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psnet.ahrq.gov/issue/organizational-learning-morbidity-and-mortality-conference
June 09, 2015 - Redesigning a morbidity and mortality program in a university-affiliated pediatric anesthesia
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psnet.ahrq.gov/issue/drug-error-anaesthetic-practice-review-896-reports-australian-incident-monitoring-study
June 13, 2011 - Federation of Societies of Anaesthesiologists (WHO-WFSA) International Standards for a Safe Practice of Anesthesia
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psnet.ahrq.gov/issue/retained-guidewires-veterans-health-administration-getting-root-problem
March 13, 2013 - January 17, 2019
Anesthesia adverse events voluntarily reported in the Veterans Health
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psnet.ahrq.gov/issue/clinical-pharmacist-led-integrated-approach-evaluation-medication-errors-among-medical
December 09, 2020 - March 29, 2023
Accuracy of spinal anesthesia drug concentrations in mixtures prepared
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psnet.ahrq.gov/issue/use-patient-pictures-and-verification-screens-reduce-computerized-provider-order-entry-errors
November 16, 2022 - June 12, 2019
Perspectives on anesthesia and perioperative patient safety: past, present
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psnet.ahrq.gov/issue/briefing-and-debriefing-operating-room-using-fighter-pilot-crew-resource-management
May 29, 2024 - June 29, 2011
Medication errors in pediatric anesthesia: a report from the Wake Up Safe
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psnet.ahrq.gov/issue/safety-first-using-checklist-intrafacility-transport-adult-intensive-care-patients
October 09, 2024 - October 9, 2024
Failure to debrief after critical events in anesthesia is associated
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psnet.ahrq.gov/issue/examining-nature-interprofessional-interventions-designed-promote-patient-safety-narrative
August 17, 2018 - March 23, 2011
A theoretical model of flow disruptions for the anesthesia team during
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psnet.ahrq.gov/issue/incidence-opioid-misuse-among-surgical-patients-persistent-opioid-use
October 13, 2018 - emergency teams: a cross-sectional observation study on the use of closed-loop communication among anesthesia
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psnet.ahrq.gov/issue/s-teams-truly-multiprofessional-course-focusing-nontechnical-skills-improve-patient-safety
November 30, 2022 - February 23, 2018
Complications associated with the anesthesia transport of pediatric
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psnet.ahrq.gov/web-mm/secured-not-always-safe
October 01, 2015 - She received spinal anesthesia, and the airway was maintained with the use of a laryngeal mask airway … This unusual case of mediastinitis, which temporally followed the use of laryngeal mask airway (LMA) anesthesia … this way, it may provide additional safety over the positive pressure ventilation used in "general anesthesia … During standard preoperative consenting, the anesthesia team discusses the general approach to anesthesia … Such events should reinforce the importance of a comprehensive and vigilant approach to anesthesia care
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psnet.ahrq.gov/node/49731/psn-pdf
April 01, 2015 - The percentage of OR fires increased over time, from
less than 1% of all surgical anesthesia claims … in 1985–1994 to 4.4% of all surgical anesthesia claims
between 2000–2009.(7) This trend was especially … pronounced among claims for monitored anesthesia. … If heavy sedation with supplemental oxygen is required, the ASA
advisory recommends general anesthesia … Anesthesia Patient Safety Foundation, Fire Safety Video. [Available at]
4.
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psnet.ahrq.gov/issue/center-patient-safety
May 01, 2016 - September 20, 2023
Outcomes from Wake Up Safe, the pediatric anesthesia quality improvement … January 21, 2021
Anesthesia Awareness Registry. … March 17, 2011
WebAIRS Anesthesia Incident Reporting System.
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psnet.ahrq.gov/issue/perioperative-safety-culture-principles-practices-and-pragmatic-approaches
January 23, 2013 - January 23, 2013
Quality of Anesthesia Care. … December 15, 2021
Safety and Quality in Perioperative Anesthesia Care. … April 7, 2021
Quality of Anesthesia Care.
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psnet.ahrq.gov/node/33892/psn-pdf
May 03, 2016 - This technique, used in anesthesia to understand failures (see also Cooper et al. 1978
and Flanagan … psnet.ahrq.gov/issue/critical-incident-technique-bibliography-2001
https://psnet.ahrq.gov/issue/preventable-anesthesia-mishaps-study-human-factors
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psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.311_slideshow.ppt
December 01, 2013 - Thrombolysis. 2013;36:212-222. http://www.ncbi.nlm.nih.gov/pubmed/23532364
14
TSOACs and Neuraxial Anesthesia … Patients undergoing neuraxial anesthesia (such as the epidural catheter in this case) are at risk for … (2)
Recent guidelines from the American Society of Regional Anesthesia and Pain Medicine recommend that … Regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy: American Society … of Regional Anesthesia and Pain Medicine Evidence-Based Guidelines (Third Edition).
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psnet.ahrq.gov/issue/key-vulnerabilities-surgical-environment-container-mix-ups-and-syringe-swaps
June 10, 2018 - November 29, 2017
View More
Related Resources
Anesthesia Patient … Multiple High-Risk Events Involving Workflow for Wasting of Medications Used by Anesthesia … May 3, 2006
WebM&M Cases
Unexplained Apnea Under Anesthesia
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psnet.ahrq.gov/node/46442/psn-pdf
October 04, 2017 - This special issue focuses on
transfers involving anesthesia care. … psnet.ahrq.gov/issue/inadequate-hand-communication
https://psnet.ahrq.gov/issue/intraoperative-handoffs-among-anesthesia-providers-increase-incidence-documentation-errors
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psnet.ahrq.gov/node/34754/psn-pdf
February 06, 2018 - He and Morell are well suited
to be at the helm of the first anesthesia textbook on patient safety.
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psnet.ahrq.gov/node/35116/psn-pdf
April 06, 2011 - crises-clinical-care-approach-management
This commentary discusses the many facets of crisis management in anesthesia … This commentary is
accompanied by a manual of 24 specific sub-algorithms in anesthesia crisis management