Hospital harm is everyone’s concern
Hospital Harm Improvement Resource
How to Use the Hospital Harm Measure for Improvement
Learning from Harm
General Patient Safety Quality Improvement and Measurement Resources
Hypoglycemia: Introduction
Hypoglycemia: Discharge Abstract Database
Hypoglycemia: Importance to Patients and Families
Hypoglycemia: Clinical and System Reviews, Incident Analyses
Hypoglycemia: Measures
Hypoglycemia: Success Stories
Hypoglycemia: References
Aspiration Pneumonia: Introduction
Aspiration Pneumonia: Discharge Abstract Database
Aspiration Pneumonia: Importance to Patients and Families
Aspiration Pneumonia: Clinical and System Reviews, Incident Analyses
Aspiration Pneumonia: Measures
Aspiration Pneumonia: Success Stories
Aspiration Pneumonia: References
Delirium: Introduction
Delirium: Discharge Abstract Database
Delirium: Importance to Patients and Families
Delirium: Clinical and System Reviews, Incident Analyses
Delirium: Measures
Delirium: Prevention Success Stories
Delirium: References
Infusion, Transfusion and Injection Complications: Introduction
Infusion, Transfusion and Injection Complications: Discharge Abstract Database
Infusion, Transfusion and Injection Complications: Importance to Patients and Families
Infusion, Transfusion and Injection Complications: Clinical and System Reviews, Incident Analyses
Infusion, Transfusion and Injection Complications: Measures
Infusion, Transfusion and Injection Complications: Success Stories
Infusion, Transfusion and Injection Complications: References
Medication Incidents: Introduction
Medication Incidents: Discharge Abstract Database
Medication Incidents: Importance to Patients and Families
Medication Incidents: Clinical and System Reviews, Incident Analyses
Medication Incidents: Measures
Medication Incidents Prevention Success Stories
Medication Incidents: References
Obstetric Hemorrhage: Introduction
Obstetric Hemorrhage: Discharge Abstract Database
Obstetric Hemorrhage: Importance to Patients and Families
Obstetric Hemorrhage: Clinical and System Reviews, Incident Analyses
Obstetric Hemorrhage: Measures
Obstetric Hemorrhage: Success Stories
Obstetric Hemorrhage: References
Patient Trauma: Introduction
Patient Trauma: Discharge Abstract Database
Patient Trauma: Importance to Patients and Families
Patient Trauma: Clinical and System Reviews, Incident Analyses
Patient Trauma: Measures
Patient Trauma: Success Stories
Patient Trauma: References
Pneumonia: Introduction
Pneumonia: Discharge Abstract Database
Pneumonia: Importance to Patients and Families
Pneumonia: Clinical and System Reviews, Incident Analyses
Pneumonia: Measures
Pneumonia: Success Stories
Pneumonia: References
Pneumothorax: Introduction
Pneumothorax: Discharge Abstract Database
Pneumothorax: Importance to Patients and Families
Pneumothorax: Clinical and System Reviews, Incident Analyses
Pneumothorax: Measures
Pneumothorax: Success Stories
Pneumothorax: References
Post Procedural Infections: Introduction
Post Procedural Infections: Discharge Abstract Database
Post Procedural Infections: Importance to Patients and Families
Post Procedural Infections: Clinical and Systems Reviews, Incident Analyses
Post Procedural Infections: Measures
Post Procedural Infections: Success Stories
Post Procedural Infections: References
Pressure Ulcer: Introduction
Pressure Ulcer: Discharge Abstract Database
Pressure Ulcer: Importance to Patients and Families
Pressure Ulcer: Clinical and System Reviews, Incident Analyses
Pressure Ulcer: Measures
Pressure Ulcer: Success Stories
Pressure Ulcer: References
Sepsis: Introduction
Sepsis: Discharge Abstract Database
Sepsis: Importance to Patients and Families
Sepsis: Clinical and System Reviews, Incident Analyses
Sepsis: Measures
Sepsis: Success Stories
Sepsis: References
UTI: Introduction
UTI: Discharge Abstract Database
UTI: Importance to Patients and Families
UTI: Clinical and System Reviews, Incident Analyses
UTI: Measures
UTI: Success Stories
UTI: References
Venous Thromboembolism: Introduction
VTE: Discharge Abstract Database
VTE: Importance to Patients and Families
VTE: Clinical and System Reviews, Incident Analyses
VTE: Measures
VTE: Prevention Success Stories
VTE: References
Wound Disruption: Introduction
Wound Disruption: Discharge Abstract Database
Wound Disruption: Importance to Patients and Families
Wound Disruption: Clinical and System Review, incident analysis
Wound Disruption: Measures
Wound Disruption: Success Stories
Wound Disruption: References
Obstetric Trauma: Introduction
Obstetric Trauma: Discharge Abstract Database
Obstetric Trauma: Importance to Patients and Families
Obstetric Trauma: Clinical and System Reviews, Incident Analyses
Obstetric Trauma: Measures
Obstetric Trauma: Success Stories
Obstetric Trauma: References
Procedure-Associated Shock: Introduction
Procedure-Associated Shock: Discharge Abstract Database
Procedure-Associated Shock: Importance to Patients and Families
Procedure-Associated Shock: Clinical and System Review, Incident Analysis
Procedure-Associated Shock: Measures
Procedure-Associated Shock: Success Stories
Procedure-Associated Shock: References
Selected Serious Events: Introduction
Selected Serious Events: Discharge Abstract Database
Selected Serious Events: Importance to Patients and Families
Selected Serious Events: Clinical And System Reviews, Incident Analyses
Selected Serious Events: Measures
Selected Serious Events: Success Stories
Selected Serious Events: References
Electrolyte and Fluid Imbalance: Introduction
Electrolyte and Fluid Imbalance: Discharge Abstract Database
Electrolyte and Fluid Imbalance: Importance to Patients and Families
Electrolyte and Fluid Imbalance: Clinical and System Reviews, Incident Analyses
Electrolyte and Fluid Imbalance: Measures
Electrolyte and Fluid Imbalance: Success Stories
Electrolyte and Fluid Imbalance: References
Anemia – Hemorrhage (Health Care / Medication Associated Condition): Introduction
Anemia – Hemorrhage (Health Care / Medication Associated Condition): Discharge Abstract Database
Anemia – Hemorrhage (Health Care / Medication Associated Condition): Importance to Patients and Families
Anemia – Hemorrhage (Health Care / Medication Associated Condition): Clinical and System Reviews, Incident Analyses
Anemia – Hemorrhage (Health Care / Medication Associated Condition): Measures
Anemia – Hemorrhage (Health Care / Medication Associated Condition): Success Stories
Anemia – Hemorrhage (Health Care / Medication Associated Condition): References
Anemia – Hemorrhage (Procedure-Associated Conditions): Introduction
Anemia – Hemorrhage (Procedure-Associated Conditions): Discharge Abstract Database
Anemia – Hemorrhage (Procedure-Associated Conditions): Importance to Patients and Families
Anemia – Hemorrhage (Procedure-Associated Conditions): Clinical and System Reviews, Incident Analyses
Anemia – Hemorrhage (Procedure-Associated Conditions): Measures
Anemia – Hemorrhage (Procedure-Associated Conditions): Success Stories
Anemia – Hemorrhage (Procedure-Associated Conditions): References
Birth Trauma: Introduction
Birth Trauma: Discharge Abstract Database
Birth Trauma: Importance To Patients And Families
Birth Trauma: Clinical and System Reviews, Incident Analyses
Birth Trauma: Measures
Birth Trauma: Success Stories
Birth Trauma: References
Device Failure: Introduction
Device Failure: Discharge Abstract Database
Device Failure: Importance to Patients and Families
Device Failure: Clinical and System Reviews, Incident Analyses
Device Failure Measures
Device Failure: Success Stories
Device Failure: References
Infections due to Clostridium difficile, MRSA or VRE: Introduction
Infections due to Clostridium difficile, MRSA or VRE: Discharge Abstract Database
Infections due to Clostridium difficile, MRSA or VRE: Importance to Patients and Families
Infections due to Clostridium difficile, MRSA or VRE: Surveillance, Outbreak Management
Infections due to Clostridium difficile, MRSA or VRE: Clinical and System Reviews, Incident Analyses
Infections due to Clostridium difficile, MRSA or VRE: Measures
Infections due to Clostridium difficile, MRSA or VRE: Success Stories
Infections due to Clostridium difficile, MRSA or VRE: References
Laceration: Introduction
Laceration: Discharge Abstract Database
Laceration: Importance to Patients and Families
Laceration: Clinical and System Review Incident Analyses
Laceration: Measures
Laceration: Success Stories
Laceration: References
Retained Foreign Body: Introduction
Retained Foreign Body: Discharge Abstract Database
Retained Foreign Body: Importance to Patients and Families
Retained Foreign Body: Clinical and System Reviews, Incident Analyses
Retained Foreign Body: Measures
Retained Foreign Body: Success Stories
Retained Foreign Body: References
Viral Gastroenteritis: Introduction
Viral Gastroenteritis: Discharge Abstract Database
Viral Gastroenteritis: Importance to Patients and Families
Viral Gastroenteritis: Surveillance, Outbreak Management
Viral Gastroenteritis: Clinical and System Reviews, Incident Analyses
Viral Gastroenteritis: Measures
Viral Gastroenteritis: Success Stories
Viral Gastroenteritis: References
Hospital Harm Figure 1 Transcript

In this section :

  • Hospital harm is everyone’s concern
    • Hospital Harm Improvement Resource
      • How to Use the Hospital Harm Measure for Improvement
      • Learning from Harm
      • General Patient Safety Quality Improvement and Measurement Resources
      • Hypoglycemia: Introduction
      • Aspiration Pneumonia: Introduction
      • Delirium: Introduction
      • Infusion, Transfusion and Injection Complications: Introduction
      • Medication Incidents: Introduction
      • Obstetric Hemorrhage: Introduction
      • Patient Trauma: Introduction
      • Pneumonia: Introduction
      • Pneumothorax: Introduction
      • Post Procedural Infections: Introduction
      • Pressure Ulcer: Introduction
      • Sepsis: Introduction
      • UTI: Introduction
      • Venous Thromboembolism: Introduction
      • Wound Disruption: Introduction
      • Obstetric Trauma: Introduction
      • Procedure-Associated Shock: Introduction
      • Selected Serious Events: Introduction
      • Electrolyte and Fluid Imbalance: Introduction
      • Anemia – Hemorrhage (Health Care / Medication Associated Condition): Introduction
      • Anemia – Hemorrhage (Procedure-Associated Conditions): Introduction
      • Birth Trauma: Introduction
      • Device Failure: Introduction
      • Infections due to Clostridium difficile, MRSA or VRE: Introduction
      • Laceration: Introduction
      • Retained Foreign Body: Introduction
      • Viral Gastroenteritis: Introduction
      • Hospital Harm Figure 1 Transcript

Procedure-Associated Shock: Success Stories

Surviving Sepsis

In April 2008, a 70-year-old independent lady with no previous comorbidities became a grandmother for the first time and was looking forward to watching her family grow-up. She developed a cough' became breathless and presented to her local hospital. She was admitted and developed severe sepsis and septic shock secondary to her community-acquired pneumonia; she died within seven hours. Her sepsis was not recognized, and antibiotics and fluids were not given in a timely manner. The patient's family and the well-meaning and competent medical and nursing team were devastated.

So begins the account of a real patient story that compelled Dr. Matt Inada-Kim and colleagues to tackle the problem of managing sepsis within their practice (Patient Stories, 2020).

https://www.patientstories.org.uk/recent-posts/surviving-sepsis-a-human-factors-approach/

 

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