course material

1. Reply 1 he safety of our patients is an important
Reply 1 he safety of our patients is an important aspect of healthcare and is the basis of
quality healthcare. When patients come to the healthcare system there is an expectation of
safety and quality healthcare however this is often not realized due to errors caused by
healthcare workers. Reducing these errors will lead to improvements in quality of care and
patient safety. According to Nickitas, Middaugh, and Aries (2016), the Institute of Medicine
in a 1999 Seminal report stated that “To ERR is human” meaning that errors are inevitable
because of the human aspect of healthcare. The Institute of Medicine’s (IOM) seminal
report in 1999, To Err, is Human: Building a Safer Health System became the basis of policy
actions to improve patient safety. The goal of this report was to design healthcare
processes to ensure processes of care that will protect patients from accidental
injury. According to Rodziewicz, Houseman, and Hipskind (2021), approximately 400,000
hospitalized patients experience some type of preventable harm each year resulting in
approximately 100,000 people dying each year and a c to hospitals of which costs
approximately $20 billion per year. The IOM report (1999) gave rise to federal agency
initiatives to improve patient safety in healthcare. One such agency is the Agency for
Healthcare Research and Quality (AHRQ). The AHRQ is a federal agency tasked with
improving the safety and quality of America’s health care system by developing the
knowledge, tools, and data needed to improve the health care system (AHRQ, 2021). After
the 1999 IOM report, AHRQ has been extremely effective in addressing patient
safety. According to AHRQ, the U.S. health care system prevented 1.3 million errors, saved
50,000 lives, and avoided $12 billion in wasteful spending from 2010–2013 (AHRQ,
2021). Some of the more popular tools developed by AHRQ are the Team Strategies and
Tools to Enhance Performance and Patient Safety 2.0 (TeamSTEPPS), Consumer
Assessment of Healthcare Providers and Systems (CAHPS), Guide to Patient and Family
Engagement in Hospital Quality and Safety, Surveys on Patient Safety Culture (SOPS)
(AHRQ, 2021). 2. The majority of health care errors occur in inpatient settings. Errors are
becoming increasingly common in outpatient settings. Discuss at least two (2) reasons for
the increasing errors in outpatient settings. Medical errors are a serious public health
problem and a leading cause of death in the United States. There are two main categories of
errors; Errors of omission occur as a result of actions not taken and Errors of the
commission occur as a result of the wrong action taken (Rodziewicz, Houseman, &
Hipskind, 2021). Medication errors are classified as errors of commission which are a big
problem in the hospital setting as well as in ambulatory care. In a 2011 study by Sarkar et

2. al., more than 4.5 million ambulatory care visits occur every year due to adverse drug
events. A greater focus on ADE prevention and detection is warranted among patients
receiving multiple medications in primary care practices. Risk factors for ADE include
polypharmacy as well as health literacy. In ambulatory settings, polypharmacy is a big
problem and medication reconciliation by healthcare professionals is one way to reduce the
dire effects of polypharmacy. The level of health literacy of patients and their caregivers is a
source of ambulatory care medical errors. This leads to patients not taking the medication
as prescribed which can lead to detrimental outcomes. Another major error in ambulatory
settings is missed diagnostics. In a 2014 study, The frequency of diagnostic errors in
outpatient care: estimations from three large observational studies involving US adult
populations, by Singh, Meyer, and Thomas, it is estimated that 5% of adults in the United
States experience a missed or delayed diagnosis each year. Missed diagnosis can delay
treatments and reduce the likelihood of a good prognosis.Reference Rodziewicz, L.,
Houseman, B., and Hipskind, E. (2021). Medical Error Reduction and Prevention.
https://www.ncbi.nlm.nih.gov/books/NBK499956/Sarkar, U., López, A., Maselli, H.,
Gonzales, R. (2011). Adverse drug events in U.S. adult ambulatory medical care. Health
Serv Res. https://pubmed.ncbi.nlm.nih.gov/21554271/Singh, H., Meyer, N., Thomas,
J. (2014). The frequency of diagnostic errors in outpatient care: estimations from three
large observational studies involving US adult populations.
https://pubmed.ncbi.nlm.nih.gov/24742777/The Agency for Healthcare Research and
Quality. (2021). Agency for Healthcare Research and Quality: A Profile.
https://www.ahrq.gov/cpi/about/profile/index.htmlThe Agency for Healthcare Research
and Quality. (2019). Ambulatory Care Safety.https://psnet.ahrq.gov/primer/ambulatory-
care-safetyReply 2 Intentional fatalities in health-care settings are among the most tragic
incidents that may occur to a patient seeking medical help. Unintentional deaths in health
care settings, particularly those caused by medical mistakes, have been on the rise in recent
years. To lessen the causes of unintended fatalities, such mistakes must be avoided. The
importance of federal programs and patient safety in reducing medical mistakes in health
care institutions is critical. Patient safety is a distinct health-care field that focuses on
patient safety while receiving health-care services. Patient safety, moreover, is founded on
the prevention, mitigation, reporting, and analysis of different medical mistakes that might
result in negative consequences, including patient mortality (Liu et al., 2018). The World
Health Organization now considers patient safety to be an endemic problem. As a result,
patient safety plays a critical role in protecting the interests of patients by preventing many
causes that might have negative consequences for them (Khan et al., 2018). Patient safety is
a field that focuses not only on the safety of patients in a health-care setting, but also on
actions that may be taken to ensure patient safety with minimum effort on the part of
health-care personnel. As a result, patient safety plays a critical role in supporting the
interests of patients by preventing a variety of circumstances that might have a negative
influence on them (Khan et al.,2018). Patient safety is a field that focuses not only on the
safety of patients in a health-care setting, but also on actions that may be taken to ensure
patient safety with minimum effort on the part of health-care personnel. As a result, patient
safety is critical in reducing medical mistakes in a health-care institution and preventing

3. unintended fatalities among health-care workers.2. The majority of health care errors occur
in inpatient settings. Errors are becoming increasingly common in outpatient
settings. Discuss at least two (2) reasons for the increasing errors in outpatient
settings. Medical mistakes have now risen to become the industry’s third greatest cause of
mortality, notably in the United States. Medical mistakes have exceeded other top causes of
death, such as diabetes, Alzheimer’s disease, and strokes. However, the major issue in the
health-care business is the causation of medical mistakes in outpatient settings. Medical
mistakes in outpatient settings have been linked to an insufficient flow of information.
There is little doubt that information flow is crucial in a health-care context, especially
when different service areas are involved (Bates & Singh, 2018). However, there are times
when there is an inadequate flow of information, particularly when important information
is required, resulting in fatalities. Information such as the transfer of patients to other
health-care institutions, for example, might result in medical blunders. Medical mistakes
induced by a lack of information flow are mostly caused by a lack of communication of
patient findings and a negative impact on pharmaceutical prescriptions. Medical mistakes
have always occurred in such situations, resulting in serious health implications for the
patients. Human personnel issues may contribute to medical mistakes in outpatient health
care settings. More precisely, there have been several occasions when people’s carelessness
has resulted in health care practitioners failing to guarantee that health care protocols,
rules, procedures, and health care standards are followed appropriately in a health care
environment. Poor labeling and record keeping can also describe the human issues in a
health-care context (Royce et al., 2019). When health-care workers make mistakes owing to
a lack of expertise, the consequences are frequently tragic.The health care providers must
learn the importance of consulting with peers, appropriate application of expertise, and
proper formulation of a health care plan. It is the role of a health care provider to consider
the most evident disease diagnosis and practice of health care in such an automated sense
to avoid medical errors in the health care settings, particularly in outpatient
settings.References:Bates, D. W., & Singh, H. (2018). Two decades since to err is human: an
assessment of progress and emerging priorities in patient safety. Health Affairs, 37(11),
1736-1743.Liu, X., Zheng, J., Liu, K., Baggs, J. G., Liu, J., Wu, Y., & You, L. (2018). Hospital
nursing organizational factors, nursing care left undone, and nurse burnout as predictors of
patient safety: A structural equation modeling analysis. International journal of nursing
studies, 86, 82-89.Royce, C. S., Hayes, M. M., & Schwartzstein, R. M. (2019). Teaching critical
thinking: a case for instruction in cognitive biases to reduce diagnostic errors and improve
patient safety. Academic Medicine, 94(2), 187-194.