Patient Safety

Infection Prevention in conjunction with the CAUTI (Catheter Associated Urinary Tract Infection) Team and CLABSI (Central Line Associated Blood Stream Infection) VAT (Vascular Access Team) Committee implemented a new initiative called Eyes on the Lines to decrease indwelling urinary catheters...
The purpose of this project is exploring opportunities for decreasing bleeding post percutaneous coronary intervention with the overall goal to decrease patient length of stay and mortality and increase patient satisfaction and safety. The data documents Good Samaritan University hospital’s...
An interdisciplinary care model was implemented in January 2020 to improve cardiopulmonary resuscitation care outcomes. Through consistent collaboration of a Physician Champion, a Clinical Nurse Specialist (CNS), a Registered Nurse Quality Specialist, and Quality Data Abstractors, implementation of evidence-based strategies...
Most care delivery in the US is provided in ambulatory settings, yet quality improvement and patient safety efforts are heavily weighted towards inpatient settings. It is estimated that 5% of outpatient encounters result in an adverse event, however, efforts to...
For prescribing teratogenic medications to women Veterans, although both the national pharmacy Teratogenic Medication warning and national guidance regarding teratogenic clinical reminders were implemented, process was not optimal as most medications were prescribed in the specialty setting and processes implemented...
This session will review the DMAIC process and tools used to improve handoff communication between departments, with transportation services and from the Emergency Department to inpatient nursing units. Problem: Patient handoffs are a well-known time of risk. A handoff contains:...
The University of Colorado Department of Medicine Systems Improvement Conference analyzes safety cases within a Just Culture lens to discover system-based issues, rather than blaming providers, for errors that occur in our hospital system. This type of analysis, called Safety...
Medical errors and harm are global phenomena and a top ten leading cause of death, accounting for over 251,000 annual U.S. deaths. The Salzburg Global Seminar statement (2019) emphasizes the analysis of real-time incident data to identify harm. Incident underreporting...
Lack of mobility has been proven to lead to complications and adverse effects on hospitalized patients such as increased length of stay, pressure ulcers, falls and DVTs/PEs. At Atrium Health Pineville, we experienced challenges with both documenting and executing our...
Diabetic foot is a chronic serious complication of diabetes mellitus (DM). It has a worldwide prevalence of 6.3% and accounts for hospitalization in 4-10% of diabetic patients. (1) Diabetic foot imposes a great challenge on the affected individuals, affecting both...
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