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Showing results for "adverse event".
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9761. Implementation of a modified bedside handoff for a postpartum unit. | PSNet
      psnet.ahrq.gov/issue/implementation-modified-bedside-handoff-postpartum-unit
      November 16, 2022 - January 2, 2017 Families as partners in hospital error and adverse event surveillance

9762. Patient safety: this is public health. | PSNet
      psnet.ahrq.gov/issue/patient-safety-public-health
      July 19, 2023 - February 24, 2016 Patient safety professionals as the third victims of adverse events … Safety Nets to Reduce Missed and Delayed Diagnoses of Cancer July 31, 2023 Using event

9763. Operating management system for high reliability: leadership, accountability, learning and innovation in healthcare. | PSNet
      psnet.ahrq.gov/issue/operating-management-system-high-reliability-leadership-accountability-learning-and
      July 01, 2016 - January 6, 2017 Using event reports in real-time to identify and mitigate patient safety … Topic Hospitals Facility and Group Administrators Medicine Epidemiology of Errors and Adverse

9764. Distracted practice: a concept analysis. | PSNet
      psnet.ahrq.gov/issue/distracted-practice-concept-analysis
      February 27, 2009 - March 8, 2017 Post event debriefs: a commitment to learning how to better care for patients … Administrators Medicine Psychological and Social Complications Epidemiology of Errors and Adverse

9765. Medical Problem Solving: An Analysis of Clinical Reasoning. | PSNet
      psnet.ahrq.gov/issue/medical-problem-solving-analysis-clinical-reasoning
      July 18, 2018 - September 26, 2012 Adverse events present on arrival to the emergency department: the … February 15, 2017 When safety event reporting is seen as punitive: "I've been PSN-ed!

9766. The Role of Clinical Learning Environments in Preparing New Clinicians to Engage in Patient Safety. | PSNet
      psnet.ahrq.gov/issue/role-clinical-learning-environments-preparing-new-clinicians-engage-patient-safety
      November 18, 2020 - solutions for patient safety in an infectious-agent-isolation environment: a study of 484 COVID-19-related event … The Topic Ambulatory Care Health Care Providers Medicine Epidemiology of Errors and Adverse

9767. Impact of hospital accreditation on quality improvement in healthcare: a systematic review. | PSNet
      psnet.ahrq.gov/issue/impact-hospital-accreditation-quality-improvement-healthcare-systematic-review
      September 23, 2020 - May 11, 2014 View More Related Resources Lessons from Event Reports … September 20, 2023 Racial, Ethnic, and Payer Disparities in Adverse Safety Events: Are

9768. Written Signout: It Only Works If You Use The Right One | PSNet
      psnet.ahrq.gov/web-mm/written-signout-it-only-works-if-you-use-right-one
      April 24, 2018 - Fortunately, the patient did not experience any adverse consequences as a result of the error. … Sentinel Event Alert. Inadequate hand-off communication. September 11, 2017;(58):1-6. … Rates of medical errors and preventable adverse events among hospitalized children following implementation … Related Resources From the Same Author(s) Families as partners in hospital error and adverse … event surveillance.

9769. Dangerous Dapsone | PSNet
      psnet.ahrq.gov/web-mm/dangerous-dapsone
      January 10, 2011 - Fortunately for this patient, this mistake did not cause her adverse long-term clinical consequences. … Clinical pharmacists have a positive impact on adverse drug events ( 13,14 ), yet in this case a phone … Pharmacist participation on physician rounds and adverse drug events in the intensive care unit. … Pharmacists on rounding teams reduce preventable adverse drug events in hospital general medicine units … February 14, 2024 Adverse safety events in emergency medical services care of children

9770. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/42454/psn-pdf
      September 09, 2013 - The project led to an 11% reduction in preventable adverse events, but hospital reimbursements decreased … relationship-between-occurrence-surgical-complications-and-hospital-finances https://psnet.ahrq.gov/issue/how-guide-prevent-obstetrical-adverse-events

9771. Decreasing ADEs in Montana Frontier Critical Access Hospitals through HIT | Digital Healthcare Research
      digital.ahrq.gov/ahrq-funded-projects/decreasing-ades-montana-frontier-critical-access-hospitals-through-hit
      January 01, 2023 - Population Rural Populations Type of Care Acute Care Health Care Theme Adverse … Healthcare Performance Improvement Network initiated this study to assess the opportunities to decrease adverse

9772. Electronic Prescribing Using A Community Utility: The ePrescribing Gateway | Digital Healthcare Research
      digital.ahrq.gov/ahrq-funded-projects/electronic-prescribing-using-community-utility-eprescribing-gateway
      January 01, 2023 - Prescribing Care Setting Ambulatory Setting Pharmacy Health Care Theme Adverse … Physicians reviewed and rated suspected adverse drug events and medication errors.

9773. NPSD Data Spotlight: Patterns of Fall Interventions (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/npsd/data/spotlights/spotlight-patterns-fall-interventions.pdf
      September 01, 2023 - Healthcare providers submit patient safety event data to Patient Safety Organizations (PSOs), which … In addition, causal inferences cannot be based on these event data alone. … harm is defined as harm to the patient after discovery of the incident and any attempts to minimize adverse … associations between various concurrent reported event characteristics. … Does error and adverse event reporting by physicians and nurses differ? Jt. Comm. J. Qual.

9774. Overcoming barriers to adopting and implementing computerized physician order entry systems in U.S. hospitals. | PSNet
      psnet.ahrq.gov/issue/overcoming-barriers-adopting-and-implementing-computerized-physician-order-entry-systems-us
      July 10, 2008 - June 28, 2010 Medication dispensing errors and potential adverse drug events before and … January 7, 2015 Relationship between medication event rates and the Leapfrog computerized

9775. Think twice: effects on diagnostic accuracy of returning to the case to reflect upon the initial diagnosis. | PSNet
      psnet.ahrq.gov/issue/think-twice-effects-diagnostic-accuracy-returning-case-reflect-upon-initial-diagnosis
      June 08, 2022 - September 23, 2020 Collaborative case review: a systems-based approach to patient safety event … February 22, 2023 Structural racism and adverse maternal health outcomes: a systematic

9776. Pediatric faculty knowledge and comfort discussing diagnostic errors: a pilot survey to understand barriers to an educational program. | PSNet
      psnet.ahrq.gov/issue/pediatric-faculty-knowledge-and-comfort-discussing-diagnostic-errors-pilot-survey-understand
      April 22, 2020 - April 22, 2020 Adverse events associated with procedural sedation and analgesia in a … October 16, 2024 A systemwide strategy to embed equity into patient safety event analysis

9777. Harnessing the power of medical malpractice data to improve patient care. | PSNet
      psnet.ahrq.gov/issue/harnessing-power-medical-malpractice-data-improve-patient-care
      September 25, 2019 - April 21, 2021 Predictive power of the "trigger tool" for the detection of adverse events … October 14, 2020 Special Section: Event Analysis and Risk Management.

9778. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/43567/psn-pdf
      October 21, 2016 - National Action Plan for Adverse Drug Event Prevention. … https://psnet.ahrq.gov/issue/national-action-plan-adverse-drug-event-prevention This national action … aims to align the efforts of multiple federal programs committed to reducing patient harms related to adverse … common usage and their very high potential to cause clinically significant, preventable, and measurable adverse … https://psnet.ahrq.gov/issue/national-action-plan-adverse-drug-event-prevention https://psnet.ahrq.gov

9779. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/35023/psn-pdf
      March 04, 2011 - Building a framework for trust: critical event analysis of deaths in surgical care. … Building a framework for trust: critical event analysis of deaths in surgical care. … commentary discusses the role of the Scottish Audit of Surgical Mortality (SASM) on trends in adverse … Findings include a decrease over time in the percentage of deaths for which adverse events in management … conclude that voluntary mortality audits may lead to important changes in practice and focusing on adverse

9780. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/45468/psn-pdf
      October 11, 2017 - Identification and characterization of adverse drug events in primary care. … Identification and Characterization of Adverse Drug Events in Primary Care. … https://psnet.ahrq.gov/issue/identification-and-characterization-adverse-drug-events-primary-care Adverse … drug event during a change in medications. … Less than 10% of patients experienced an adverse drug event, which the authors conclude represents an