big Picture

 

January 27, 2009

Oxygen Therapy: Everything You Wanted to Know and More!

 

January 20, 2009

The WHO Surgical Safety Checklist Delivers the Outcomes

 

January 13, 2009

Lab Errors in the News

 

January 6, 2009

Preventing Inpatient Suicides

 

December 30, 2008

Unintended Consequences: Is Medication Reconciliation Next?

 

December 23, 2008

Why Safety Alerts Often Fail

 

December 16, 2008

Joint Commission Sentinel Event Alert on Hazards of Healthcare IT

 

December 9, 2008

Huddles in Healthcare

 

 

December 2, 2008

Playing without the ball…the art of communication in healthcare

 

November 25, 2008  

Wrong-Site Neurosurgery

 

November 18, 2008  

Ticket to Ride: Checklist, Form, or Decision Scorecard?

 

November 11, 2008  

Probiotics and VAP Prevention

 

November 4, 2008  

Beta Blockers Take More Hits

 

October 28, 2008 

More on Computerized Trigger Tools

 

October 21, 2008

Preventing Delirium

 

October 14, 2008

Managing Delirium

 

October 7, 2008

Lessons from Falls....from Rehab Medicine

 

September 30, 2008

Hot Topic: Handoffs

 

September 23, 2008

Checklists and Wrong Site Surgery

 

September 16, 2008

More on Radiology as a High Risk Area

 

September 9, 2008

Less is More….and Do You Really Need that Decimal?

 

September 2, 2008

Updates on VAP Prevention

 

August 26, 2008

Pattern Recognition and CPOE

 

August 19, 2008

Arterial Line Issues

 

August 12, 2008

Jerome Groopman’s “How Doctors Think”

 

August 5, 2008

Tip of the Week on Vacation

 

July 29, 2008

Heparin-Induced Thrombocytopenia

 

July 22, 2008

Lots New in the Anticoagulation Literature

 

July 15, 2008

Heparin Flushes.....Again!

 

July 8, 2008

Medical Helicopter Crashes

 

July 1, 2008

WHO’s New Surgical Safety Checklist

 

June 24, 2008

Urinary Catheter-Related UTI’s: Bladder Bundles

 

June 17, 2008

Technology Workarounds Defeat Safety Intent

 

June 10, 2008

Monitoring the Postoperative COPD Patient

 

June 3, 2008

UK Advisory on Chest Tube Insertion

 

May 27, 2008

If You Do RCA’s or Design Healthcare Processes…Read Gary Klein’s Work

 

May 20, 2008

CPOE Unintended Consequences – Are Wrong Patient Errors More Common?

 

May 13, 2008

Medication Reconciliation: Topical and Compounded Medications

 

May 6, 2008

Preoperative Screening for Obstructive Sleep Apnea

 

April 29, 2008

ASA Practice Advisory on Operating Room Fires

 

April 22, 2008

CMS Expanding List of No-Pay Hospital-Acquired Conditions

 

April 15, 2008

Computerizing Trigger Tools

 

April 8, 2008

Oxygen as a Medication

 

April 1, 2008

Pennsylvania PSA’s FMEA on Telemetry Alarm Interventions

 

March 25, 2008

More on MRSA

 

March 18, 2008

Is Desmopressin on Your List of Hi-Alert Medications?

 

March 11, 2008

Lessons from Ophthalmology

 

March 4, 2008

Housestaff Awareness of Risks for Hazards of Hospitalization

 

February 26, 2008

Nightmares….The Hospital at Night

 

February 19, 2008

MRI Safety

 

February 12, 2008

More on Tracking Test Results

 

February 5, 2008

Reducing Errors in Obstetrical Care

 

January 29, 2008

Thoughts on the Recent Neonatal Nursery Fire

 

January 22, 2008

More on the Cost of Complications

 

January 15, 2008

Managing Dangerous Medications in the Elderly

 

January 8, 2008

Urinary Catheter-Associated Infections

 

January 1, 2008

Fall Prevention

 

December 25, 2007

Happy Holidays 

 

December 18, 2007

Bed Rails

 

December 11, 2007

Communication…Communication…Communication

 

December 4, 2007

Surgical Fires

 

November 27,2007

More on Rapid Response Teams

 

November 20, 2007

New Evidence Questions Perioperative Beta Blocker Use

 

November 13, 2007

AHRQ's Free Patient Safety Tools DVD

 

November 6, 2007

Don Norman Does It Again!

 

October 30, 2007

Using IHI’s Global Trigger Tool

 

October 23, 2007

Medication Reconciliation Tools

 

October 16, 2007

Radiology as a Site at High-Risk for Medication Errors

 

October 9, 2007

Errors in the Laboratory

 

October 2, 2007

Taking Off From the Wrong Runway

 

September 25, 2007

Lessons from the National Football League

 

September 18, 2007

Wristbands: The Color-Coded Conundrum

 

September 11, 2007

Root Cause Analysis of Chemotherapy Overdose

 

September 4, 2007

Workarounds as a Safety Issue

 

August 28, 2007

Lessons Learned from Transportation Accidents

 

August 21, 2007

Costly Complications About To Become Costlier

 

August 14, 2007

More Medication-Related Issues in Ambulatory Surgery

 

August 7, 2007

Role of Maintenance in Incidents

 

July 31, 2007

Dangers of Neuromuscular Blocking Agents

 

July 24, 2007

Serious Incident Response Checklist

 

July 17, 2007

Falls in Patients on Coumadin or Other Anticoagulants

 

July 10, 2007

Catheter Connection Errors/Wrong Route Errors

 

July 3, 2007

Tip of the Week on Vacation

 

June 26, 2007

Pneumonia in the Stroke Patient

 

June 19, 2007

Unintended Consequences of Technological Solutions

 

June 12, 2007

Medication-Related Issues in Ambulatory Surgery

 

June 5, 2007

Patient Safety in Ambulatory Surgery

 

May 29, 2007

Read Anything & Everything Written by Malcolm Gladwell!

 

May 22, 2007

More on TeamSTEPPS™

 

May 15, 2007

Communication, Hearback and Other Lessons from Aviation

 

May 8, 2007

Doctor, when do I get this red rubber hose removed?

 

May 1, 2007

The Missed Cancer

 

April 23, 2007

Predictable Errors

 

April 16, 2007

Falls with Injury

 

April 9, 2007

Make Your Surgical Timeouts More Useful

 

April 2, 2007

More Alarm Issues

 

March 26, 2007

Alarms Should Point to the Problem

 

March 19, 2007

Put that machine back the way you found it!

 

March 12, 2007

10x Overdoses

 

March 5, 2007

Disabled Alarms

 

February 26, 2007

Unintended Consequences

 

 

 

Click on the "Contact Us" button at the left to send us your comments on our "Patient Safety Tip of the Week" cases.

 

To get "Patient Safety Tip of the Week " emailed to you, click here and enter "subscribe" in the subject field.

 

 

471 Fort Gray Drive
Lewiston, NY 14092

ph: 1-866-9PSAFETY
fax: 716-285-4327
alt: 716-285-0012