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Cooling Brain-injured Babies to Reduce Disability, Liability
By Tom A. Augello, CRICO

Research and recent experience show that some babies who show signs of brain injury suffered before or during birth have better outcomes when hospitals cool the baby’s body temperature. Thus, early identification and treatment of this condition has the potential for improving patient outcomes and reducing the risk of liability. CRICO has recently awarded grant funding to promulgate guidelines, titled “Therapeutic Hypothermia in Neonates,” that were developed under its federally-designated PSO component entity.  

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Culture Helped, Hurt in this Dosage Error
By Barbara Szeidler, RN, BS, LNC, CPHQ, CPPS, CRICO
Tom A. Augello, CRICO

In this case, an 8-year-old girl experienced a tenfold dosing error of clotting factor, requiring admission and observation due to increased risk of stroke. It could be said that the culture at this hospital both contributed to the error, and contributed to a good response by staff.

 

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Defendants Talk, Standard of Care, Case Studies, and more...
By Alison Anderson, Missy Padoll, Wallinda Hutson, CRICO

Insight February 2017:  Defendants Talk, Standard of Care, Case Studies, and more

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Let’s Be Clear About This
By Jock Hoffman, CRICO

The wrong words may be harmful.


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Opioids, Skipped Test, Wrong Dx, and more...
By Alison Anderson, Missy Padoll, Wallinda Hutson, CRICO

Insight January 2017:  Opioids, Skipped Test, Wrong Dx, and more.

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Patient Safety Alerts Library

Each AMC PSO Patient Safety Alert takes an in-depth look at one or two topics such as Patient Falls and Results Management. Visit our library to see the available reports and fill out a form to receive a PDF of one or more issues. 

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No Review of Test Result, and
Girl Suffers Wrong Dx for Years
By Kathy Dwyer, MSN, RN, CRICO, Terese Berry, MD, CRICO, Tom A. Augello, CRICO

An 8-year old girl was treated over three years for a condition she never had. Multiple providers missed a test result that showed she had celiac disease, so it went untreated and she suffered. The resulting lawsuit resulted in a settlement against two of her doctors. This case study not only reviews the facts, but it also features suggestions from an expert reviewer on how to prevent similar mistakes managing test results.

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Patient Voice: Beth Felt a Lump but the Nurse Didn’t. How a Patient and her Providers Turned it Around
By Tom A. Augello, CRICO

Patient Voice: Beth felt a lump in her breast but the NP covering for her regular primary care doctor told her there wasn't a need for testing because she didn't feel it. An insistent patient, a concerned doctor, an apology, stellar coordination with specialists, and remission complete the story. Now, this patient praises her health care providers and the institutions they work in.

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MedMal Defendants, Prostate Cancer Screening, and more...
By Alison Anderson, CRICO, Missy Padoll, CRICO, Wallinda Hutson, CRICO

Insights December 2016: MedMal Defendants, Prostate CA Screening, and more...

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Resources for Presenters

The CRICO Are You Safe? case studies contain information that you can access in different formats: web pages, one page handouts, and a slideshow version with additional data included.

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