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Showing results for "described".

6381. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49785/psn-pdf
      February 01, 2017 - Refused Medication Error February 1, 2017 Foley M. Refused Medication Error. PSNet [internet]. 2017. https://psnet.ahrq.gov/web-mm/refused-medication-error The Case A 59-year-old man was admitted to the hospital with acute renal failure and mental status changes. He was alert to self and place only. The patient h…

6382. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/33633/psn-pdf
      May 01, 2006 - Patient Safety in the Physician Office Setting May 1, 2006 Elder NC. Patient Safety in the Physician Office Setting. PSNet [internet]. 2006. https://psnet.ahrq.gov/perspective/patient-safety-physician-office-setting Perspective Dr. Jones was sure he had increased Mr. H's cholesterol-lowering medication to 80 mg 6 …

6383. Rescue Improvement Conference Innovation Summary | PSNet
      psnet.ahrq.gov/innovation/rescue-improvement-conference-innovation-summary
      September 23, 2024 - Rescue Improvement Conference Innovation Summary Save Save to your library Print Download PDF Share Facebook Twitter Linkedin Copy URL July 23, 2024 View more articles from the same authors. Innovation Contact …

6384. Primers | PSNet
      psnet.ahrq.gov/primers-0
      March 15, 2025 - Primers Guides for key topics in patient safety through context, epidemiology, and relevant AHRQ PSNet content. The Patient Safety 101 Primer provides an overview of the patient safety field and covers key definitions and concepts. Latest Primers Clinical Decision Support Systems March…

6385. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/33677/psn-pdf
      November 01, 2008 - Health Care–Acquired Urinary Tract Infection: The Problem and Solutions November 1, 2008 Nicolle LE. Health Care–Acquired Urinary Tract Infection: The Problem and Solutions. PSNet [internet]. 2008. https://psnet.ahrq.gov/perspective/health-care-acquired-urinary-tract-infection-problem-and-solutions Perspective U…

6386. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49533/psn-pdf
      March 01, 2007 - Staggered Sensitivity Results March 1, 2007 Guglielmo JB. Staggered Sensitivity Results. PSNet [internet]. 2007. https://psnet.ahrq.gov/web-mm/staggered-sensitivity-results The Case A 60-year-old woman with squamous cell carcinoma of the glottis underwent laryngectomy, anterior neck dissection, and pectoralis fla…

6387. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49599/psn-pdf
      February 23, 2010 - Defensive Medicine: "Glowing" with Pain February 1, 2010 Sethi MK. Defensive Medicine: "Glowing" with Pain. PSNet [internet]. 2010. https://psnet.ahrq.gov/web-mm/defensive-medicine-glowing-pain The Case   A 31-year-old man presented to the emergency department (ED) complaining of abdominal pain and vomiting. The…

6388. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/33582/psn-pdf
      September 15, 2024 - Detection of Safety Hazards September 15, 2024 Detection of Safety Hazards. PSNet [internet]. 2019. https://psnet.ahrq.gov/primer/detection-safety-hazards PSNet primers are regularly reviewed and updated by the UC Davis PSNet Editorial Team to ensure that they reflect current research and practice in the patient s…

6389. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/73455/psn-pdf
      June 30, 2021 - She described it as “not a black-out but a feeling of a white-out” occurring roughly once every month … a time when she was feeling particularly stressed, she experienced a more severe episode that she described … This sensation is described by patients in a variety of ways such as a forceful or irregular heartbeat

6390. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/836839/psn-pdf
      March 31, 2022 - Interestingly, a barrier identified in the systematic analysis study that the authors described as “less … The areas of action are described as having three core pillars for ultimate outcomes of psychologically … Adaptation of existing measures for assessing psychological safety has been described, and one study

6391. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49864/psn-pdf
      June 01, 2019 - things to go well in the health care setting and are only possible in an environment that can best be described … In the case described above, a patient care assistant spoke up after witnessing a physician making a … In the vignette described above, we know that the patient care assistant did speak up.

6392. Safeguarding Diagnostic Testing at the Point of Care | PSNet
      psnet.ahrq.gov/web-mm/safeguarding-diagnostic-testing-point-care
      September 30, 2011 - The simplest point-of-care tests, such as the urine pregnancy test described in this case, can be performed … require manual result entry into middleware or the patient record, as seen with the urine pregnancy test described … The type of pregnancy testing described in this case is CLIA waived.

6393. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49819/psn-pdf
      February 01, 2018 - due to a preventable adverse event in hospital, a series of errors contributed to the tragic outcome described … A more explicitly described contingency plan regarding the exact dose and route of heparin to be initiated … well as improved handoff quality and reductions in handoff-related adverse events such as the event described

6394. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49764/psn-pdf
      June 01, 2016 - In the scenario described above, the referring ED physician did not appropriately communicate the specific … Consultation," to highlight the general principles to be followed by a consultant.(2) In the case described

6395. 'Speaking Up' for patient safety and staff well-being: a qualitative study. | PSNet
      psnet.ahrq.gov/issue/speaking-patient-safety-and-staff-well-being-qualitative-study
      November 16, 2016 - September 23, 2017 How well is quality improvement described in the perioperative care

6396. Communication about harm reduction with patients who have opioid use disorder. | PSNet
      psnet.ahrq.gov/issue/communication-about-harm-reduction-patients-who-have-opioid-use-disorder
      January 02, 2017 - June 16, 2021 How well is quality improvement described in the perioperative care literature

6397. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49412/psn-pdf
      September 01, 2003 - study, with 7% having the potential for harming the patient.(4) Wrong dose errors, such as the case described … omission error may be a possible explanation.(4) The investigation following the suspected error described

6398. Duplicate Insulin Order | PSNet
      psnet.ahrq.gov/web-mm/duplicate-insulin-order
      May 04, 2012 - insulin-related hypoglycemia and errors occur annually, with 30% resulting in hospital admission.( 2 ) One report described … In the case described, several factors contributed to the error at each phase of the medication-use process … orders, as seen in this case, have also been found to be higher during handoff times.( 9 ) One study described

6399. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49552/psn-pdf
      January 01, 2008 - that such errors are common, but better tracking is needed before these rates can be more accurately described … While some legal experts may highlight the perceived risk of full error disclosure (as described in … there are relatively few formal support programs available for providers after errors occur.(6) As described

6400. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/33663/psn-pdf
      September 15, 2008 - Conclusion The path to a totally safe hospital or health system can be best described as a journey. … This report has described steps from our particular journey at AHS. … psnet.ahrq.gov//#ref7 https://psnet.ahrq.gov//#ref8 https://psnet.ahrq.gov//#figure This report has described