-
psnet.ahrq.gov/node/48057/psn-pdf
June 26, 2019 - multicenter-study-evaluate-benefits-technology-assisted-workflow-iv-room-
efficiency-costs-and
Medication errors associated with compounding are well-described
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psnet.ahrq.gov/node/50370/psn-pdf
January 01, 2020 - A past WebM&M commentary described an
incident involving miscommunication in the operating room that
-
psnet.ahrq.gov/node/73130/psn-pdf
January 01, 2022 - Vineet Chopra described the development and implementation of MAGIC
in Michigan hospitals.
-
psnet.ahrq.gov/node/47900/psn-pdf
January 01, 2021 - survey, 85% of physicians reported involvement in either an adverse event or near miss, and nearly half
described
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psnet.ahrq.gov/sites/default/files/2024-10/spotlight_case_delayed_symptomatic_subdural_hematoma_slides.pptx
January 01, 2024 - among patients not taking (0.7%) versus those taking antithrombotics (0.6%).11
Mourad and colleagues described … subdural hematomas have been reported to occur after initially negative head CTs, as in the patient described … Olivero and colleagues described 37 patients who underwent surgery for chronic subdural hematomas, 7 … In a series described by Amrhein and colleagues,25 the sensitivity and specificity of a non-enhanced … difficulties with concentration and memory were attributed to the prior concussion (a cognitive bias sometimes described
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psnet.ahrq.gov/node/46043/psn-pdf
April 05, 2017 - This magazine article described how a
13-hospital health system used handoff standardization tools such
-
psnet.ahrq.gov/node/45071/psn-pdf
April 27, 2016 - psnet.ahrq.gov/issue/using-simulation-identify-sources-medical-diagnostic-error-child-physical-abuse
This study described
-
psnet.ahrq.gov/node/45929/psn-pdf
August 23, 2017 - /issue/managing-diagnostic-uncertainty-primary-care-systematic-critical-review
A recent commentary described
-
psnet.ahrq.gov/node/33825/psn-pdf
January 01, 2017 - Indeed, one early study that
described the RCA process within the Veterans Affairs health system did … effectiveness-and-efficiency-root-cause-analysis-medicine
In a widely cited 2016 commentary, Peerally and colleagues described … Focusing more specifically on problems with RCA tools and techniques, Card described "the problem with … An earlier study
described the development and adoption of a rapid approach to RCAs, referred to as
-
psnet.ahrq.gov/node/49683/psn-pdf
April 01, 2013 - In addition, the GI consult
described how the patient requested a reduction in the haloperidol dose … Adverse motor
effects associated with this antagonism (e.g., Parkinsonism and dystonia) were described … At least one case report has described this pattern with olanzapine.(11) Withdrawal
dyskinesias, presumably … related to dopaminergic sensitivity, are also described.(12) Additional
discontinuation symptoms, related
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psnet.ahrq.gov/issue/usa-today-news-series-clarifying-issues-and-embracing-community-pharmacy-safety
March 14, 2023 - news series on medication errors in community pharmacies, identifies important causes of errors not described
-
psnet.ahrq.gov/node/47640/psn-pdf
March 20, 2019 - determined to be approaching high reliability using the High Reliability Health Care Maturity
model described
-
psnet.ahrq.gov/node/47547/psn-pdf
February 13, 2019 - An
Annual Perspective discussed the extent of harm associated with opioid prescribing and described
-
psnet.ahrq.gov/node/837028/psn-pdf
May 04, 2022 - Both
professions described unflattering and stereotypical behaviors of the other (i.e., doctors are
-
psnet.ahrq.gov/node/44946/psn-pdf
February 01, 2017 - This study
described the implementation of an institution-wide mortality review process, which identified
-
psnet.ahrq.gov/node/47043/psn-pdf
January 01, 2019 - association-nurse-engagement-and-nurse-staffing-patient-safety
This cross-sectional study found that nurses reporting a lower level of engagement also described
-
psnet.ahrq.gov/node/34805/psn-pdf
November 07, 2017 - The overall error rate reported per admission approached 15% with several classification
types described
-
psnet.ahrq.gov/node/43243/psn-pdf
June 11, 2014 - Physicians
described the process to be valuable, educational, and effective.
-
psnet.ahrq.gov/node/44017/psn-pdf
April 08, 2018 - Although the authors described some of the potential benefits of these apps, they
note that their research
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psnet.ahrq.gov/node/44113/psn-pdf
November 06, 2015 - doctors at a British hospital reported a willingness to help improve safety by reporting concerns, but
described