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Showing results for "adverse event".
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9821. Surgical safety checklist compliance: a job done poorly! | PSNet
      psnet.ahrq.gov/issue/surgical-safety-checklist-compliance-job-done-poorly
      April 25, 2016 - June 14, 2017 Adverse events after screening and follow-up colonoscopy. … April 22, 2016 Assessing distractors and teamwork during surgery: developing an event-based

9822. Reducing surgical specimen errors through multidisciplinary quality improvement. | PSNet
      psnet.ahrq.gov/issue/reducing-surgical-specimen-errors-through-multidisciplinary-quality-improvement
      July 28, 2021 - October 27, 2021 Harnessing event report data to identify diagnostic error during the … Advanced medication reconciliation: a systematic review of the impact on medication errors and adverse

9823. Transfer of accountability: transforming shift handover to enhance patient safety. | PSNet
      psnet.ahrq.gov/issue/transfer-accountability-transforming-shift-handover-enhance-patient-safety
      April 24, 2018 - Related Resources From the Same Author(s) Families as partners in hospital error and adverse … event surveillance.

9824. Making surgical wards safer for patients with diabetes: reducing hypoglycaemia and insulin errors. | PSNet
      psnet.ahrq.gov/issue/making-surgical-wards-safer-patients-diabetes-reducing-hypoglycaemia-and-insulin-errors
      February 18, 2019 - Diabetes care involves the use medications that have high risk of adverse drug events . … August 19, 2020 Bringing the equity lens to patient safety event reporting.

9825. Self-reported violations during medication administration in two paediatric hospitals. | PSNet
      psnet.ahrq.gov/issue/self-reported-violations-during-medication-administration-two-paediatric-hospitals
      December 01, 2010 - July 1, 2016 Anatomy of a patient safety event: a pediatric patient safety taxonomy. … March 17, 2010 Wrong-side/wrong-site, wrong-procedure, and wrong-patient adverse events

9826. How, when, and why bad apples spoil the barrel: negative group members and dysfunctional groups. | PSNet
      psnet.ahrq.gov/issue/how-when-and-why-bad-apples-spoil-barrel-negative-group-members-and-dysfunctional-groups
      August 08, 2018 - CHaMP: A model for building a center to support health care worker well-being after experiencing an adverse … event.

9827. Improving standardization of paging communication using quality improvement methodology. | PSNet
      psnet.ahrq.gov/issue/improving-standardization-paging-communication-using-quality-improvement-methodology
      September 23, 2020 - March 25, 2017 A human factors and survey methodology-based design of a web-based adverse … event reporting system for families.

9828. Controlled substance drug diversion by healthcare workers as a threat to patient safety. | PSNet
      psnet.ahrq.gov/issue/controlled-substance-drug-diversion-healthcare-workers-threat-patient-safety
      April 05, 2023 - April 26, 2023 Latent and active failures perfectly align to allow a preventable adverse … event to reach a patient.

9829. Lack of patient knowledge regarding hospital medications. | PSNet
      psnet.ahrq.gov/issue/lack-patient-knowledge-regarding-hospital-medications
      September 20, 2006 - Human Factor Analysis and Classification System" (HFACS) model to the prevention of medical errors and adverse … Addressing mistreatment of providers by patients and family members as a patient safety event

9830. Canadian Association of University Surgeons' Annual Symposium. Surgical simulation: the solution to safe training or a promise unfulfilled? | PSNet
      psnet.ahrq.gov/issue/canadian-association-university-surgeons-annual-symposium-surgical-simulation-solution-safe
      March 09, 2022 - May 25, 2022 The social cost of adverse medical events, and what we can do about it. … April 6, 2022 View More Related Resources Impact of critical event

9831. Critical Issues in Food Allergy: A National Academies Consensus Report. | PSNet
      psnet.ahrq.gov/issue/critical-issues-food-allergy-national-academies-consensus-report
      November 16, 2022 - November 16, 2022 Families as partners in hospital error and adverse event surveillance

9832. Clinical triggers and vital signs influencing crisis acknowledgment and calls for help by anesthesiologists: a simulation-based observational study. | PSNet
      psnet.ahrq.gov/issue/clinical-triggers-and-vital-signs-influencing-crisis-acknowledgment-and-calls-help
      June 15, 2012 - April 16, 2018 Rapid learning of adverse medical event disclosure and apology.

9833. The impact of anti-infective drug shortages on hospitals in the United States: trends and causes. | PSNet
      psnet.ahrq.gov/issue/impact-anti-infective-drug-shortages-hospitals-united-states-trends-and-causes
      October 19, 2022 - October 23, 2024 Families as partners in hospital error and adverse event surveillance

9834. Identifying patients whose symptoms are underrecognized during treatment with breast radiotherapy. | PSNet
      psnet.ahrq.gov/issue/identifying-patients-whose-symptoms-are-underrecognized-during-treatment-breast-radiotherapy
      May 25, 2022 - of human errors resulting in diagnostic errors in the emergency department: an analysis of serious adverse … event reports.

9835. Operative team communication during simulated emergencies: too busy to respond? | PSNet
      psnet.ahrq.gov/issue/operative-team-communication-during-simulated-emergencies-too-busy-respond
      March 04, 2020 - July 25, 2011 A new safety event reporting system improves physician reporting in the … June 10, 2020 Development of a pediatric adverse events terminology.

9836. Medicare nonpayment, hospital falls, and unintended consequences. | PSNet
      psnet.ahrq.gov/issue/medicare-nonpayment-hospital-falls-and-unintended-consequences
      October 19, 2022 - November 16, 2022 Families as partners in hospital error and adverse event surveillance

9837. Unrecognized cardiovascular emergencies among Medicare patients. | PSNet
      psnet.ahrq.gov/issue/unrecognized-cardiovascular-emergencies-among-medicare-patients
      November 16, 2022 - September 29, 2017 Families as partners in hospital error and adverse event surveillance

9838. 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

9839. 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

9840. 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