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psnet.ahrq.gov/perspective/rethinking-root-cause-analysis
August 21, 2016 - Annual Perspective
Rethinking Root Cause Analysis
Kiran Gupta, MD, MPH, and Audrey Lyndon, PhD | January 1, 2016
View more articles from the same authors.
Citation Text:
Gupta K, Lyndon A. Rethinking Root Cause Analysis. PSNet [internet]. Rockville (MD): Age…
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psnet.ahrq.gov/node/49436/psn-pdf
February 26, 2004 - transfusion-associated infectious disease.(1) As is well demonstrated in this case, safe transfusion begins
with the correct … ED staffs are acutely sensitive to these issues and have adopted strategies
to help achieve the correct … Bar codes
were introduced to correct this flawed practice, but the solution provided merely an illusion
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psnet.ahrq.gov/issue/shared-mdis-can-cross-contamination-be-avoided
May 03, 2023 - December 23, 2016
Correct use of inhalers: help patients breathe easier.
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psnet.ahrq.gov/issue/patient-safety-25
December 14, 2022 - January 19, 2022
Use of complete medication history to identify and correct transitions-of-care
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psnet.ahrq.gov/issue/high-reliability-organizations-hros-what-they-know-we-dont-part-i
July 27, 2022 - July 27, 2022
Correct use of inhalers: help patients breathe easier.
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psnet.ahrq.gov/issue/advancing-safety-closed-loop-communication-test-results
November 13, 2019 - February 7, 2024
These patients had to lobby for correct diabetes diagnoses.
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psnet.ahrq.gov/web-mm/inside-time-out
March 01, 2004 - With respect to the "content" of a time out, the Joint Commission requires confirmation of the correct … patient, correct side and site, agreement on the procedure to be performed, correct patient position … May 27, 2010
Doing the "right" things to correct wrong-site surgery.
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psnet.ahrq.gov/issue/strong-surgery
October 15, 2018 - October 15, 2018
What is Correct-Site Surgery?
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psnet.ahrq.gov/node/49805/psn-pdf
September 01, 2017 - Having a
dedicated radiologist read all images the following workday ultimately led to this patient's correct … indication of a
life-threatening emergency, and a high level of expertise may be required for their correct … Correct interpretation may provide critical information in life-threatening emergencies.
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psnet.ahrq.gov/node/50930/psn-pdf
February 21, 2020 - These include patient receipt of the incorrect prescription (e.g., receiving
the wrong drug or the correct … Pharmacists ensure that patients not only get the correct medication and dosing, but that they have the … review and approval of prescriptions before nurses can access a
medicine is critical to ensuring the correct
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psnet.ahrq.gov/perspective/pharmacist-role-patient-safety
June 29, 2020 - These include patient receipt of the incorrect prescription (e.g., receiving the wrong drug or the correct … Pharmacists ensure that patients not only get the correct medication and dosing, but that they have the … review and approval of prescriptions before nurses can access a medicine is critical to ensuring the correct
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psnet.ahrq.gov/web-mm/local-anesthesia-induced-coma-during-total-knee-arthroplasty
October 27, 2021 - It also highlights that the correct diagnosis and treatment of LAST in the operating room is critically … member should introduce him or herself by name and role, confirm out loud that they are performing the correct … operation on the correct patient and site and then verbally review with one another, in turn, the critical
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psnet.ahrq.gov/web-mm/hazards-loading-doses
December 01, 2003 - The ED physician ordered the correct loading dose of intravenous (IV) phenytoin, to be administered every … computerized prescribing systems should have checks in place that flag potential dosing errors and provide correct … systems should have dosing checks in place that not only flag potential dosing errors, but also provide correct
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psnet.ahrq.gov/issue/accuracy-popular-online-symptom-checker-ophthalmic-diagnoses
March 04, 2011 - As with prior studies , the performance of the online symptom checker in producing the correct diagnosis
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psnet.ahrq.gov/issue/cognitive-forcing-tool-mitigate-cognitive-bias-randomised-control-trial
November 07, 2018 - This simulation study randomized physicians to identify the correct diagnosis in a standardized case
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psnet.ahrq.gov/issue/using-computerized-virtual-cases-explore-diagnostic-error-practicing-physicians
August 20, 2018 - and overall diagnostic performance was poor, with less than a third of respondents identifying the correct
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psnet.ahrq.gov/issue/blink-or-think-can-further-reflection-improve-initial-diagnostic-impressions
November 28, 2012 - recertification examination and found that when they changed answers, it was usually from an incorrect to a correct
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psnet.ahrq.gov/issue/reduction-hospital-wide-clinical-laboratory-specimen-identification-errors-following-process
August 26, 2011 - Correct identification of patient specimens is crucial to timely and accurate diagnosis .
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psnet.ahrq.gov/issue/medical-costs-alzheimers-disease-misdiagnosis-among-us-medicare-beneficiaries
August 20, 2018 - medical services, costing approximately $9,500 to $14,000 more each year, up until the time of their correct
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psnet.ahrq.gov/issue/incidence-multiple-sclerosis-misdiagnosis-referrals-two-academic-centers
April 24, 2018 - misdiagnosis including exposure to high-risk medications with resultant adverse drug events and delay in correct