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Total Results: 376 records

Showing results for "bedside shift report".

81. Double Dosing, by the Rules | PSNet
    psnet.ahrq.gov/web-mm/double-dosing-rules
    February 03, 2010 - Conduct a nursing education program that stresses the importance of bringing the MAR to the bedside and … Readers should not interpret any statement in this report as an official position of AHRQ or of the U.S … February 3, 2010 ISMP medication error report analysis. … June 16, 2019 ISMP medication error report analysis. … Aspergillus Mediastinitis & Endocarditis in a Pediatric Patient Complicating Cardiac Surgery and Bedside

82. Psn-Pdf (pdf file)
    psnet.ahrq.gov/node/36021/psn-pdf
    September 24, 2016 - This study discovered that nurses experienced more than eight work system failures during an 8-hour shift … The authors advocate for continued efforts to differentiate between tactics taken by bedside nurses

83. Diagnostic errors and abnormal diagnostic tests lost to follow-up: a source of needless waste and delay to treatment. | PSNet
    psnet.ahrq.gov/issue/diagnostic-errors-and-abnormal-diagnostic-tests-lost-follow-source-needless-waste-and-delay
    December 22, 2008 - frames diagnostic errors and missed test results within the context of the Crossing the Quality Chasm report … December 22, 2008 Readiness to report medical treatment errors: the effects of safety … September 14, 2022 Bringing change-of-shift report to the bedside: a patient- and family-centered … September 18, 2013 Root cause analysis reports help identify common factors in delayed

84. Nurse/physician communication through a sensemaking lens: shifting the paradigm to improve patient safety. | PSNet
    psnet.ahrq.gov/issue/nursephysician-communication-through-sensemaking-lens-shifting-paradigm-improve-patient
    June 05, 2024 - Related Resources From the Same Author(s) Oncology patients' willingness to report … December 19, 2018 Using incident reports to assess communication failures and patient … July 13, 2010 The Medication Manager: results of a medication at the bedside pilot in

85. Agitated Delirium Contributes to Missed Testing and Delayed Diagnosis of Gastric Perforation | PSNet
    psnet.ahrq.gov/web-mm/agitated-delirium-contributes-missed-testing-and-delayed-diagnosis-gastric-perforation
    June 28, 2023 - Describe how high-quality communication is essential, especially during shift changes and/or difficult … attempts, the NGT was replaced, but X-ray was not performed due to miscommunication at the change of shift … A case report of esophageal perforation: Complication of nasogastric tube placement. … Readers should not interpret any statement in this report as an official position of AHRQ or of the U.S … authors has any affiliation or financial involvement that conflicts with the material presented in this report

86. Lapse in Antibiotics Leads to Sepsis | PSNet
    psnet.ahrq.gov/web-mm/lapse-antibiotics-leads-sepsis
    November 21, 2021 - A recent systematic study suggested that bedside handoffs during nursing shift transition is a potential … solution to the communication errors associated with shift-to-shift handoffs.( 10 ) Problems arising … Nursing staff, physicians in the receiving units, and pharmacy staff all report reminding physicians … Bedside shift-to-shift handoffs: a systematic review of the literature. … Readers should not interpret any statement in this report as an official position of AHRQ or of the U.S

87. Psn-Pdf (pdf file)
    psnet.ahrq.gov/node/846171/psn-pdf
    July 26, 2022 - Describe how high-quality communication is essential, especially during shift changes and/or difficult … hour delay in X-ray confirmation of NGT placement, apparently due to miscommunication at change-of-shift … A case report of esophageal perforation: Complication of nasogastric tube placement. … Readers should not interpret any statement in this report as an official position of AHRQ or of the … authors has any affiliation or financial involvement that conflicts with the material presented in this report

88. Deploying med reconciliation. | PSNet
    psnet.ahrq.gov/issue/deploying-med-reconciliation
    January 06, 2017 - February 17, 2011 Bedside shift report improves patient safety and nurse accountability

89. Failures in communication through documents and documentation across the perioperative pathway. | PSNet
    psnet.ahrq.gov/issue/failures-communication-through-documents-and-documentation-across-perioperative-pathway
    August 07, 2013 - Improving Diagnostic Safety and Quality April 26, 2023 Using incident reports … November 16, 2015 Nurses discuss bedside handover and using written handover sheets. … February 13, 2013 The ins and outs of change of shift handoffs between nurses: a communication … January 7, 2011 Implementing bedside handover: strategies for change management.

90. Misplaced Nasogastric Tube Resulting in Aspiration | PSNet
    psnet.ahrq.gov/web-mm/misplaced-nasogastric-tube-resulting-aspiration
    August 01, 2009 - During nursing shift change, the incoming nurse was told that the NG tube was ready for use. … breakdown of closed loop communication between the physician and the nurse, and between nurses at change of shift … communication between the provider and initial nurse, inaccurate information was conveyed to the oncoming shift … June 16, 2019 ISMP medication error report analysis. … June 16, 2019 ISMP medication error report analysis.

91. On the Other Hand | PSNet
    psnet.ahrq.gov/web-mm/other-hand
    December 12, 2012 - During the night shift, the midnight BP measurement using the right arm revealed a very low pressure … Methods of alerting the bedside practitioner are promising, yet they introduce new safety concerns. … The use of any bedside or applied patient alert (e.g., allergy bracelets, overhead signs, tattoos) relies … Allow time for a comprehensive report at nursing change of shift and during physician "hand-offs." … History March 21, 2009 WebM&M Cases Dangerous Shift

92. A review of verbal order policies in acute care hospitals. | PSNet
    psnet.ahrq.gov/issue/review-verbal-order-policies-acute-care-hospitals
    January 03, 2017 - Related Resources From the Same Author(s) Making the transition to nursing bedside … shift reports. … August 31, 2022 ISMP medication error report analysis. … December 3, 2008 Medication-related patient safety incidents in critical care: a review of reports

93. Towards an understanding of the information dynamics of the handover process in aged care settings—a prerequisite for the safe and effective use of ICT. | PSNet
    psnet.ahrq.gov/issue/towards-understanding-information-dynamics-handover-process-aged-care-settings-prerequisite
    August 19, 2016 - This study reports on the development of a process map for the nursing shift handoff at a geriatric … March 11, 2013 Nurses discuss bedside handover and using written handover sheets. … April 6, 2011 Implementing bedside handover: strategies for change management.

94. Patient Safety and Quality. | PSNet
    psnet.ahrq.gov/issue/patient-safety-and-quality
    January 19, 2022 - July 6, 2011 Bringing change-of-shift report to the bedside: a patient- and family-centered

95. The admission conference call: a novel approach to optimizing pediatric emergency department to admitting floor communication. | PSNet
    psnet.ahrq.gov/issue/admission-conference-call-novel-approach-optimizing-pediatric-emergency-department-admitting
    December 21, 2022 - This project report describes a novel procedure for handoffs from the emergency department to the inpatient … December 5, 2018 Bedside shift report improves patient safety and nurse accountability

96. Psn-Pdf (pdf file)
    psnet.ahrq.gov/node/49536/psn-pdf
    May 01, 2007 - During the night shift, the midnight BP measurement using the right arm revealed a very low pressure … paper and electronic) are often inaccessible to the clinician providing care to the patient at the bedside … Methods of alerting the bedside practitioner are promising, yet they introduce new safety concerns. … The use of any bedside or applied patient alert (e.g., allergy bracelets, overhead signs, tattoos) relies … Allow time for a comprehensive report at nursing change of shift and during physician "hand-offs."

97. Psn-Pdf (pdf file)
    psnet.ahrq.gov/node/865540/psn-pdf
    April 11, 2024 - During nursing shift change, the incoming nurse was told that the NG tube was ready for use. … of closed loop communication between the physician and the nurse, and between nurses at change of shift … communication between the provider and initial nurse, inaccurate information was conveyed to the oncoming shift … Readers should not interpret any statement in this report as an official position of AHRQ or of the … authors has any affiliation or financial involvement that conflicts with the material presented in this report

98. Fatigue in nurses and medication administration errors: a scoping review. | PSNet
    psnet.ahrq.gov/issue/fatigue-nurses-and-medication-administration-errors-scoping-review
    December 01, 2021 - Thirty-one studies reported that long hours , shift work , overtime, and/or poor sleep quality contributed … February 10, 2021 Nursing bedside clinical handover—an integrated review of issues and … calculation errors and other numeracy mishaps in hospitals: analysis of the nature and enablers of incident reports … November 25, 2020 Nurses' shift length and overtime working in 12 European countries:

99. Spotlight Case [MONTH] 2003 (ppt file)
    psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.188_slideshow.ppt
    November 01, 2008 - Spotlight Case [MONTH] 2003 Spotlight Case November 2008 Dangerous Shift Source and Credits … changes Understand the limits of standardizing handoffs in preventing errors at shift change Explain … This transfer happened to coincide with a shift change for both the nursing staff and the physicians … Case: Dangerous Shift (2) The off-going nurse assumed the transfer would take place immediately and … Approximately 45 minutes later, the unit clerk called the infant’s bedside nurse to report that the infant

100. Failure mode and effects analysis: a useful tool for risk identification and injury prevention. | PSNet
     psnet.ahrq.gov/issue/failure-mode-and-effects-analysis-useful-tool-risk-identification-and-injury-prevention
     September 24, 2010 - May 10, 2013 A safe haven for nurses to report medication errors? … April 7, 2010 View More Related Resources Does a unit shift report … April 10, 2019 Implementing bedside handoff in the emergency department: a practice improvement