Newsletter
Patient Falls
Patient Safety Alert 23: Patient Falls (PDF)
The AMC PSO convened a panel of nursing leaders to review recent trends, evaluate the current literature, and discuss novel interventions aimed at mitigating the risk regarding patient falls.
Risks
Table 1 includes a list of the contributing factors to patient falls identified at this session: To gain a better understanding of failure to rescue’s causes and potential solutions, the AMC PSO assembled a panel of subject matter experts to review the following:
- Inadequate patient assessment, specifically related to medication regimens...
AMC PSO
Our Patient Safety Organization convenes clinical leaders to identify and mitigate emerging risks.
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More AMC PSO Content
Publications such as whitepapers and guidelines derived from the AMC PSO convenings.
No Surgical Items Left Behind
Newsletter
While the occurrence is rare, Massachusetts reported rising rates of retained surgical items over the past several years.
Periprocedural Management of Anticoagulation Therapy
Newsletter
Patient Safety Alert Issue 24: The AMC PSO recently convened to discuss this high-risk area and important patient safety issue, the contributing factors often associated with this medication event type, and the strategies to proactively mitigate this risk.
Failure to Rescue
Newsletter
Patient Safety Alert Issue 22: The AMC PSO has recently assembled a panel of subject matter experts to review data, literature, and their own experiences with insufficient patient monitoring and failure to rescue.
Results Management Report
Newsletter
Patient Safety Alert Issue 21: Continuing deliberations on test results management begun in 2013, the Academic Medical Center Patient Safety Organization (AMC PSO) gathered a panel of ambulatory risk management and patient safety experts to address this persistent issue. Related literature shows that 25% of all outpatient medical errors can be attributed to the test-results follow up process.