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Showing results for "culture of safety".

9341. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/33835/psn-pdf
      June 01, 2017 - is internationally recognized for using routine data to identify disparities in quality and patient safety … In one hospital I worked at, the microbiologist had to come in to deal with your blood culture. … So, you were encouraged not to do blood cultures on the weekend. … We published in Quality and Safety in Health Care in 2009; the study received huge amounts of press … Our hypothesis was that if the weekend effect was really a quality or safety issue, then we might expect

9342. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/45156/psn-pdf
      June 22, 2017 - Some of this lack of effect may be due to users engaging in workarounds that bypass safety features … Use of workarounds was associated with new potential safety risks, but the authors note that workarounds … often represent a reasonable adaptation on the part of frontline staff—especially if the technology … They therefore advocate for more formal characterization of workarounds as a part of human factors engineering … approaches to improving safety.

9343. Medication Errors in Retail Pharmacies: Wrong Patient, Wrong Instructions. | PSNet
      psnet.ahrq.gov/web-mm/medication-errors-retail-pharmacies-wrong-patient-wrong-instructions
      March 19, 2019 - Not meeting this Joint Commission requirement and failing to follow the patient safety safeguard of the … National observational study of prescription dispensing accuracy and safety in 50 pharmacies. … The Differences Between Human Error, At-Risk Behavior, and Reckless Behavior Are Key to a Just Culture … March 19, 2019 The safety of electronic prescribing: manifestations, mechanisms, and … and Quality April 26, 2023 Creating a stronger culture of safety within US

9344. Emergency Error | PSNet
      psnet.ahrq.gov/web-mm/emergency-error
      January 18, 2013 - The case raised many questions about the safety of and errors associated with emergency surgery. … Quality and safety on an acute surgical ward: an exploratory cohort study of process and outcome. … Effect of a comprehensive surgical safety system on patient outcomes. … April 24, 2018 Association of diagnostic stewardship for blood cultures in critically … ill children with culture rates, antibiotic use, and patient outcomes: results of the Bright STAR Collaborative

9345. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/60910/psn-pdf
      January 01, 2021 - hospital-and-system-wide-interventions-health-care-associated-infections- systematic-review This systematic review examined effectiveness of … strategies-prevent-healthcare-associated-infections-through-hand-hygiene https://psnet.ahrq.gov/issue/psychological-safety-and-infection-prevention-practices-results-national-survey … https://psnet.ahrq.gov/issue/psychological-safety-and-infection-prevention-practices-results-national-survey

9346. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/842762/psn-pdf
      January 18, 2023 - healthcare workers and patients after medical error through mutual healing: another step towards patient safety … healthcare workers and patients after medical error through mutual healing: another step towards patient safety … psnet.ahrq.gov/issue/fatal-solutions-how-healthcare-system-used-tragedy-transform-itself-and-redefine-just-culture

9347. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/36455/psn-pdf
      December 22, 2010 - the American Association of Critical Care Nursing and the American College of Chest Physicians, calls … for improving patient safety in the intensive care unit (ICU) by redesigning the ICU work environment … The authors cite the recommendations of the seminal Institute of Medicine reports on medical errors … and health care quality as drivers of their recommendations to carry out multidisciplinary education … and patient care, encourage patient participation in safety measures, and evaluate providers on their

9348. Safe Surgery 2020. | PSNet
      psnet.ahrq.gov/issue/safe-surgery-2015
      February 22, 2023 - socio-cultural dynamics in hospital settings: a study of staff experiences of speaking up across seven … for safety I and safety II. … the time": the surgical safety checklist, patient safety, and the everyday experience of practice variation … July 1, 2016 Implementation of the surgical safety checklist in South Carolina hospitals … May 11, 2016 Surgical team member assessment of the safety of surgery practice in 38

9349. Improving healthcare systems' disclosures of large-scale adverse events: a Department of Veterans Affairs leadership, policymaker, research and stakeholder partnership. | PSNet
      psnet.ahrq.gov/issue/improving-healthcare-systems-disclosures-large-scale-adverse-events-department-veterans
      August 18, 2021 - Improving healthcare systems' disclosures of large-scale adverse events: a Department of Veterans Affairs … staff understanding of the rationale for disclosure. … Improving healthcare systems' disclosures of large-scale adverse events: a Department of Veterans Affairs … November 18, 2016 Exploring the association between organizational culture and large-scale … June 28, 2013 Measuring the cost of hospital adverse patient safety events.

9350. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/37773/psn-pdf
      May 21, 2008 - critical-incident-reporting-system-emergency-medicine This article explains how critical incident reporting systems and safety … culture can help ensure successful error reduction efforts in both general and emergency medicine.

9351. Patient Safety Improvement Corps: An AHRQ/VA partnership. | PSNet
      psnet.ahrq.gov/issue/patient-safety-improvement-corps-ahrqva-partnership
      December 24, 2008 - May 24, 2015 Training of Hospital Staff To Respond to a Mass Casualty Incident. … July 13, 2022 Evaluation of Quality, Safety, and Value in Veterans Health Administration … September 15, 2021 Implementing a Program of Patient Safety in Small Rural Hospitals. … A case of cascade iatrogenesis. … Systemic vulnerabilities to suicide among veterans from the Iraq and Afghanistan conflicts: review of

9352. Adverse events and hospital-acquired conditions associated with potential low-value care in Medicare beneficiaries. | PSNet
      psnet.ahrq.gov/issue/adverse-events-and-hospital-acquired-conditions-associated-potential-low-value-care-medicare
      May 19, 2021 - This study explored the association between eight low-value care procedures and length of stay (LOS … overuse of medical tests and treatments at US hospitals using Medicare claims. … September 7, 2022 Effect of pharmacist email alerts on concurrent prescribing of opioids … March 5, 2008 Association of display of patient photographs in the electronic health … August 7, 2019 The relationship between culture of safety and rate of adverse events

9353. Should medical errors be disclosed to pediatric patients? Pediatricians' attitudes toward error disclosure. | PSNet
      psnet.ahrq.gov/issue/should-medical-errors-be-disclosed-pediatric-patients-pediatricians-attitudes-toward-error
      June 15, 2011 - The practice of disclosing errors to patients is considered the standard of care, but many physicians … for disclosure in this study suggests that prior work in this area is successfully changing physician culture … February 24, 2011 Effects of state opioid prescribing laws on use of opioid and other … October 4, 2011 View More Related Resources In their own words: safety … of medical errors.

9354. Raising the alarm: a cross-sectional study exploring the factors affecting patients' willingness to escalate care on surgical wards. | PSNet
      psnet.ahrq.gov/issue/raising-alarm-cross-sectional-study-exploring-factors-affecting-patients-willingness-escalate
      September 12, 2016 - April 6, 2015 Effectiveness of interventions to improve patient handover in surgery: … of patients, clinical staff, and administrators. … February 7, 2024 Standardization and visualization of the surgical time-out. … The impact of medical errors. … December 22, 2010 Creating safety culture on nursing units: human performance and organizational

9355. Case not closed: prescription errors 12 years after computerized physician order entry implementation. | PSNet
      psnet.ahrq.gov/issue/case-not-closed-prescription-errors-12-years-after-computerized-physician-order-entry
      April 08, 2011 - The authors argue for surveillance of electronic prescribing in order to detect medication errors . … Lessons learned from a systems approach to engaging patients and families in patient safety … January 24, 2024 Determinants of burnout and other aspects of psychological well-being … May 5, 2021 An intervention to increase situational awareness and the Culture of Mutual … January 20, 2021 Effects of CPOE-based medication ordering on outcomes: an overview of

9356. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/841566/psn-pdf
      December 14, 2022 - , but are given the time to do it within a culture of safety, where they feel they can speak up (report … Workforce safety is part of patient safety. … There are many lessons here, including communication strategies, culture, leadership, teamwork training … We wish to promote systems of safety to ensure that safety remains durable, even at times of immense … I have a personal belief that if we unleash the voice of the patient in quality reporting, we are going

9357. In Conversation With... Ann Gaffey, RN, MSN, CPHRM and Bruce Spurlock, MD | PSNet
      psnet.ahrq.gov/perspective/conversation-ann-gaffey-rn-msn-cphrm-and-bruce-spurlock-md
      March 30, 2020 - Most of our work is in patient safety and quality in the hospital space. … The new cross-cutting topics, such as Safety Culture, Teamwork and Communication, etc. also help to highlight … For all of the patient safety topics, we need to think about how to maximize the use of technology. … All of that affects patient safety. … The included cross-cutting topics/practices are: improving safety culture; teamwork and team training

9358. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49466/psn-pdf
      October 14, 2004 - At a deeper level, physicians need to make sure they do not contribute to a culture in which non- physician … entry (CPOE) and the electronic medical record (EMR) create safety mechanisms to assure that important … Eisenberg Patient Safety Awards. System innovation: Concord Hospital. … Making health care safer: a critical analysis of patient safety practices. … Patient Safety Leadership WalkRounds. Jt Comm J Qual Saf. 2003;29:16-26.

9359. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/848108/psn-pdf
      April 26, 2023 - Workplace culture and human resource availability are common barriers to best practices To understand … Numerous barriers to reporting exist including fear of consequences, a culture of blame, perception … and non-punitive manner are needed, as are clear reporting guidelines and cultures that embrace humility … Quality Use of Medicines – medication safety issues in naming; look?alike, sound? … The attitudes and beliefs of healthcare professionals on the causes and reporting of medication errors

9360. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49844/psn-pdf
      October 01, 2018 - risk posed by overcrowded EDs necessitates having a proactive, systems-based approach grounded in a culture … of safety to ensure that the highest value care is reliably provided to fragile patients seeking emergency … High reliability organizations maintain an institutional culture preoccupied with rooting out system … a myriad of stressors.(7) In addition to a robust event reporting and safety infrastructure, high reliability … The long road to patient safety: a status report on the patient safety systems.