Saturday 11 July 2015
Saturday 27 June 2015
Friday 26 June 2015
Saturday 30 May 2015
Friday Brain Fry! 29 May 2015
Patient Safety: A Computer Beats A Pen For Getting Prescriptions Right
Drug errors inside hospitals remain a big problem. By one estimate, 1 in 7 hospitalized patients suffers some form of error in care. Nearly a third of those mistakes are related to drugs. And those mix-ups can lead to longer hospital stays, unnecessary suffering, permanent damage or death.
Cancer Care Ontario did a systematic review in 2012, which indicated that only small percentage of hospitals in the US use CPOE for complex chemotherapy regimens. The error rate pre-CPOE was 15%, and the error rate post- CPOE was 5%. Interestingly, 92% of the post-CPOE errors were found in prescriptions that were still being handwritten, because the prescribing module was not yet available for all prescriptions.
Risk Management: Every change or improvement may have its own risks!
The design of the software can introduce errors "that would never occur on paper," like picking the wrong option from a drop-down menu.
Leadership Development: Who should be taking leadership for CPOE implementation?
In healthcare, its often unclear who is suppose to lead! In public health system, healthregions are very dependent on government funding. If an initiative such as CPOE is not funded by the MOH, its very difficult to get Hospitals leadership excited about it. In general health regions are reluctant to install the CPOE systems, because they're seen as expensive and painful to implement. Having a unified front with the administration and physician leaders is key to move CPOE forward in a collaborative environment. The reason why some organizations are successful [implementing CPOE] is due to the leadership and vision from their CEO and board of directors.
Lean Thinking: Mistake-proofing CPOE
Leapfrog for example, requires that hospitals test their CPOE systems to see if the pre-programmed rules actually catch harmful mistakes. They feed in fake patients and fake prescription orders — some of which contain fatal errors. Across the board, about one-third of them slip through.
Want to Read More: http://n.pr/AFiPzFl, http://bit.ly/1cp6HFR and http://bit.ly/1BvY5Ui
Video of the week!: Benefits of CPOE
http://youtu.be/sTp7NgETuvg
Tuesday 26 May 2015
Wednesday 20 May 2015
Sunday 17 May 2015
Friday 15 May 2015
Lean or Six Sigma
http://www.lean.org/Search/Documents/242.pdf
Jignesh Padia
Risk Management Coordinator
Quality, Safety and Risk
Saskatchewan Cancer Agency
#204-3775 Pasqua Street
Regina, SK S4S 6W8
Phone: 306.791.2777; Fax: 306.584.2733
Email: jignesh.padia@saskcancer.ca
Confidentiality Notice: This communication, including any attachments, is for the intended recipient(s) only. It may contain confidential and/or personal information. If you have received this communication in error do not copy or distribute it to another person or use for any other purpose. Please delete and notify me immediately.
Thursday 14 May 2015
Wednesday 13 May 2015
Patient Centred Care
Quality Field Notes: Engaging Patients Improves Health and Health Care
http://www.academyhealth.org/files/issues/ConsumerEngagement.pdf
http://www.academyhealth.org/files/issues/Evidence.pdf
http://www.academyhealth.org/files/issues/ConsumerDecide.pdf
http://www.academyhealth.org/files/issues/NavigatingHealthCare.pdf
http://www.academyhealth.org/Publications/BriefList.cfm?navItemNumber=534
http://www.academyhealth.org/Programs/content.cfm?ItemNumber=3927&navItemNumber=2505
Can patient safety be measured by patient experiences
http://www.ncbi.nlm.nih.gov/pubmed/18491690
your healthcare be involved
http://www.oha.com/KnowledgeCentre/Library/PatientSafety/Documents/1838_OHA_PSTpamphlet_ENG.pdf
Safety Culture
http://www.myschospital.org/docs/news6-09pulse.pdf
http://www.ahrq.gov/patients-consumers/care-planning/errors/20tips/
http://www.ahrq.gov/patients-consumers/care-planning/errors/20tips/20tips.pdf
http://health.gov.ie/wp-content/uploads/2014/03/en_patientsafety.pdf
http://www.who.int/patientsafety/information_centre/reports/Alliance_Forward_Programme_2008.pdf
http://www.who.int/patientsafety/information_centre/WHO_EIP_HDS_PSP_2006.1.pdf
http://www.who.int/patientsafety/en/
Advances in Patient Safety: From Research to Implementation. Volumes 1-4
Employee patient safety handbook
http://file.lacounty.gov/dhs/cms1_214905.pdf
Analysis in brief patient safety in Canada CIHI
https://secure.cihi.ca/free_products/Patient_Safety_AIB_EN_070814.pdf
https://secure.cihi.ca/free_products/HCIC_2010_Web_e.pdf
https://secure.cihi.ca/estore/productFamily.htm?locale=en&pf=PFC1984
https://www.accreditation.ca/sites/default/files/patient-safety-strategy-en.pdf
Mistake-Proofing the Design of Health Care Processes
Jignesh Padia
Risk Management Coordinator
Quality, Safety and Risk
Saskatchewan Cancer Agency
#204-3775 Pasqua Street
Regina, SK S4S 6W8
Phone: 306.791.2777; Fax: 306.584.2733
Email: jignesh.padia@saskcancer.ca
Confidentiality Notice: This communication, including any attachments, is for the intended recipient(s) only. It may contain confidential and/or personal information. If you have received this communication in error do not copy or distribute it to another person or use for any other purpose. Please delete and notify me immediately.
Monday 11 May 2015
Radiation Therapy Knowlege Docs
Standards
http://www.camrt.ca/_old_site//abouttheprofession/Standards_of_Practice.pdf
RM Guidelines
Quality Assurance Guidelines for Canadian Radiation Treatment Programs
http://www.caro-acro.ca/Assets/CPQR.pdf
An international review of patient safety measures in radiotherapy practice.
http://www.ncbi.nlm.nih.gov/pubmed/19395105
independent review of the circumstances surrounding a serious adverse incident
http://www.who.int/patientsafety/news/Radiotherapy_adverse_event_Toft_report.pdf
The application of error reduction QA philosophy in HDR brachytherapy
http://www.aapm.org/meetings/amos2/pdf/26%20-4515-95088-176.pdf
Risk Management for Health Technology Assessment ...
http://www.inahta.org/wp-content/themes/inahta/img/AboutHTA_Risk_management_for_HTA_programs.pdf
A Reference Guide for Learning from Incidents in Radiation Treatment
http://www.assembly.ab.ca/lao/library/egovdocs/2006/alhfm/153508.pdf
An Exploratory Review of Evaluations of Health Technology Assessment Agencies
unintended overeposure of patient lisa norris during radiation treatment
https://www.aapm.org/government_affairs/documents/glasgowEvent10-06.pdf
national association for healthcare quality Industry trends.
http://www.nahq.org/enews/pdfs/1208_trends.pdf
managing patient flow reducing hospital overcrowding
http://www.ahrq.gov/research/findings/final-reports/ptflow/ptflowguide.pdf
Robert
Jignesh Padia
Risk Management Coordinator
Quality, Safety and Risk
Saskatchewan Cancer Agency
#204-3775 Pasqua Street
Regina, SK S4S 6W8
Phone: 306.791.2777; Fax: 306.584.2733
Email: jignesh.padia@saskcancer.ca
Confidentiality Notice: This communication, including any attachments, is for the intended recipient(s) only. It may contain confidential and/or personal information. If you have received this communication in error do not copy or distribute it to another person or use for any other purpose. Please delete and notify me immediately.
Background Paper for the Development of National Guidelines for the Disclosure of Adverse Events
http://www.patientsafetyinstitute.ca/english/toolsresources/disclosure/documents/background%20paper%20for%20the%20canadian%20disclosure%20guidelines.pdf
Jignesh Padia
Risk Management Coordinator
Quality, Safety and Risk
Saskatchewan Cancer Agency
#204-3775 Pasqua Street
Regina, SK S4S 6W8
Phone: 306.791.2777; Fax: 306.584.2733
Email: jignesh.padia@saskcancer.ca
Confidentiality Notice: This communication, including any attachments, is for the intended recipient(s) only. It may contain confidential and/or personal information. If you have received this communication in error do not copy or distribute it to another person or use for any other purpose. Please delete and notify me immediately.
THE IMPACT OF DISCLOSURE OF ADVERSE EVENTS ON LITIGATION AND SETTLEMENT
http://www.patientsafetyinstitute.ca/english/toolsresources/disclosure/documents/the%20impact%20of%20disclosure%20on%20litigation%20a%20review%20for%20the%20cpsi.pdf
Jignesh Padia
Risk Management Coordinator
Quality, Safety and Risk
Saskatchewan Cancer Agency
#204-3775 Pasqua Street
Regina, SK S4S 6W8
Phone: 306.791.2777; Fax: 306.584.2733
Email: jignesh.padia@saskcancer.ca
Confidentiality Notice: This communication, including any attachments, is for the intended recipient(s) only. It may contain confidential and/or personal information. If you have received this communication in error do not copy or distribute it to another person or use for any other purpose. Please delete and notify me immediately.
Patient Safety and Healthcare Error in the Canadian Healthcare System
Jignesh Padia
Risk Management Coordinator
Quality, Safety and Risk
Saskatchewan Cancer Agency
#204-3775 Pasqua Street
Regina, SK S4S 6W8
Phone: 306.791.2777; Fax: 306.584.2733
Email: jignesh.padia@saskcancer.ca
Confidentiality Notice: This communication, including any attachments, is for the intended recipient(s) only. It may contain confidential and/or personal information. If you have received this communication in error do not copy or distribute it to another person or use for any other purpose. Please delete and notify me immediately.
Saturday 25 April 2015
Too busy to improve! How to deal with that mentality at workplace!
https://hakanforss.wordpress.com/2014/03/10/are-you-too-busy-to-improve/
http://www.lean.org/LeanPost/Posting.cfm?LeanPostId=340
http://www.lean.org/LeanPost/Posting.cfm?LeanPostId=340
Subscribe to:
Posts (Atom)