-
psnet.ahrq.gov/node/41643/psn-pdf
September 05, 2012 - issue/randomized-field-study-leadership-walkrounds-based-intervention
Leadership WalkRounds have been described
-
psnet.ahrq.gov/node/47257/psn-pdf
September 26, 2018 - An Annual Perspective described the challenges in measuring and responding
to serious patient harm.
-
psnet.ahrq.gov/primer/failure-rescue
September 15, 2024 - For example, Gaba described most anesthetic accidents as evolving from small errors and system failures … Causes and Prevention of Failure-to-Rescue Previous research has described three critical stages that … A 2022 systematic review described this paradigm as the 3Rs (recognize, relay and react) underpinning … such as the need for external model validation to ensure generalizability. 3 Recent research has also described
-
psnet.ahrq.gov/node/48112/psn-pdf
July 10, 2019 - A WebM&M commentary described a
chemotherapy infusion error that caused renal failure.
-
psnet.ahrq.gov/node/48060/psn-pdf
June 19, 2019 - Perspective discussed
problematic prescribing practices that likely contribute to adverse events and described
-
psnet.ahrq.gov/issue/courage-speak-out-study-describing-nurses-attitudes-report-unsafe-practices-patient-care
April 24, 2018 - A recent WebM&M commentary described how leaders can encourage and reward speaking up.
-
psnet.ahrq.gov/node/43632/psn-pdf
December 19, 2014 - should-i-report-qualitative-study-barriers-incident-reporting-among-nurses-
working-nursing
In this qualitative study, nursing staff in long-term care facilities described
-
psnet.ahrq.gov/node/34665/psn-pdf
December 24, 2008 - Two contrasting theoretical models of learning are introduced, with the traditional
model described
-
psnet.ahrq.gov/node/45129/psn-pdf
August 03, 2016 - A PSNet perspective described how fatigue can affect physician
performance.
-
psnet.ahrq.gov/node/46664/psn-pdf
December 22, 2018 - Perspective reviewed problematic prescribing practices that likely contribute to adverse events and
described
-
psnet.ahrq.gov/node/34784/psn-pdf
June 24, 2015 - Team dimensions, behaviors, and activities are
described in detail.
-
psnet.ahrq.gov/node/46833/psn-pdf
December 03, 2018 - A past WebM&M commentary described
the harms associated with inappropriate antibiotic use.
-
psnet.ahrq.gov/node/42683/psn-pdf
December 02, 2014 - restrictions negatively affect resident education and continuity of care, and almost half of
those surveyed described
-
psnet.ahrq.gov/node/35703/psn-pdf
July 13, 2010 - injury-and-liability-associated-monitored-anesthesia-care-closed-claims-
analysis
Using closed malpractice claims from a previously described
-
psnet.ahrq.gov/node/45690/psn-pdf
June 28, 2017 - Challenges associated with checklist
implementation are well described.
-
psnet.ahrq.gov/node/45596/psn-pdf
January 09, 2018 - This study described the myriad
challenges faced by the National Health Service (NHS) in its quest to
-
psnet.ahrq.gov/node/45085/psn-pdf
May 04, 2016 - A WebM&M
commentary described best practices for opioid prescribing.
-
psnet.ahrq.gov/node/45445/psn-pdf
September 27, 2016 - using-kotters-change-model-implementing-bedside-handoff-quality-
improvement-project
Change management has been described
-
psnet.ahrq.gov/node/44887/psn-pdf
March 16, 2016 - Participants believed teamwork and safety culture had improved, but they described challenges
to implementing
-
psnet.ahrq.gov/node/44257/psn-pdf
November 06, 2015 - systems-approach-evaluating-ionizing-radiation-six-focus-areas-improve-
quality-efficiency-and
Radiation therapy has been described