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Princeton, NJ: Robert Wood Johnson Foundation; November 2010.
Part I of this three-part series examines the quality improvement experience of four health care organizations and one state government. Part II examines how nursing intersects with health information technology implementation efforts. Part III examines how the design of the care environment affects patient outcomes.
Cases & Commentaries
- Web M&M
Tess Pape, PhD, RN, CNOR; February 2006
Bypassing the safeguards of an automated dispensing machine in a skilled nursing facility, a nurse administers medications from a portable medication cart. A non-diabetic patient receives insulin by mistake, which requires his admission to intensive care and delays his chemotherapy for cancer.