Introduction of enterprise risk management in neonatal intensive care unit to reduce breast milk errors.

Preterm infants born before 34 weeks gestation are unable to feed by mouth. Mothers of these preterm infants are thus asked to pump breast milk to be fed to infants through a nasogastric tube. Each mother's pumped breast milk must be carefully labelled and stored so that it is not fed to the wrong baby during the infants stay in the neonatal intensive care unit, which can range from days to months.

2010 Annual National Patient Safety Foundation Congress: conference proceedings.

On May 17Y19, 2010, the National Patient Safety Foundation(NPSF) held its Annual Patient Safety Congress in Orlando, Florida. Entitled 'Getting Results: Solutions That Work', the meeting reinforced the need to focus on critical work in patient safety as health care reform begins to unfold. Without this focus, the industry will not be able to realize the Institute of Medicine's aims for safer, more efficient, equitable, timely, and truly patient-centered health care.

Event reporting: the value of a nonpunitive approach.

This article will discuss why patient safety has been so hard to achieve due to long standing beliefs that when errors occur individuals must be blamed or punished. It will offer suggestions as to how a culture of learning can be advanced by fostering a different approach to medical errors and how reporting systems and an analytic process that always identifies root causes of problems can help physicians reduce harm to patients and ultimately malpractice risk.

Organizational factors associated with high performance in quality and safety in academic medical centers.

Purpose: Leaders of academic medical centers (AMCs) are challenged to ensure consistent high performance in quality and safety across all clinical services. The authors sought to identify organizational factors associated with AMCs that stood out from their peers in a composite scoring system for quality and safety derived from patient-level data.

Method: A scoring method using measures of safety, mortality, clinical effectiveness, and equity of care was applied to discharge abstract data from 79 AMCs for 2003-2004.