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psnet.ahrq.gov/node/50754/psn-pdf
December 18, 2019 - Determine systems approaches that facilitate advance care planning between the healthcare team,
patient … It is important for health care providers and the lay public alike to understand that DN(A)R increasingly … Health care providers may sometimes erroneously interpret
DN(A)R status to mean that a patient wants … planning or goals-of-care conversations in
medical school and postgraduate training along with systems-level … and
other EHR systems to make code status a prominent and easily-seen entry near or at the top of the
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psnet.ahrq.gov/perspective/media-essential-if-sometimes-arbitrary-promoter-patient-safety
October 01, 2009 - searching for systems factors, without immediately zeroing in on more dramatic and obvious sharp-end … So I think it's a combination of both people and systems. … between the role that systems play in problems and the role that people play in problems, and the interplay … Experience
May 1, 2005
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Health … Care Providers
Health Care Executives and Administrators
Public Reporting
Role of the Media
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psnet.ahrq.gov/web-mm/delay-appropriate-diagnosis-and-treatment-leading-death-pulmonary-embolism
December 31, 2024 - patient population with massive or submassive PE, streamline patient assessment, and facilitate and … latent systems issues. … , and systems modifications. … Healthcare systems should continually evaluate for and address communication barriers that lead to these … Multimodality Assessment of Right Ventricular Strain in Patients With Acute Pulmonary Embolism.
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psnet.ahrq.gov/node/49717/psn-pdf
September 01, 2014 - Describe the importance of understanding the nature of the acute pain and its relationship to the
chronic … cross-tolerance and facilitate ease of dose calculations. … The opioid abuse and misuse epidemic: implications for
pharmacists in hospitals and health systems. … Department of Health and Human Services. … Department of Health and Human Services.
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psnet.ahrq.gov/perspective/opioid-overdose-patient-safety-problem
May 01, 2017 - Risk mitigation measures, such as urine toxicology screening, patient contracts, and risk assessment … prescriber PDMP use and providing integrated query systems that minimize provider burden will help to … While there are no perfect risk assessment instruments, universal screening and triaging of chronic opioid … , and a smattering of tricyclics and so on. … May 8, 2017
Assessment of the FDA Risk Evaluation and Mitigation Strategy for transmucosal
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psnet.ahrq.gov/node/837324/psn-pdf
July 08, 2022 - systems conducted their own internal efforts, and all 220 California hospitals were
exposed to state-wide … Safety assessment of a large-scale
improvement collaborative to reduce nulliparous cesarean delivery … [9] Department of Health and Human Services Office of Disease Prevention and Health Promotion. … Safety Assessment of a Large-Scale
Improvement Collaborative to Reduce Nulliparous Cesarean Delivery … Safety Assessment of a Large-Scale
Improvement Collaborative to Reduce Nulliparous Cesarean Delivery
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psnet.ahrq.gov/web-mm/dangers-missing-epidural-abscess-multiple-visits-and-delayed-diagnosis-severely-negative
April 27, 2022 - painful areas, and thorough neurologic assessment including reflexes, grading of muscle activity, sensory … assessment, and gait. … In patients with severe symptoms or risk factors, a post-void residual bladder volume and assessment … communicate a history, or a patient unwilling to undergo testing or evaluation necessary for diagnosis. 34 Systems … and symptoms of SEA.
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psnet.ahrq.gov/perspective/conversation-charles-ornstein
October 01, 2009 - So I think it's a combination of both people and systems. … between the role that systems play in problems and the role that people play in problems, and the interplay … searching for systems factors, without immediately zeroing in on more dramatic and obvious sharp-end … March 1, 2007
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Hospitals
Health … Care Providers
Health Care Executives and Administrators
Active Errors
Latent Errors
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psnet.ahrq.gov/node/49595/psn-pdf
December 01, 2009 - systems-level issues that
facilitate triggering of the superficial vein thrombosis illness script ( … for
the sake of another, larger group of clinicians who consume and act upon the terminology (and this … although "adenoma" usually connotes benignity
Preoperative
clearance
• "clearance" implies certainty in assessment … Department of Health and Human Services. … Department of Health and Human Services.
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psnet.ahrq.gov/node/60744/psn-pdf
July 29, 2020 - killer of women and better understanding of gender
differences in the presentation and pathophysiology … see the patient or review the medical record.33,34 Recent
improvements in electronic medical record systems … relationship.34 While formal cardiology consultations for preoperative risk stratification or heart
failure assessment … Pharmacotherapy Self-Assessment Program, seventh
edition (PSAP-VII) Cardiology.2020:179-99.
13. … Assessment
and Treatment of Patients With Type 2 Myocardial Infarction and Acute Nonischemic Myocardial
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psnet.ahrq.gov/web-mm/failure-adhere-dietary-restrictions-leading-complications-and-poor-follow
March 29, 2023 - This risk-benefit assessment needs to be performed individually based on the specific clinical situation … In cases where this is unclear, formal cognitive assessment may be needed, as cognitive disorders are … assessment. 30 Conclusion This patient probably did not suffer any harm as a result of this communication … View More
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Emergency Departments
Operating Room
Health … Care Providers
Nurses
Emergency Medicine
View More
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psnet.ahrq.gov/perspective/conversation-david-juurlink-md-phd
May 22, 2017 - of Medicine 1980 Porter and Jick. … , and a smattering of tricyclics and so on. … Risk mitigation measures, such as urine toxicology screening, patient contracts, and risk assessment … prescriber PDMP use and providing integrated query systems that minimize provider burden will help to … While there are no perfect risk assessment instruments, universal screening and triaging of chronic opioid
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psnet.ahrq.gov/web-mm/isolated-clot-real-error
December 01, 2013 - Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services … Department of Health and Human Services. … Department of Health and Human Services. … 2003
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Intensive Care Units
Health … Care Providers
Critical Care
Diagnostic Test Interpretation Error
Anticoagulants
View
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psnet.ahrq.gov/web-mm/too-many-cooks-kitchen
March 07, 2018 - Use of TEE allows direct visualization of cardiac filling and contractility, as well as assessment of … Research has shown that such systems improve response time and overall patient outcomes. 21
The … Trauma Mortality in Mature Trauma Systems: Are We Doing Better? … Comparison of Early Warning Scoring Systems for Hospitalized Patients With and Without Infection at Risk … Care Providers
Surgery
Orthopedic Surgery
Surgical Complications
View More
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psnet.ahrq.gov/node/72739/psn-pdf
February 10, 2021 - patient population with massive or
submassive PE, streamline patient assessment, and facilitate and … latent systems issues. … , and systems
modifications. … Healthcare systems should continually evaluate for and address communication barriers that lead to these … Multimodality Assessment of Right Ventricular Strain in
Patients With Acute Pulmonary Embolism.
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psnet.ahrq.gov/node/73334/psn-pdf
August 01, 2024 - light-linking systems.17 While
additional research will be required to determine which of these solutions … continuous medication to an intermittent one and
delivery of inconsistent doses and rates outside of … Ontario health technology assessment
series. 2014;14(5):1.
18. … Ontario health technology
assessment series. 2012;12(16):1.
43. Furniss D, Back J, Blandford A. … Department of Health and Human Services.
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psnet.ahrq.gov/node/49808/psn-pdf
October 01, 2017 - , during transfer, and
posttransfer.(4)
Pretransfer preparation should include an assessment of the … of
modern portable and mobile health equipment. … in the assembly of needed equipment and medications. … Department of Health and Human Services. … Department of Health and Human Services.
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psnet.ahrq.gov/perspective/conversation-enrico-coiera-mb-bs-phd
February 01, 2014 - Coiera has researched and written about clinical communication processes and information systems. … EC : Very interesting work has come out of the design of computer systems and human–computer interaction … EC : I don't believe that the design of modern health IT systems actually reflects this literature and … It's very important to recognize that these devices are built for the consumer world; while they're very … Care Providers
Quality and Safety Professionals
Information Professionals
Organizational Behaviorists
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psnet.ahrq.gov/web-mm/fatal-patient-controlled-analgesia-pca-opioid-induced-respiratory-depression
May 26, 2021 - These best practices include, but are not limited to, comprehensive identification and assessment of … Identification and Assessment of High-Risk Patients
Risk factors for opioid-induced respiratory depression … , assessment and documentation of patient responses to opioid administration. 30 In postoperative patients … database, the interval between the last nursing assessment and detection of respiratory depression was … Safety assessment of postoperative pain management by an acute pain service.
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psnet.ahrq.gov/node/49822/psn-pdf
March 01, 2018 - Factors that increase risk of extension to proximal DVT and swing the balance in favor of anticoagulation … widely used in the treatment and prevention of
VTE. … Duration of anticoagulant therapy for deep vein thrombosis and pulmonary embolism. … Department of Health and Human Services. … Department of Health and Human Services.