Risk of mistaken DNR orders.

James E Rohrer; W. Vance Esler; Qaiser Saeed; Samreen Saeed; Phillip Periman; David Beggs; Paul Hancock; Seah H Lim

Study

Risk of mistaken DNR orders.

March 22, 2006

Rohrer JE, Esler WV, Saeed Q, et al. Supportive Care in Cancer. 2006;14(8).

View more articles from the same authors.

This survey of community cancer center patients found that approximately 70% misunderstood the meaning of do-not-resuscitate (DNR).

PubMed citation

Available at

Related Resources From the Same Author(s)

The impact of transitioning from a 24-hour to a 16-hour call model amongst a cohort of Canadian anesthesia residents at McMaster University—a survey study.

October 7, 2015

The influence of formulation and medicine delivery system on medication administration errors in care homes for older people.

January 30, 2011

Spike in fatal medication errors at the beginning of each month.

March 6, 2005

The use of computers for clinical care: a case series of advanced US sites.

March 6, 2005

Using performance improvement to enhance time-out compliance and prevent wrong-site surgery.

August 11, 2021

Underdiagnosis of hypertension in children and adolescents.

September 5, 2007

A July spike in fatal medication errors: a possible effect of new medical residents.

June 16, 2010

Transforming team performance through reimplementation of the surgical safety checklist.

December 6, 2023

Deficits in communication and information transfer between hospital-based and primary care physicians: implications for patient safety and continuity of care.

February 28, 2007

Systematic review: the evidence that publishing patient care performance data improves quality of care.

February 27, 2008

Reducing inappropriate diagnostic practice through education and decision support.

May 19, 2010

Reduction in pediatric identification band errors: a quality collaborative.

August 22, 2012

The role of teamwork in the professional education of physicians: current status and assessment recommendations.

March 6, 2005

Kaiser Permanente's performance improvement system, part 4: creating a learning organization.

January 30, 2005

Facilitators and barriers to the implementation of surgical safety checklist (SSC): an integrative review.

November 15, 2023

Development of a standardized, citywide process for managing smart-pump drug libraries.

August 1, 2018

Standardized handoff report form in clinical nursing education: an educational tool for patient safety and quality of care.

December 9, 2015

A steep increase in domestic fatal medication errors with use of alcohol and/or street drugs.

August 6, 2008

Geometric probability distribution for modeling of error risk during prescription dispensing.

June 14, 2006

Association between ophthalmologist age and unsolicited patient complaints.

January 10, 2018

Adverse events in the neonatal intensive care unit: development, testing, and findings of an NICU-focused trigger tool to identify harm in North American NICUs.

October 25, 2006

Adverse drug events and medication errors in psychiatry: methodological issues regarding identification and classification.

March 26, 2008

Adverse events associated with the use of complementary and alternative medicine in children.

January 12, 2011

A prospective review of adverse events during interhospital transfers of neonates by a dedicated neonatal transfer service.

May 14, 2008

Implementing patient safety practices in small ambulatory care settings.

July 19, 2006

Nonoperating room anaesthesia: safety, monitoring, cognitive aids and severe acute respiratory syndrome coronavirus 2.

August 12, 2020

Non-technical skills in surgery during the COVID-19 pandemic: an observational study.

March 9, 2022

Using consumer-based kiosk technology to improve and standardize medication reconciliation in a specialty care setting.

April 29, 2009

Patient-reported service quality on a medicine unit.

November 30, 2005

What can hospitalized patients tell us about adverse events? Learning from patient-reported incidents.

August 17, 2005

Systems engineering and human factors support of a system of novel EHR-integrated tools to prevent harm in the hospital.

April 17, 2019

Neuroscience critical care: the role of the advanced practice nurse in patient safety.

November 23, 2005

Potential role of pharmacogenomics in reducing adverse drug reactions: a systematic review.

August 31, 2005

Blood bank specimen mislabeling: a College of American Pathologists Q-Probes study of 41,333 blood bank specimens in 30 institutions.

June 7, 2017

Nurse–physician teamwork in the emergency department: impact on perceptions of job environment, autonomy, and control over practice.

May 8, 2013

The safety of emergency care systems: results of a survey of clinicians in 65 US emergency departments.

March 4, 2009

The National Emergency Department Safety Study: study rationale and design.

January 9, 2008

Standard practices for computerized clinical decision support in community hospitals: a national survey.

July 11, 2012

Planning and implementing a systems-based patient safety curriculum in medical education.

August 13, 2008

Clinical care checklists: salvations or frustrations?

June 1, 2011

Using simulation to improve systems.

August 12, 2015

The business case for patient safety.

February 14, 2007

Unexpected hypoglycemia in a critically ill patient.

March 15, 2006

Computerized physician order entry and medication errors: finding a balance.

July 6, 2005

John M. Eisenberg Patient Safety Awards. Research: David W. Bates, MD, MSc, Brigham and Women's Hospital.

March 6, 2005

Using a patient internet portal to prevent adverse drug events: a randomized, controlled trial.

September 11, 2013

Medication safety messages for patients via the web portal: the MedCheck intervention.

July 11, 2007

Do medical inpatients who report poor service quality experience more adverse events and medical errors?

February 13, 2008

Risk of medication safety incidents with antibiotic use measured by defined daily doses.

December 11, 2013

Association between electronic health record implementations and hospital-acquired conditions in pediatric hospitals.

August 2, 2023

Health information exchange and patient safety.

November 7, 2007

Double reading in breast cancer screening: cohort evaluation in the CO-OPS trial.

August 29, 2018

Root cause analyses of suicides of mental health clients.

November 18, 2015

ACR guidance document on MR safe practices: 2013.

March 21, 2013

Clinical decision support for atypical orders: detection and warning of atypical medication orders submitted to a computerized provider order entry system.

June 25, 2014

Electronic results management in pediatric ambulatory care: qualitative assessment.

January 28, 2009

Prescribers' responses to alerts during medication ordering in the long term care setting.

August 30, 2006

Safety climate and medical errors in 62 US emergency departments.

January 9, 2013

Medical error disclosure training: evidence for values-based ethical environments.

January 12, 2011

Commonly used, easily confused: let's eliminate hyper and hypo.

November 10, 2010

Critical drug–drug interactions for use in electronic health records systems with computerized physician order entry: review of leading approaches.

June 15, 2011

Evaluation and certification of computerized physician order entry systems.

November 22, 2006

The consequences of whistle-blowing: an integrative review.

July 26, 2017

Clinic design for safety during the pandemic: safety or teamwork, can we only pick one?

May 11, 2022

Evaluating a patient safety learning laboratory to create an interdisciplinary ecosystem for health care innovation.

July 13, 2022

Clinical application of a computerized system for physician order entry with clinical decision support to prevent adverse drug events in long-term care.

January 18, 2006

Computerized physician order entry with clinical decision support in the long-term care setting: insights from the Baycrest Centre for Geriatric Care.

October 26, 2005

Patient safety attitudes and behaviors of graduating medical students.

September 21, 2011

Using incident reporting to improve patient safety: a conceptual model.

March 28, 2007

Responding to large-scale testing errors.

March 31, 2010

Educational opportunities with postevent debriefing.

May 11, 2016

Pharmacists in pharmacovigilance: can increased diagnostic opportunity in community settings translate to better vigilance?

July 9, 2014

Debriefing in the emergency department after clinical events: a practical guide.

December 17, 2014

Association between hospital acquired harm outcomes and membership in a national patient safety collaborative.

August 10, 2022

Health apps and health policy: what is needed?

October 24, 2018

Tracking with virtual slides: a tool to study diagnostic error in histopathology.

August 5, 2009

Frequency, expected effects, obstacles, and facilitators of disclosure of patient safety incidents: a systematic review.

May 10, 2017

Healthcare-associated adverse events in alternate level of care patients awaiting long-term care in hospital.

September 14, 2022

CheckPOINT: a simple tool to measure Surgical Safety Checklist implementation fidelity.

October 18, 2023

Fatigue in radiology: a fertile area for future research.

July 31, 2019

Clinical alarms: improving efficiency and effectiveness.

November 9, 2005

Post-discharge adverse events among urban and rural patients of an urban community hospital: a prospective cohort study.

May 20, 2015

Use of medical abbreviations and acronyms: knowledge among medical students and postgraduates.

July 13, 2016

Standardizing opioid prescriptions to patients after ambulatory oncologic surgery reduces overprescription.

July 1, 2020

Can electronic clinical documentation help prevent diagnostic errors?

March 31, 2010

Two decades since To Err Is Human: an assessment of progress and emerging priorities in patient safety.

November 7, 2018

Medication administration errors by nurses: adherence to guidelines.

January 30, 2013

Standardized orders for titrating vasopressors: do efforts to improve safety slow delivery of care?

September 11, 2019

Barcoded medication administration: a last line of defense.

May 21, 2008

Resident participation does not affect surgical outcomes, despite introduction of new techniques.

September 22, 2010

Full work analysis of resident work hours.

June 11, 2008

Hamilton Acute Pain Service Safety Study: using root cause analysis to reduce the incidence of adverse events.

April 2, 2014

The patient's "story": an examination of patient-reported safety incidents in general practice.

May 4, 2022

Patients' experiences and perspectives of patient-reported outcome measures in clinical care: a systematic review and qualitative meta-synthesis.

May 11, 2022

Implementation, evaluation, and recommendations for extension of AHRQ Common Formats to capture patient- and carepartner-generated safety data.

July 11, 2018

American College of Endocrinology and American Association of Clinical Endocrinologists position statement on patient safety and medical system errors in diabetes and endocrinology.

December 7, 2005

Why do people sue doctors? A study of patients and relatives taking legal action.

June 24, 2009

Systems thinking for managing COVID-19 in health care systems: seven key messages.

September 23, 2020

Teamwork and team performance in multidisciplinary cancer teams: development and evaluation of an observational assessment tool.

June 29, 2011

Effect of surgical safety checklists on pediatric surgical complications in Ontario.

April 6, 2016

Related Resources

How Columbia ignored women, undermined prosecutors and protected a predator for more than 20 years.

September 20, 2023

‘The Retrievals’ reveals painful experiences of female patients are often ignored.

September 6, 2023

Stigmatizing language expressed towards individuals with current or previous OUD who have pain and cancer: a qualitative study.

June 14, 2023

Diagnostic errors in musculoskeletal oncology and possible mitigation strategies.

May 24, 2023

Quality and Safety Considerations in Intensity Modulated Radiation Therapy: An ASTRO Safety White Paper Update.

May 17, 2023

"We're not taken seriously": describing the experiences of perceived discrimination in medical settings for Black women.

March 22, 2023

The impact of COVID-19 workflow changes on radiation oncology incident reporting.

November 2, 2022

A perfect storm averted: flawed systems, a dropped ball, and cognitive biases delay a critical diagnosis.

November 2, 2022

Comparison of a voluntary safety reporting system to a global trigger tool for identifying adverse events in an oncology population.

August 3, 2022

Identifying patients whose symptoms are underrecognized during treatment with breast radiotherapy.

May 4, 2022

Estimation of breast cancer overdiagnosis in a U.S. breast screening cohort.

March 16, 2022

Comparison of a focused family cancer history questionnaire to family history documentation in the electronic medical record.

March 16, 2022

Evaluating incident learning systems and safety culture in two radiation oncology departments.

February 16, 2022

Encouraging patients to speak up about problems in cancer care.

January 12, 2022

Using failure mode and effects analysis to increase patient safety in cancer chemotherapy.

December 22, 2021

Mix-ups between the influenza (Flu) vaccine and COVID-19 vaccines.

October 20, 2021

Leading causes of anesthesia-related liability claims in ambulatory surgery centers.

October 6, 2021

FDA Safety Communication: update--robotically-assisted surgical devices in mastectomy.

August 20, 2021

Use of therapeutic outcomes monitoring method for performing of pharmaceutical care in oncology patients.

April 28, 2021

Description of the role of pharmacist independent double checks during cognitive order verification of outpatient parenteral anti-cancer therapy.

March 24, 2021

WebM&M Cases

Delayed Breast Cancer Diagnosis: A False Sense of Security.

December 23, 2020

Missing the near miss: recognizing valuable learning opportunities in radiation oncology.

December 16, 2020

Nurses' perceptions of open disclosure processes in cancer care: a cross-sectional study.

December 16, 2020

Comparing the evolution of risk culture in radiation oncology, aviation, and nuclear power.

December 9, 2020

Obstetrician-gynecologist views of pregnancy-related medication safety.

November 4, 2020

The challenges and opportunities for shared decision making highlighted by COVID-19.

August 12, 2020

Oncology pharmacist-led medication reconciliation among cancer patients initiating chemotherapy.

July 29, 2020

Indication-specific opioid prescribing for US patients with Medicaid or private Insurance, 2017

June 10, 2020

A war on two fronts: cancer care in the time of COVID-19.

April 22, 2020

Discrepant advanced directives and code status orders: a preventable medical error.

October 2, 2019

See More About The Topic

Ambulatory Clinic or Office

Health Care Providers

Quality and Safety Professionals

Patients

Medical Oncology

Risk of mistaken DNR orders.

Connect With Us

Sign up for Email Updates

Agency for Healthcare Research and Quality

Risk of mistaken DNR orders.

Connect With Us

Sign up for Email Updates

Agency for Healthcare Research and Quality

Submit Your Innovations

Continue as a Guest

Continue Logged In

Submit Your Innovations

Continue as a Guest

Continue logged in

New Users to the PSNet site