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Understanding the JCAHOs Universal Protocol for Preventing
Reducing surgical site infections Case study
Understanding how health literacy affects patient safety
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abbreviations administer adverse event allergy anesthesiologist antibiotic blanket orders caregivers cause Cefazolin cephalosporin changes clinical clinicians communication develop director documentation dose double-check ensure example facility factors failure mode Fly says FMEA Hauser says health literacy Hicks says high-alert medication high-risk hip and knee hospital hospital's identify infection control infusion pumps insulin intensivist interpreter involved JCAHO JCAHO wants JCAHO's sentinel event label leaders mark Medical Center medical errors medical record medication orders medication safety National Patient Safety occur Patient Safety Goals Pelt performance improvement pharmacists pharmacy pharmacy staff physicians potential preoperative problems procedure Pronovost quality improvement RCA process recommends reduce require risk manager root-cause analysis sentinel event site-marking standards surgeon Surgical Infection Prevention surgical team team members triage verbal orders verify Warren Hospital workspace wrong wrong-site surgery Yakima Valley