Newspaper/Magazine Article State: nurse error caused death. Save Save to your library Print Share Facebook Twitter Linkedin Copy URL August 2, 2006 View more articles from the same authors. This article reports on a federal warning issued to a hospital after a medication error led to the death of a 16-year-old girl. Free full text Save Save to your library Print Share Facebook Twitter Linkedin Copy URL Cite Related Resources From the Same Author(s) Committed to Safety: Ten Case Studies on Reducing Harm to Patients. May 10, 2006 Stories from the sharp end: case studies in safety improvement. March 29, 2006 Navigating risks in breast cancer diagnosis and treatment. October 28, 2015 Checking the right boxes, but failing the patient. December 2, 2009 The Role of Hospitalists in Patient Safety. December 2, 2009 Whack-a-Mole: The Price We Pay For Expecting Perfection. February 24, 2010 The phantom menace of sleep-deprived doctors. August 24, 2011 Medical misdiagnoses can have fatal consequences. July 6, 2011 Safer Hospital Care: Strategies for Continuous Innovation, Second Edition. May 16, 2019 How American health care killed my father. August 26, 2009 You've detailed your last wishes, but doctors may not see them. April 11, 2018 Most dangerous time at the hospital? It may be when you leave. March 30, 2016 Reducing preventable harm in hospitals. February 3, 2016 Minimizing medical mistakes: mother's mission to reduce hospital errors. June 3, 2015 Patient and family advisory councils. The Massachusetts experience. January 6, 2016 Getting the diagnosis wrong. October 21, 2015 2 MSO programs show value of safety position. November 21, 2018 How one hospital improved patient safety in 10 minutes a day. November 14, 2018 Solving the puzzle: improving safety outcomes. October 23, 2013 Medical malpractice: why is it so hard for doctors to apologize? February 6, 2013 Safety in numbers? Try connectivity. February 22, 2012 Computer viruses are "rampant" on medical devices in hospitals. October 31, 2012 In a culture of disrespect, patients lose out. July 31, 2013 Bad hospital design is making us sicker. March 8, 2017 Ebola case raises concern about everyday hospital safety. October 29, 2014 Are hospitals in a med safety standard slump? September 24, 2014 Robotic-assisted surgery: focus on training and credentialing. September 24, 2014 When medical students make errors. May 28, 2014 VA Health Care: Improvements Needed in Processes Used to Address Providers' Actions That Contribute to Adverse Events. January 15, 2014 Unintended side effects: arbitration and the deterrence of medical error. January 21, 2015 A night in the hospital, from both ends of the stethoscope. January 20, 2021 Eliminating insulin errors: RPhs share tricks. April 12, 2006 Doctors, lawyers make deal on medical-malpractice bill. March 8, 2006 Why doctors so often get it wrong. March 8, 2006 Point-of-care medication error prevention: best practices in action. June 6, 2007 VA takes the lead in paperless care. April 25, 2007 Medical culture about errors may be changing. September 19, 2007 Medical error reporting system still a year off. August 29, 2007 State starts project to track serious hospital mistakes. February 15, 2006 Technology has transformed the VA. May 24, 2006 Patient-Centered Care: What Does It Take? November 21, 2007 Patient safety: the patient's role. February 14, 2007 Inquiry into reporter's death finds multiple failures in care. July 5, 2006 The consumer: and now, a warning about labels. November 9, 2005 When doctors say, "We're sorry." August 24, 2005 IOM panel reviews lessons for medication safety. July 6, 2005 Standards, audits, and saying I'm sorry: an engineer's family proposes solutions. June 15, 2005 Hospital errors jeopardize Angola virus battle. May 11, 2005 Buried answers. May 11, 2005 The Challenger Launch Decision: Risky Technology, Culture, and Deviance at NASA. March 27, 2005 Patient Safety and the "Just Culture": A Primer for Health Care Executives. March 27, 2005 WebM&M Cases Unexpected Drawbacks of Electronic Order Sets November 1, 2016 Still Failing the Frail. November 28, 2018 WebM&M Cases Correct Treatment Plan for Incorrect Diagnosis: A Pharmacist Intervention March 1, 2017 WebM&M Cases Are We Pushing Graduate Nurses Too Fast? March 1, 2011 WebM&M Cases Empiric Steroids: the Good, the Bad, and the Ugly September 1, 2008 WebM&M Cases Back Again March 1, 2008 WebM&M Cases Code Blue—Where To? October 1, 2007 WebM&M Cases PCA Overdose August 21, 2005 WebM&M Cases Hidden Mystery March 1, 2005 WebM&M Cases Making Do September 1, 2003 Disclosure after adverse medical outcomes: a multidimensional challenge. November 13, 2019 WebM&M Cases Suicide Risk in the Hospital May 1, 2018 Getting Results: Reliably Communicating and Acting on Critical Test Results. July 12, 2006 Improving Health Care. March 6, 2005 PEXiS. March 6, 2005 Perspective The Second Victim Phenomenon: A Harsh Reality of Health Care Professions May 1, 2011 The Commonwealth Fund Quality Improvement Colloquium: Patient Safety Five Years After To Err Is Human. March 27, 2005 Hidden mistakes in hospitals. November 25, 2009 The Invisible Gorilla: and Other Ways Our Intuitions Deceive Us. August 11, 2010 Keeping the Commitment: A Progress Report on Four Early Leaders in Patient Safety Improvement. March 30, 2011 Factors influencing patient safety during postoperative handover. December 14, 2016 Around the Patient Bed: Human Factors and Safety in Health Care. October 23, 2013 Improving Patient Safety in Long-Term Care Facilities: Training Modules. August 8, 2012 Building a Culture of Candour: a Review of the Threshold for the Duty of Candour and of the Incentives for Care Organisations to Be Candid. April 2, 2014 Medication Safety Officer's Handbook. July 23, 2014 Omission of high-alert medications: a hidden danger. January 7, 2015 Preventing catheter-related bloodstream infections: thinking outside the checklist. April 1, 2009 Web sites compare how hospitals measure up. September 3, 2008 Do panels vary when assessing intrapartum adverse events? The reproducibility of assessments by hospital risk management groups. November 22, 2006 The Anatomy of Medical Error: Preventing Harm with People-Based Patient Safety. October 25, 2006 Suicides point to gaps in treatment. Errors in psychiatric diagnoses and drugs plague strained immigration system. May 21, 2008 Patient safety in the ED. May 31, 2006 Fixing the medication reconciliation breakdown. December 20, 2006 Promoting Patient Safety Through Effective Health Information Technology Risk Management. July 23, 2014 Special Report: Quality of Care Survey. June 20, 2007 WebM&M Cases Privacy or Safety? August 21, 2015 WebM&M Cases Missing the Point—Eye Injury December 1, 2011 Patient-safety and quality initiatives in the intensive-care unit. April 5, 2006 Perspective Implementing a Patient Safety Program at a Large National Health System January 1, 2008 Perspective Team Training: Classroom Training vs. High-Fidelity Simulation March 1, 2006 Patient Safety Supplement. July 22, 2015 Hospital Medication Errors Commonplace. August 23, 2006 WebM&M Cases Breathe Easy: Safe Tracheostomy Management August 21, 2015 For some troops, powerful drug cocktails have deadly results. February 23, 2011 Selecting Quality and Resource Use Measures: A Decision Guide for Community Quality Collaboratives. August 25, 2010 Medical error reduction: the effect of employee satisfaction with organizational support. June 8, 2011 Nurses' role in detecting deterioration in ward patients: systematic literature review. September 30, 2009 Goals and Priorities for Health Care Organizations to Improve Safety Using Health IT. Revised Report. June 29, 2016 Confidential Physician Feedback Reports: Designing for Optimal Impact on Performance. March 16, 2016 View More Related Resources Investigators find hospital error caused mother’s death in Brooklyn. January 24, 2024 Look-alike medications in the perioperative setting: scoping review of medication incidents and risk reduction interventions. October 11, 2023 WebM&M Cases Sleep Deprivation Leads to Medication Error During Spinal Epidural Anesthesia. August 30, 2023 Amid lack of accountability for bias in maternity care, a California family seeks justice. August 16, 2023 ‘I felt like I was dying’: how women with postpartum depression fall through the cracks of U.S. health care. July 5, 2023 WebM&M Cases Hurried Team Huddle and Poor Communication: Unsafe Practice During Anesthesia for Emergency Cesarean Delivery. June 28, 2023 Taking a closer look at medication errors that involve oxytocin. June 14, 2023 Why do so many Black women die in pregnancy? One reason: doctors don't take them seriously. May 31, 2023 Tools for establishing a sustainable safety culture within maternity services: a retrospective case study. April 26, 2023 Addressing Medical Gaslighting to Improve Maternal Health—Together. March 29, 2023 National patient safety goal to improve health care equity. February 8, 2023 A deadly epidural, delivered by a doctor with a history of mistakes. February 1, 2023 Accuracy of spinal anesthesia drug concentrations in mixtures prepared by anesthetists. January 11, 2023 Development of the Leapfrog Group's bar code medication administration standard to address hospital inpatient medication safety. September 21, 2022 Abortion bans have consequences for wanted pregnancies, too. August 17, 2022 Society for Maternal-Fetal Medicine Special Statement: a critique of postpartum readmission rate as a quality metric. May 18, 2022 WebM&M Cases Saline Flush Leads to Acute Paralysis of an Awake Patient: Risks of Improper Medication Labeling in an Operating Room April 27, 2022 Annual Perspective Annual Perspective: Topics in Medication Safety March 31, 2022 A widow’s mission to change NC dental sedation rules. March 23, 2022 Improving communication and teamwork during labor: a feasibility, acceptability, and safety study. March 16, 2022 Safety, Equity and Engagement in Maternity Services. January 12, 2022 Adverse glycemic events and critical emergencies. December 15, 2021 How low can they go? Rural hospitals weigh keeping obstetric units when births decline. November 24, 2021 The postpartum hemorrhage patient safety bundle implementation at a single institution: successes, failures, and lessons learned, October 27, 2021 Decreased incidence of cesarean surgical site infection rate with hospital-wide perioperative bundle. September 29, 2021 A crisis within a crisis. September 15, 2021 WebM&M Cases Two Cases of Retained Vaginal Packing: When Writing an Order is Not Enough April 28, 2021 Incidence of accidental awareness during general anaesthesia in obstetrics: a multicentre, prospective cohort study. February 17, 2021 Identification and safe storage of look-alike, sound-alike medicines in automated dispensing cabinets. February 3, 2021 Incidence of Adverse Events in Indian Health Service Hospitals. December 23, 2020 View More See More About The Topic Labor and Delivery Facility and Group Administrators Quality and Safety Professionals Policy Makers Anesthesiology View More
VA Health Care: Improvements Needed in Processes Used to Address Providers' Actions That Contribute to Adverse Events. January 15, 2014
The Commonwealth Fund Quality Improvement Colloquium: Patient Safety Five Years After To Err Is Human. March 27, 2005
Keeping the Commitment: A Progress Report on Four Early Leaders in Patient Safety Improvement. March 30, 2011
Building a Culture of Candour: a Review of the Threshold for the Duty of Candour and of the Incentives for Care Organisations to Be Candid. April 2, 2014
Do panels vary when assessing intrapartum adverse events? The reproducibility of assessments by hospital risk management groups. November 22, 2006
Suicides point to gaps in treatment. Errors in psychiatric diagnoses and drugs plague strained immigration system. May 21, 2008
Promoting Patient Safety Through Effective Health Information Technology Risk Management. July 23, 2014
Selecting Quality and Resource Use Measures: A Decision Guide for Community Quality Collaboratives. August 25, 2010
Medical error reduction: the effect of employee satisfaction with organizational support. June 8, 2011
Nurses' role in detecting deterioration in ward patients: systematic literature review. September 30, 2009
Goals and Priorities for Health Care Organizations to Improve Safety Using Health IT. Revised Report. June 29, 2016
Look-alike medications in the perioperative setting: scoping review of medication incidents and risk reduction interventions. October 11, 2023
WebM&M Cases Sleep Deprivation Leads to Medication Error During Spinal Epidural Anesthesia. August 30, 2023
Amid lack of accountability for bias in maternity care, a California family seeks justice. August 16, 2023
‘I felt like I was dying’: how women with postpartum depression fall through the cracks of U.S. health care. July 5, 2023
WebM&M Cases Hurried Team Huddle and Poor Communication: Unsafe Practice During Anesthesia for Emergency Cesarean Delivery. June 28, 2023
Why do so many Black women die in pregnancy? One reason: doctors don't take them seriously. May 31, 2023
Tools for establishing a sustainable safety culture within maternity services: a retrospective case study. April 26, 2023
Accuracy of spinal anesthesia drug concentrations in mixtures prepared by anesthetists. January 11, 2023
Development of the Leapfrog Group's bar code medication administration standard to address hospital inpatient medication safety. September 21, 2022
Society for Maternal-Fetal Medicine Special Statement: a critique of postpartum readmission rate as a quality metric. May 18, 2022
WebM&M Cases Saline Flush Leads to Acute Paralysis of an Awake Patient: Risks of Improper Medication Labeling in an Operating Room April 27, 2022
Improving communication and teamwork during labor: a feasibility, acceptability, and safety study. March 16, 2022
How low can they go? Rural hospitals weigh keeping obstetric units when births decline. November 24, 2021
The postpartum hemorrhage patient safety bundle implementation at a single institution: successes, failures, and lessons learned, October 27, 2021
Decreased incidence of cesarean surgical site infection rate with hospital-wide perioperative bundle. September 29, 2021
WebM&M Cases Two Cases of Retained Vaginal Packing: When Writing an Order is Not Enough April 28, 2021
Incidence of accidental awareness during general anaesthesia in obstetrics: a multicentre, prospective cohort study. February 17, 2021
Identification and safe storage of look-alike, sound-alike medicines in automated dispensing cabinets. February 3, 2021