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psnet.ahrq.gov/web-mm/nosy-business
September 01, 2004 - Nosy Business
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Richard R. Orlandi, MD | April 1, 2010
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The Case A 59-year-old man with a history of idiopathic thrombocytopenic…
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psnet.ahrq.gov/issue/flawed-self-assessment-hand-hygiene-major-contributor-infections-clinical-practice
September 02, 2020 - intensification, missed visits, and scheduled follow-up interval with racial or ethnic disparities in blood … pressure control.
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psnet.ahrq.gov/web-mm/weighing-surgical-safety
August 10, 2019 - SPOTLIGHT CASE
Weighing In on Surgical Safety
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Jay B. Brodsky, MD; Michael Margarson, MD | August 1, 2010
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Case Ob…
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psnet.ahrq.gov/issue/preventing-maternal-death
March 27, 2024 - This recently retired alert targets prevention of maternal death and highlights the need to manage blood … pressure, pay attention to vital signs following cesarean delivery , and hemorrhage.
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psnet.ahrq.gov/web-mm/navigating-chaos-fatal-iatrogenic-liver-injury-patient-admitted-leg-fractures
November 27, 2019 - She had hypotension, with blood pressure around 80s/50s.
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psnet.ahrq.gov/web-mm/hospital-acquired-diabetic-ketoacidosis
November 30, 2023 - ulcer, presented to the emergency department (ED) with asymptomatic post-dialysis hypertension, with a blood … pressure of 246/100. … He reported taking his regular blood pressure medications without any clear trigger for this hypertensive … He was treated in the ED with hydralazine and clonidine, with mild improvement in blood pressure.
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psnet.ahrq.gov/issue/accuracy-pressure-ulcer-events-us-nursing-home-ratings
August 09, 2023 - Study
Accuracy of pressure ulcer events in US nursing home ratings.
Citation Text:
Chen Z, Gleason LJ, Sanghavi P. Accuracy of pressure ulcer events in US nursing home ratings. Med Care. Epub 2022 Aug 4. doi: 10.1097/mlr.0000000000001763
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psnet.ahrq.gov/web-mm/real-heartache
October 01, 2018 - On physical examination, his initial blood pressure was elevated at 192/100 mm Hg, but his heart rate … cocktail" (an oral antacid/anesthetic combination) was given, and the patient reported symptom relief; his blood … pressure also normalized.
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psnet.ahrq.gov/issue/does-time-pressure-have-negative-effect-diagnostic-accuracy
January 16, 2019 - Study
Does time pressure have a negative effect on diagnostic accuracy?
Citation Text:
ALQahtani DA, Rotgans JI, Mamede S, et al. Does Time Pressure Have a Negative Effect on Diagnostic Accuracy? Acad Med. 2016;91(5):710-716. doi:10.1097/ACM.0000000000001098.
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psnet.ahrq.gov/issue/emergency-departments-are-higher-risk-locations-wrong-blood-tube-errors
November 17, 2021 - intensification, missed visits, and scheduled follow-up interval with racial or ethnic disparities in blood … pressure control.
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psnet.ahrq.gov/web-mm/sudden-collapse-during-upper-gastrointestinal-endoscopy-expect-unexpected
November 15, 2023 - heart rate monitors, two-lead electrocardiography, continuous capnography , and non-invasive arterial blood … pressure measurements. … Adult guidelines recommend monitoring blood pressure, oxygenation, and heart rate along with clinical
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psnet.ahrq.gov/web-mm/lapse-antibiotics-leads-sepsis
October 17, 2012 - Upon further evaluation, she was noted to have a rapid heart rate and low blood pressure. … Several hours later, the patient was noted to be lethargic with a low blood pressure. … While the inpatient care team discussed possible causes for her low blood pressure, the microbiology
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psnet.ahrq.gov/issue/shift-shift-nursing-handover-interventions-associated-improved-inpatient-outcomes-falls
December 14, 2022 - Review
Shift-to-shift nursing handover interventions associated with improved inpatient outcomes - falls, pressure injuries and medication administration errors: an integrative review.
Citation Text:
Hada A, Coyer F. Shift-to-shift nursing handover interventions associated with improved …
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psnet.ahrq.gov/issue/medical-misdiagnoses-put-pressure-patients-stay-engaged
October 05, 2016 - Newspaper/Magazine Article
Medical misdiagnoses put pressure on patients to stay engaged.
Citation Text:
Innes S. Arizona Daily Star. September 12, 2016.
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psnet.ahrq.gov/perspective/conversation-eric-j-topol-md
March 27, 2024 - For example blood pressure, giving a nice screenshot summarizing data for a day, a week, or a month. … For example, some chronic condition that needs to be managed, like glucose or blood pressure but also … We could not get blood pressure with each heartbeat, all the time, real-time streaming while you're sleeping … If I have not received that data beforehand, I will review it during the visit to see how well their blood … pressure is being monitored.
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psnet.ahrq.gov/issue/human-factors-and-quality-improvement-emergency-department-reducing-potential-errors-blood
September 26, 2007 - Study
Human factors and quality improvement in the emergency department: reducing potential errors in blood collection.
Citation Text:
Bashkin O, Caspi S, Swissa A, et al. Human Factors and Quality Improvement in the Emergency Department: Reducing Potential Errors in Blood Collection. J …
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psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.224_slideshow.ppt
October 01, 2010 - falls in dialysis centers include:
Patient age
Total number of co-morbidities
Predialysis systolic blood … pressure
History of falls
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Cook WL, Tomlison G, Donaldson M, Markowitz SN, Naglie G, Sobolev
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psnet.ahrq.gov/web-mm/overdose-oxygen
June 01, 2010 - She remained afebrile with a normal blood pressure and pulse, and the remainder of the physical examination
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psnet.ahrq.gov/issue/case-transfusion-error-trauma-patient-subsequent-root-cause-analysis-leading-institutional
April 06, 2022 - Commentary
A case of transfusion error in a trauma patient with subsequent root cause analysis leading to institutional change.
Citation Text:
Clifford SP, Mick PB, Derhake BM. A Case of Transfusion Error in a Trauma Patient With Subsequent Root Cause Analysis Leading to Institutional Ch…
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psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.227_slideshow.ppt
November 01, 2010 - His white blood cell count, which had been normal previously, was now very high (31,000), and his blood … pressure was lower than usual