Physician: 'I almost killed a patient' because of an advance directive.

Newspaper/Magazine Article

Physician: 'I almost killed a patient' because of an advance directive.

May 14, 2014

Betbeze P. HealthLeaders Media. May 2, 2014.

View more articles from the same authors.

Reporting on how misinterpretation of advance directives and living wills can detract from patient safety, this news article reveals insights from a physician who developed a checklist poster to provide decision support for clinicians and recommends standardization of the forms to reduce risks.

Free full text

Related study

Related poster (PDF)

Related Resources From the Same Author(s)

After a medical error, patients could become hospital insiders.

June 4, 2014

Malnourishment 'epidemic' plagues hospitals? Really?

October 1, 2014

Autopsy advocates.

April 30, 2014

Surgical checklists unused in 10% of hospitals, CMS data shows.

August 6, 2014

Leapfrog hospital safety scores 'depressing.'

May 22, 2013

Patient safety tool helps ID hospital errors.

January 16, 2013

Rude providers jeopardize patient safety. So stop it.

June 28, 2017

Reducing diagnostic errors.

October 19, 2016

ECRI announces top 10 healthcare technology hazards.

November 13, 2013

Hospitals lagging in PSO contracts.

June 19, 2013

How DeKalb Medical fixed drug safety problems after fatal error.

May 9, 2018

Care transitions know-how not just for clinicians.

October 11, 2017

Health systems and hospitals in pursuit of high reliability.

May 1, 2019

Top 10 medical technology hazards of 2020 announced.

October 23, 2019

Patient Safety and Quality Healthcare.

March 6, 2005

Assessing nursing quality and patient safety.

July 8, 2015

The computer will see you now.

August 28, 2019

Fatal mistakes.

March 30, 2016

eHealth for Safety: Impact of ICT on Patient Safety and Risk Management.

November 28, 2007

What a doctor may miss by reaching for the MRI first.

May 28, 2014

New HHS Data Shows Major Strides Made in Patient Safety, Leading to Improved Care and Savings.

May 21, 2014

Patient Safety Culture: Theory, Methods and Application.

January 21, 2015

Sound the alarm.

June 25, 2014

Interim Report: Review of VHA's Patient Wait Times, Scheduling Practices, and Alleged Patient Deaths at the Phoenix Health Care System.

June 4, 2014

Reminder: pay attention to the appearance of your medicines.

December 10, 2014

Is your hospital really as safe as you think? Our updated hospital safety score can help you find out.

April 16, 2014

2013 John M. Eisenberg Patient Safety and Quality Award Recipients Announced.

January 29, 2014

Hamilton father misdiagnosed with lung cancer demands answers.

November 26, 2014

Save a brain, make a checklist.

April 2, 2014

Surgical 'black box' could reduce errors.

September 10, 2014

Rethinking hospital restraints.

September 3, 2014

Veterans' Access to Care through Choice, Accountability, and Transparency Act of 2014.

August 20, 2014

A Culture of Safety in EMS Systems.

November 6, 2013

America's Hospitals: Improving Quality and Safety: The Joint Commission's Annual Report 2014.

November 26, 2014

Exploring the Costs of Unsafe Care in the NHS: A Report Prepared for the Department of Health.

November 5, 2014

Ebola case raises concern about everyday hospital safety.

October 29, 2014

Nursing homes cited 1,000 times for medication errors.

August 27, 2014

Core Entrustable Professional Activities for Entering Residency.

August 6, 2014

Patient Safety Initiative: Hospital Executive and Physician Leadership Strategies.

January 28, 2015

Finding and Preventing Patient Safety Incidents.

July 2, 2014

Medical disrespect.

February 12, 2014

Staff Care: How to Engage Staff in the NHS and Why It Matters.

February 5, 2014

Safety shortcomings spotted in Sunrise catheter case.

December 8, 2010

What surgeons leave behind costs some patients dearly.

March 20, 2013

Errors test openness at Beth Israel Deaconess. Disclosures will benefit hospital, president insists.

November 5, 2008

Get me out alive.

May 17, 2006

Addressing nurse fatigue to promote safety and health: joint responsibilities of registered nurses and employers to reduce risks.

September 14, 2016

Toolkit To Improve Safety in Ambulatory Surgery Centers.

May 17, 2017

Explicit and Standardized Prescription Medicine Instructions.

January 21, 2015

Dallas Ebola case shows even sound plans can fail spectacularly.

October 15, 2014

Awareness of patient safety grows with increased outpatient surgeries.

October 8, 2014

Are hospitals in a med safety standard slump?

September 24, 2014

In redesigned room, hospital patients may feel better already.

September 3, 2014

Applying High Reliability Principles to Infection Prevention and Control in Long Term Care.

August 6, 2014

More than 750 hospitals face Medicare crackdown on patient injuries.

July 2, 2014

Health-care providers want patients to read medical records, spot errors.

June 25, 2014

Risk Management Pearls for Medication Safety: Part I and Part II.

February 19, 2014

2014 Annual Benchmarking Report: Malpractice Risks in the Diagnostic Process.

January 14, 2015

The Public's Views on Medical Error in Massachusetts.

December 17, 2014

Dennis Quaid files suit over drug mishap.

December 19, 2007

Transforming Hospitals: Designing for Safety and Quality.

November 21, 2007

An Avoidable Death of a Three-year-old Child from Sepsis.

July 16, 2014

US drug shortages threatening those whose lives depend on crucial remedies.

May 18, 2011

Safer Clinical Systems: Evaluation Findings.

February 18, 2015

Is surgery safer at a teaching hospital?

November 12, 2014

NCPDP Recommendations and Guidance for Standardizing the Dosing Designations on Prescription Container Labels of Oral Liquid Medications Version 1.0.

April 16, 2014

International Comparisons: A Focus on Quality of Care.

March 26, 2014

Safety-I and Safety-II: The Past and Future of Safety Management.

August 20, 2014

Assessment of DoD Wounded Warrior Matters: Managing Risks of Multiple Medications.

March 5, 2014

Physician resiliency and wellness for transforming a health system.

May 30, 2018

Protect Patients Against Preventable Harm from Improper Use of Single-dose⁄Single-use Vials.

May 16, 2012

ER doctor discusses role in Ebola patient's initial misdiagnosis.

December 17, 2014

Mid Staffordshire NHS Foundation Trust Quality Report.

November 12, 2014

At surgery clinic, rush to save Joan Rivers's life.

September 24, 2014

Patient Safety: Perspectives on Evidence, Information and Knowledge Transfer.

June 4, 2014

A growing number of primary-care doctors are burning out. How does this affect patients?

April 9, 2014

Antimicrobial Stewardship Toolkit.

July 16, 2014

In military care, a pattern of errors but not scrutiny.

July 9, 2014

Hospitals put pharmacists in the ER to cut medication errors.

June 18, 2014

Silencing many hospital alarms leads to better health care.

February 5, 2014

Healthcare Safety for Nursing Personnel: An Organizational Guide to Achieving Results.

February 4, 2015

Hard Truths: the Journey to Putting Patients First.

November 27, 2013

Safety requires a state of mindfulness.

March 22, 2006

Geisinger Health System's plan to fix America's health care.

October 15, 2008

Preventing medication mistakes.

May 16, 2012

Please don't sleep through this wake-up call.

March 27, 2005

Thinking about our thinking as physicians.

October 19, 2011

21st Century Health Information Act of 2005.

May 25, 2005

Promoting Patient Safety Through Effective Health Information Technology Risk Management.

July 23, 2014

Far more could be done to stop the deadly bacteria C. diff.

August 29, 2012

Losing Laura.

November 14, 2018

Generic drug names: fertile ground for errors?

August 31, 2005

FDA Pharmacists Help Consumers Use Medicines Safely.

November 19, 2014

Is a tired doctor a safe doctor?

November 12, 2014

The other opioid crisis: hospital shortages lead to patient pain, medical errors.

March 28, 2018

When is the surgeon too old to operate?

February 13, 2019

Josie King Act of 2004.

March 27, 2005

Old and overmedicated: the real drug problem in nursing homes.

December 17, 2014

Joshua’s Story.

December 3, 2014

Patient Safety in Private Hospitals: the Known and the Unknown Risk.

September 10, 2014

Related Resources

Healthcare wants to fly as high as the aviation industry. Can it?

November 8, 2023

Alliance for Innovation on Maternal Health: Consensus Bundle on Sepsis in Obstetric Care.

October 11, 2023

Patient Safety Innovations

Ambulatory Safety Nets to Reduce Missed and Delayed Diagnoses of Cancer

July 31, 2023

WebM&M Cases

Critical Echocardiogram Result Lost to Follow-up.

June 14, 2023

Patient Safety Innovations

Remote Response Team and Customized Alert Settings Help Improve Management of Sepsis

May 31, 2023

VA pauses $16B Oracle Cerner EHR deployments indefinitely to address error-ridden early rollout.

May 3, 2023

Annual Perspective

Improving Diagnostic Safety and Quality

April 26, 2023

Why hospitals still make serious medical errors—and how they are trying to reduce them.

March 29, 2023

When medical error becomes personal, activism becomes painful.

September 28, 2022

WebM&M Cases

Local Anesthesia-Induced Coma During Total Knee Arthroplasty.

July 28, 2021

Making communication and resolution programmes mission critical in healthcare organisations.

November 11, 2020

Special Section: Event Analysis and Risk Management.

October 14, 2020

A Guide to Patient Safety Improvement: Integrating Knowledge Translation & Quality Improvement Approaches.

September 23, 2020

Using telehealth to revolutionize the speed of making rare disease diagnoses.

September 9, 2020

An examination of medical malpractice claims involving physician trainees.

August 19, 2020

The Power to Predict: Leveraging Medical Malpractice Data to Reduce Patient Harm and Financial Loss.

June 24, 2020

What is an ethically informed approach to managing patient safety risk during discharge planning?

January 20, 2020

Reflections on implementing a hospital-wide provider-based electronic inpatient mortality review system: lessons learnt.

November 13, 2019

Overlooked guide wire: a multicomplicated Swiss Cheese Model example. Analysis of a case and review of the literature.

May 15, 2019

Statement on the prevention of retained foreign bodies after surgery.

October 1, 2016

The Joint Commission Big Book of Checklists. 2nd Edition.

September 7, 2016

What price must we pay for safety? Excessive cost of EPINEPHrine auto-injectors leads to error-prone use of ampuls or vials and unprepared consumers.

August 24, 2016

Why empathy may be the best risk management strategy.

March 11, 2015

Technology and error-prevention strategies: why are we still overlooking the IV room?

January 28, 2015

Managing risk during transition to new ISO tubing connector standards.

August 27, 2014

Diagnostic error: untapped potential for improving patient safety?

August 13, 2014

The right and wrong way to talk to patients about adverse events.

June 25, 2014

ACOG Committee Opinion #590: preparing for clinical emergencies in obstetrics and gynecology.

April 30, 2014

Handoff checklists improve the reliability of patient handoffs in the operating room and postanesthesia care unit.

June 12, 2013

Medical errors are hard for doctors to admit, but it's wise to apologize to patients.

June 5, 2013

See More About The Topic

Discontinuities, Gaps, and Hand-Off Problems