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2161. Key vulnerabilities in the surgical environment: container mix-ups and syringe swaps. | PSNet
      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

2162. Psn-Pdf (pdf file)
      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

2163. Risk Management and Patient Safety | PSNet
      psnet.ahrq.gov/perspective/risk-management-and-patient-safety
      December 01, 2010 - For example, in the mid-1980s, RMF asked the anesthesia chairs of the major teaching hospitals affiliated … with Harvard Medical School to review their claims and consider what might be done to improve anesthesia … safety reforms.( 4 , 5 ) Several years later, simulation-based training programs were developed in anesthesia … Standards for patient monitoring during anesthesia at Harvard Medical School. … Anesthesia Patient Safety Foundation Newsletter. Spring 2007;22:17. [Available at] 7.

2164. Improving Patient Safety in Ambulatory Surgery Centers: A Resource List for Users of the AHRQ Ambulatory Surgery Center Survey on Patient Safety Culture. (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patientsafetyculture/asc/resources/asc-resource_list.pdf
      March 01, 2016 - safe surgery checklist helps ensure certain measures or steps are taken prior to administration of anesthesia … checklist are encouraged to make any changes necessary to best address the type of patients, procedures, anesthesia … The developers recommend checking with the physicians, anesthesia providers, nurses, and facility administrators … Staffing of the postanethesia care unit is based on using the patient acuity tool, designed by peri-anesthesia … This tool allows staffing points to be assigned based on the type of anesthesia and the type of surgery

2165. Envisioning Patient Safety in the Year 2025: Eight Perspectives (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol1/Advances-Henriksen_104.pdf
      January 01, 2025 - to therapeutic and life support devices (e.g., infusion pumps, enteral feeding pumps, ventilators, anesthesia … Attempts to interconnect anesthesia machines with electrosurgical units and lasers to prevent them from … of laparoscopic CO2 insufflation if heart rate and blood pressure are not monitored), and to alert anesthesia … and cardiopulmonary bypass personnel if the anesthesia ventilator is turned off when weaning the patient … has proven true for capital equipment (e.g., physiologic monitors, defibrillators, infusion pumps, anesthesia

2166. Deaths Not Foretold: Are Unexpected Deaths Useful Patient Safety Signals? | PSNet
      psnet.ahrq.gov/web-mm/deaths-not-foretold-are-unexpected-deaths-useful-patient-safety-signals
      March 01, 2004 - patients with any code for cancer, trauma, or an immunocompromised state Complications of anesthesia … Complications attributable to anesthesia Discharges with ICD-9-CM diagnosis codes for anesthesia

2167. Mod01-Grand-Rounds-Slides (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/candor/grandrounds/mod01-grand-rounds-slides.pdf
      April 01, 2016 - Anesthesia was scheduled to be present for this procedure, but due to other emergencies, the GI physician … When he arrived, anesthesia was no longer available. … ) ■ The University of Illinois at Chicago adopted improved policies regarding anesthesia coverage

2168. Grand Rounds Presentation | Agency for Healthcare Research and Quality
      www.ahrq.gov/patient-safety/settings/hospital/candor/grand-rounds.html
      August 01, 2022 - Anesthesia was scheduled to be present for this procedure, but due to other emergencies, the GI physician … When he arrived, anesthesia was no longer available. … The University of Illinois at Chicago adopted improved policies regarding anesthesia coverage for cases

2169. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49774/psn-pdf
      November 01, 2016 - hemorrhages.(6) In such cases, hypotension is explained away as "the result of spinal or epidural anesthesia … to have significant bleeding later emerge when severe hypertensive pressures return, after regional anesthesia … the Council on Patient Safety in Women's Health Care (a consortium of major obstetric, nursing, and anesthesia

2170. Retained Surgical Items: Definition and Epidemiology. | PSNet
      psnet.ahrq.gov/primer/retained-surgical-items-definition-and-epidemiology
      September 15, 2024 - Although RSI is also an abbreviation for the anesthesia procedure, “rapid sequence induction,” confusion … includes any time after completion of the wound skin closure, even if the patient is still in the OR under anesthesia … December 22, 2010 WebAIRS Anesthesia Incident Reporting System.

2171. In Conversation with...Patrick S. Romano, MD, MPH | PSNet
      psnet.ahrq.gov/perspective/conversation-withpatrick-s-romano-md-mph
      July 10, 2024 - PR: One of the ones that we retired was the original PSI-1, which was Complications of Anesthesia. … to code postoperative nausea, which of course is a very common and expected side effect of general anesthesia … the Patient Safety Indicators were clearly associated with much worse outcomes, but Complications of Anesthesia

2172. Quality Measures for Colonoscopy (pdf file)
      digital.ahrq.gov/sites/default/files/docs/resource/Logan_QMforColonoscopy_Narrative_v4.pdf
      December 12, 2008 - sedation medications were used, where there was residual sedation from a prior procedure, or where anesthesia … sedation from prior procedure present" (Preprocedure screen), • If there is documentation of general anesthesia … (Level of sedation = "general anesthesia" ) or that an anesthesiologist or nurse anesthetist managed

2173. How much and what local adaptation is acceptable? A comparison of 24 surgical safety checklists in Switzerland. | PSNet
      psnet.ahrq.gov/issue/how-much-and-what-local-adaptation-acceptable-comparison-24-surgical-safety-checklists
      July 27, 2022 - May 19, 2021 Safety and Quality in Perioperative Anesthesia Care.

2174. Exploring stakeholder perceptions around implementation of the Operating Room Black Box for patient safety research: a qualitative study using the theoretical domains framework. | PSNet
      psnet.ahrq.gov/issue/exploring-stakeholder-perceptions-around-implementation-operating-room-black-box-patient
      November 04, 2020 - October 27, 2022 Systematic review of intraoperative anesthesia handoffs and handoff

2175. How willing are patients to question healthcare staff on issues related to the quality and safety of their healthcare? An exploratory study. | PSNet
      psnet.ahrq.gov/issue/how-willing-are-patients-question-healthcare-staff-issues-related-quality-and-safety-their
      July 31, 2008 - June 9, 2021 View More Related Resources Anesthesia-related closed

2176. Interprofessional training and communication practices among clinicians in the postoperative ICU handoff. | PSNet
      psnet.ahrq.gov/issue/interprofessional-training-and-communication-practices-among-clinicians-postoperative-icu
      February 06, 2019 - Anesthesia residents, registered nurses, and advanced practice providers indicated that they had not

2177. How To Choose a PSO | PSO
      pso.ahrq.gov/work-with/choose
      November 01, 2020 - Some PSOs specialize by topic area, such as anesthesia or medication adverse events, so you may want

2178. Psn-Pdf (pdf file)
      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.

2179. Evidence-based Practice Center Systematic Review Protocol (pdf file)
      effectivehealthcare.ahrq.gov/sites/default/files/pdf/patient-safety-practices_research-protocol.pdf
      November 09, 2011 - Glycemic control by impl evidence-based interv pract that prevent hypoglycemia  Use of preoperative anesthesia … checklists (Complications due to anesthesia equipment failures)  Protocols for high risk drugs,

2180. Psn-Pdf (pdf file)
      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