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Journal Article > Commentary
Schrøder K, Lamont RF, Jørgensen JS, Hvidt NC. BJOG. 2019;126:440-442.
Medical errors can have emotional consequences for clinicians. This commentary emphasizes the importance of organizational support for second victims to ensure that these providers receive assistance from their colleagues to remain healthy and productive. The authors suggest that peer support programs are also required in organizations with blame-free cultures to support providers who feel guilt after an error.
Journal Article > Commentary
Forster AJ, Hamilton S, Hayes T, Légaré R. Healthc Manage Forum. 2019 Jun 25; [Epub ahead of print].
Journal Article > Study
Paradiso L, Sweeney N. Nurs Manag. 2019;50:38-45.
This survey study examined the relationship between just culture—a culture of fairness and responsibility, trust, and error reporting—among nurses. Despite convenience sampling and a response rate of just over 10%, researchers did find a correlation between trust and self-reported likelihood of reporting an error. The authors call for adoption of the just culture model to enhance patient safety.
Quick Safety. April 15, 2019;(48):1-3.
Fatigue, emotional stress, and illness can affect decision-making and lead to misuse of medications. This newsletter article describes the patient safety impacts of drug diversion among health care workers and notes the importance of a culture of constructive reporting to uncover and address this unsafe behavior.
Manchester, UK: General Medical Council; June 2019.
Finding the appropriate balance between assigning criminality and accountability for tragic preventable patient harm is difficult. Summarizing a high-profile case in the United Kingdom that involved the death of a pediatric patient, misdiagnosis, and a senior pediatric trainee, this report explores elements of the criminality and accountability debate across the system and discusses policy, judicial, and individual components of a fair and just response to adverse events to keep organizations, clinicians, and patients safe.
Meeting/Conference > North Carolina Meeting/Conference
Duke Center for Healthcare Safety and Quality. September 16–18, 2019; University Tower, Durham, NC.