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Showing results for "consequences".

  1. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/33822/psn-pdf
    January 01, 2017 - In Conversation With… Paul H. O'Neill, MPA January 1, 2017 In Conversation With… Paul H. O'Neill, MPA. PSNet [internet]. 2017. https://psnet.ahrq.gov/perspective/conversation-paul-h-oneill-mpa Editor's note: Mr. O'Neill served as the United States Secretary of the Treasury under President George W. Bush and, prio…

  2. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49819/psn-pdf
    February 01, 2018 - Signout Fallout February 1, 2018 Starmer AJ, Landrigan CP. Signout Fallout. PSNet [internet]. 2018. https://psnet.ahrq.gov/web-mm/signout-fallout Case Objectives Understand the role of communication failures in medical errors and preventable adverse events. Review the evidence in support of handoff improvement pr…

  3. Weight and Height Juxtaposition in the Electronic Medical Record Causing an Accidental Medication Overdose | PSNet

    psnet.ahrq.gov/web-mm/weight-and-height-juxtaposition-electronic-medical-record-causing-accidental-medication
    March 15, 2023 - Weight and Height Juxtaposition in the Electronic Medical Record Causing an Accidental Medication Overdose Citation Text: Jain NP, Dakwa D. Weight and Height Juxtaposition in the Electronic Medical Record Causing an Accidental Medication Overdose. PSNet [internet]. Rockville (MD): Agency for Healthcare Rese…

  4. Missed Appendicitis | PSNet

    psnet.ahrq.gov/web-mm/missed-appendicitis
    March 13, 2013 - SPOTLIGHT CASE Missed Appendicitis Citation Text: Adams JG. Missed Appendicitis. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2003. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNote 7 XML E…

  5. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/866205/psn-pdf
    July 10, 2024 - Hemorrhagic Shock after Elective Spine Surgery: Failure to Rescue after Limited Response to Nursing Concerns. July 10, 2024 Zakaluzny S. Hemorrhagic Shock after Elective Spine Surgery: Failure to Rescue after Limited Response to Nursing Concerns. PSNet [internet]. 2024. https://psnet.ahrq.gov/web-mm/hemorrhagic-sh…

  6. Silent Pain in the Neck | PSNet

    psnet.ahrq.gov/web-mm/silent-pain-neck
    August 19, 2020 - Silent Pain in the Neck Citation Text: Bittner EA. Silent Pain in the Neck. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2011. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged Pu…

  7. Wrong Catheter in the Right Patient | PSNet

    psnet.ahrq.gov/web-mm/wrong-catheter-right-patient
    May 16, 2022 - Wrong Catheter in the Right Patient Citation Text: Chia C, Molla M. Wrong Catheter in the Right Patient. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2020. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML En…

  8. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/60269/psn-pdf
    April 29, 2020 - Delayed Management of Necrotizing Soft Tissue Infection – Who does the Patient Belong To? April 29, 2020 Rinderknecht T, Utter GH. Delayed Management of Necrotizing Soft Tissue Infection – Who does the Patient Belong To? PSNet [internet]. 2020. https://psnet.ahrq.gov/web-mm/delayed-management-necrotizing-soft-tiss…

  9. In Conversation With…Kaveh G. Shojania, MD | PSNet

    psnet.ahrq.gov/perspective/conversation-withkaveh-g-shojania-md
    September 01, 2011 - In Conversation With…Kaveh G. Shojania, MD September 1, 2011  Also Read an Essay Citation Text: In Conversation With…Kaveh G. Shojania, MD. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 20…

  10. Incident Reporting: More Attention to the Safety Action Feedback Loop, Please | PSNet

    psnet.ahrq.gov/perspective/incident-reporting-more-attention-safety-action-feedback-loop-please
    September 01, 2011 - Incident Reporting: More Attention to the Safety Action Feedback Loop, Please Teryl K. Nuckols, MD, MSHS | September 1, 2011  Also Read a Conversation View more articles from the same authors. Citation Text: Nuckols TK. Incident Reporting: More Attention to the …

  11. In Conversation With… Sidney Dekker, MA, MSc, PhD | PSNet

    psnet.ahrq.gov/perspective/conversation-sidney-dekker-ma-msc-phd
    February 26, 2025 - But, there are consequences.

  12. In Conversation With… Kaveh Shojania, MD | PSNet

    psnet.ahrq.gov/perspective/conversation-kaveh-shojania-md
    February 26, 2025 - The snails said we should study this because there are opportunity costs, unintended consequences, etc

  13. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/33706/psn-pdf
    February 01, 2011 - What the Journal did not allow us to publish was the cost consequences of massively reducing our postoperative

  14. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/33783/psn-pdf
    April 01, 2015 - One sad thing about patient safety is the consequences are borne almost entirely by the patient.

  15. Medication Handling and Compounding Errors in the Operating Room. | PSNet

    psnet.ahrq.gov/web-mm/medication-handling-and-compounding-errors-operating-room
    May 16, 2022 - WebM&M Cases To Dilute or Not Dilute: Drug Errors and Consequences

  16. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/849661/psn-pdf
    June 28, 2023 - pre-incision checklist likely contributed to this near miss, which may happen again in the future (with worse consequences

  17. Too Many Cooks in the Kitchen | PSNet

    psnet.ahrq.gov/web-mm/too-many-cooks-kitchen
    March 07, 2018 - Operating Room April 27, 2022 WebM&M Cases The Consequences

  18. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/73102/psn-pdf
    July 01, 2022 - are often frail and vulnerable, leaving them at increased risk of adverse drug effects and negative consequences

  19. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/60268/psn-pdf
    April 29, 2020 - 12.3%), all of which were considered minor complications that did not result in significant clinical consequences

  20. Misconnection Leading to Arterial Thrombosis | PSNet

    psnet.ahrq.gov/web-mm/misconnection-leading-arterial-thrombosis
    January 29, 2021 - Misconnecting epidural infusion tubing or oxygen tubing to an intravenous catheter may have deadly consequences
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