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To Err Is Human

To Err Is Human
Author: Institute of Medicine
Publisher: National Academies Press
Total Pages: 312
Release: 2000-03-01
Genre: Medical
ISBN: 0309068371

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Experts estimate that as many as 98,000 people die in any given year from medical errors that occur in hospitals. That's more than die from motor vehicle accidents, breast cancer, or AIDSâ€"three causes that receive far more public attention. Indeed, more people die annually from medication errors than from workplace injuries. Add the financial cost to the human tragedy, and medical error easily rises to the top ranks of urgent, widespread public problems. To Err Is Human breaks the silence that has surrounded medical errors and their consequenceâ€"but not by pointing fingers at caring health care professionals who make honest mistakes. After all, to err is human. Instead, this book sets forth a national agendaâ€"with state and local implicationsâ€"for reducing medical errors and improving patient safety through the design of a safer health system. This volume reveals the often startling statistics of medical error and the disparity between the incidence of error and public perception of it, given many patients' expectations that the medical profession always performs perfectly. A careful examination is made of how the surrounding forces of legislation, regulation, and market activity influence the quality of care provided by health care organizations and then looks at their handling of medical mistakes. Using a detailed case study, the book reviews the current understanding of why these mistakes happen. A key theme is that legitimate liability concerns discourage reporting of errorsâ€"which begs the question, "How can we learn from our mistakes?" Balancing regulatory versus market-based initiatives and public versus private efforts, the Institute of Medicine presents wide-ranging recommendations for improving patient safety, in the areas of leadership, improved data collection and analysis, and development of effective systems at the level of direct patient care. To Err Is Human asserts that the problem is not bad people in health careâ€"it is that good people are working in bad systems that need to be made safer. Comprehensive and straightforward, this book offers a clear prescription for raising the level of patient safety in American health care. It also explains how patients themselves can influence the quality of care that they receive once they check into the hospital. This book will be vitally important to federal, state, and local health policy makers and regulators, health professional licensing officials, hospital administrators, medical educators and students, health caregivers, health journalists, patient advocatesâ€"as well as patients themselves. First in a series of publications from the Quality of Health Care in America, a project initiated by the Institute of Medicine


The Health Effects of Cannabis and Cannabinoids

The Health Effects of Cannabis and Cannabinoids
Author: National Academies of Sciences, Engineering, and Medicine
Publisher: National Academies Press
Total Pages: 487
Release: 2017-03-31
Genre: Science
ISBN: 0309453070

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Significant changes have taken place in the policy landscape surrounding cannabis legalization, production, and use. During the past 20 years, 25 states and the District of Columbia have legalized cannabis and/or cannabidiol (a component of cannabis) for medical conditions or retail sales at the state level and 4 states have legalized both the medical and recreational use of cannabis. These landmark changes in policy have impacted cannabis use patterns and perceived levels of risk. However, despite this changing landscape, evidence regarding the short- and long-term health effects of cannabis use remains elusive. While a myriad of studies have examined cannabis use in all its various forms, often these research conclusions are not appropriately synthesized, translated for, or communicated to policy makers, health care providers, state health officials, or other stakeholders who have been charged with influencing and enacting policies, procedures, and laws related to cannabis use. Unlike other controlled substances such as alcohol or tobacco, no accepted standards for safe use or appropriate dose are available to help guide individuals as they make choices regarding the issues of if, when, where, and how to use cannabis safely and, in regard to therapeutic uses, effectively. Shifting public sentiment, conflicting and impeded scientific research, and legislative battles have fueled the debate about what, if any, harms or benefits can be attributed to the use of cannabis or its derivatives, and this lack of aggregated knowledge has broad public health implications. The Health Effects of Cannabis and Cannabinoids provides a comprehensive review of scientific evidence related to the health effects and potential therapeutic benefits of cannabis. This report provides a research agendaâ€"outlining gaps in current knowledge and opportunities for providing additional insight into these issuesâ€"that summarizes and prioritizes pressing research needs.


Normal Accidents

Normal Accidents
Author: Charles Perrow
Publisher: Princeton University Press
Total Pages: 462
Release: 2011-10-12
Genre: Technology & Engineering
ISBN: 140082849X

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Normal Accidents analyzes the social side of technological risk. Charles Perrow argues that the conventional engineering approach to ensuring safety--building in more warnings and safeguards--fails because systems complexity makes failures inevitable. He asserts that typical precautions, by adding to complexity, may help create new categories of accidents. (At Chernobyl, tests of a new safety system helped produce the meltdown and subsequent fire.) By recognizing two dimensions of risk--complex versus linear interactions, and tight versus loose coupling--this book provides a powerful framework for analyzing risks and the organizations that insist we run them. The first edition fulfilled one reviewer's prediction that it "may mark the beginning of accident research." In the new afterword to this edition Perrow reviews the extensive work on the major accidents of the last fifteen years, including Bhopal, Chernobyl, and the Challenger disaster. The new postscript probes what the author considers to be the "quintessential 'Normal Accident'" of our time: the Y2K computer problem.


Driver Distraction

Driver Distraction
Author: Michael A. Regan
Publisher: CRC Press
Total Pages: 674
Release: 2008-10-15
Genre: Technology & Engineering
ISBN: 1420007491

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Certain activities and events both inside and outside a vehicle can distract drivers and lead to degraded performance. New technologies- such as entertainment, communication, and driver assistance systems- play a significant role in distraction. This unique volume defines driver distraction, discusses various causes, and explains how to measure acceptable and unacceptable levels of distraction. Several chapters address measurement techniques based on performance and epidemiological studies. Most importantly, the text explores ways to mitigate driver distraction as well as countermeasures including vehicle design and effective legislation.


Under the Influence?

Under the Influence?
Author: National Research Council/Institute of Medicine
Publisher: National Academies Press
Total Pages: 334
Release: 1994-02-01
Genre: Medical
ISBN: 0309048850

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Drug use in the workplace, its effect on performance and safety, and the role of workplace drug testing has received much attention in the popular press. But what do we actually know about this troubling issue? With an extensive and readable overview of the literature, the committee presents what we do know by examining the major issues: The extent and severity of drug use on and off the job. The strengths and weaknesses of methods for detecting drug use through standard drug tests. The effect of drug use on behavior, including the results of both laboratory and field studies that have examined work-related behavior and worker productivity. The effectiveness of interventions to deal with drug use, such as employee assistance programs, health promotion programs, and treatment programs for substance abuse. This volume will be of practical interest to human resource and employee assistance program managers, policymakers, and investigators.


Engineering a Safer World

Engineering a Safer World
Author: Nancy G. Leveson
Publisher: MIT Press
Total Pages: 555
Release: 2012-01-13
Genre: Science
ISBN: 0262297302

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A new approach to safety, based on systems thinking, that is more effective, less costly, and easier to use than current techniques. Engineering has experienced a technological revolution, but the basic engineering techniques applied in safety and reliability engineering, created in a simpler, analog world, have changed very little over the years. In this groundbreaking book, Nancy Leveson proposes a new approach to safety—more suited to today's complex, sociotechnical, software-intensive world—based on modern systems thinking and systems theory. Revisiting and updating ideas pioneered by 1950s aerospace engineers in their System Safety concept, and testing her new model extensively on real-world examples, Leveson has created a new approach to safety that is more effective, less expensive, and easier to use than current techniques. Arguing that traditional models of causality are inadequate, Leveson presents a new, extended model of causation (Systems-Theoretic Accident Model and Processes, or STAMP), then shows how the new model can be used to create techniques for system safety engineering, including accident analysis, hazard analysis, system design, safety in operations, and management of safety-critical systems. She applies the new techniques to real-world events including the friendly-fire loss of a U.S. Blackhawk helicopter in the first Gulf War; the Vioxx recall; the U.S. Navy SUBSAFE program; and the bacterial contamination of a public water supply in a Canadian town. Leveson's approach is relevant even beyond safety engineering, offering techniques for “reengineering” any large sociotechnical system to improve safety and manage risk.


Managing Speed

Managing Speed
Author:
Publisher: Transportation Research Board
Total Pages: 444
Release: 1998
Genre: Business & Economics
ISBN: 9780309065023

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TRB Special Report 254 - Managing Speed: Review of Current Practices for Setting and Enforcing Speed Limits reviews practices for setting and enforcing speed limits on all types of roads and provides guidance to state and local governments on appropriate methods of setting speed limits and related enforcement strategies. Following an executive summary, the report is presented in six chapters and five appendices.


British Medical Journal

British Medical Journal
Author:
Publisher:
Total Pages: 2136
Release: 1914
Genre: Electronic journals
ISBN:

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