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psnet.ahrq.gov/issue/joshuas-story
February 26, 2014 - features an in-depth interview with the father of an infant who died following delayed diagnosis and treatment … January 31, 2018
National Diabetes Inpatient Audit -- Harms.
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psnet.ahrq.gov/web-mm/double-trouble
August 01, 2012 - an active role in their pharmaceutical care
Case & Commentary: Part 1
A 79-year-old man with diabetes … Starting therapy in an elderly patient with a single agent is generally a safer strategy, and many patients … older patients, including (i) the “start low and go slow” philosophy when initiating and intensifying a therapeutic … However, every effort must be taken to provide elderly patients with the full benefits of an optimal therapeutic … The patient was readmitted to hospital and given fluids intravenously; the antibiotic therapy was stopped
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psnet.ahrq.gov/Webmm
May 01, 2021 - Event Detection
(10)
Automatic drug dispensers
(7)
Telemedicine
(4)
Computer-Assisted Therapy … (6)
Allied Health Services
(3)
Nutrition/Dietetics
(2)
Physical and Occupational Therapy … He was treated with 14 days of intravenous penicillin but had both an inflammatory reaction to the treatment … WebM&M Cases
Delay in Appropriate Diagnosis and Treatment Leading to Death from Pulmonary Embolism … The team considered her to be low-risk and initiated therapy with a direct oral anticoagulant (DOAC).
-
psnet.ahrq.gov/webmm
May 01, 2021 - Event Detection
(10)
Automatic drug dispensers
(7)
Telemedicine
(4)
Computer-Assisted Therapy … (6)
Allied Health Services
(3)
Nutrition/Dietetics
(2)
Physical and Occupational Therapy … He was treated with 14 days of intravenous penicillin but had both an inflammatory reaction to the treatment … WebM&M Cases
Delay in Appropriate Diagnosis and Treatment Leading to Death from Pulmonary Embolism … The team considered her to be low-risk and initiated therapy with a direct oral anticoagulant (DOAC).
-
psnet.ahrq.gov/issue/heart-disease-iuds-how-doctors-dismiss-womens-pain
September 29, 2021 - September 29, 2021
Medical mystery: alcoholism didn’t cause man’s diabetes and cirrhosis … August 19, 2020
Fear of Covid-19 leads other patients to decline critical treatment.
-
psnet.ahrq.gov/issue/fda-advise-err-prevent-dangerous-drug-device-interaction-causing-falsely-elevated-glucose
May 02, 2018 - 2018
Misadministration of IV insulin associated with dose measurement and hyperkalemia treatment … May 7, 2018
Medical mystery: alcoholism didn’t cause man’s diabetes and cirrhosis.
-
psnet.ahrq.gov/node/49597/psn-pdf
February 01, 2010 - or gestational diabetes. … diet, exercise, and glucose monitoring should begin at diagnosis for all patients and may be the only
therapy … case
presentation, is available only for subcutaneous administration; is indicated for adjunctive therapy … She also complained that her acne had worsened, and she requested treatment for it. … American Diabetes Association. Standards of medical care in diabetes—2009.
-
psnet.ahrq.gov/issue/balancing-just-culture-regulatory-standards
December 13, 2023 - Same Author(s)
Defining the landscape of patient harm after osteopathic manipulative treatment … May 11, 2022
Potentially inappropriate prescribing for adults living with diabetes mellitus
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psnet.ahrq.gov/web-mm/its-all-syringe
February 01, 2013 - diabetes management. … We administer injection therapies, including vaccinations, vitamin B12, intramuscular antibiotics and … Finally, we may offer urgent treatments with triptans for acute migraine, albuterol for asthma, epinephrine … Insulin errors and injuries are common among hospitalized patients.( 4-9 ) The risk of treatment-related … A systems approach to reducing errors in insulin therapy in the inpatient setting.
-
psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.233_slideshow.ppt
February 01, 2011 - *
Case: One Toxic Drug (2)
Prior to therapy, the physician did not refer the patient for a liver … After 6 weeks of therapy, the HCV viral load was unchanged, and the patient exhibited pancytopenia. … After 9 months of treatment, a viral load was repeated and was again found to be more than 2,000,000 … (ii) no genotype performed to help guide length of therapy; (iii) no baseline labs to see if the patient … Effect of board certification on antihypertensive treatment intensification in patients with diabetes
-
psnet.ahrq.gov/issue/nonfatal-unintentional-medication-exposures-among-young-children-united-states-2001-2003
February 27, 2019 - October 25, 2017
FDA requires label warnings to prohibit sharing of multi-dose diabetes … November 17, 2011
Preventing Infections During Cancer Treatment.
-
psnet.ahrq.gov/issue/medication-safety-look-alikesound-alike-drugs-home-care
February 03, 2021 - February 3, 2010
Insulin treatment as a tracer for identifying latent patient safety … risks in home-based diabetes care.
-
psnet.ahrq.gov/issue/patient-safety-investigating-and-reporting-serious-clinical-incidents
November 10, 2017 - 2014
Root cause analysis reports help identify common factors in delayed diagnosis and treatment … May 16, 2012
Patient safety systems in the primary health care of diabetes—a story of
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psnet.ahrq.gov/web-mm/dont-wait-collect-accurate-weight-case-subtherapeutic-insulin-therapy
July 01, 2008 - Don’t Wait to Collect an Accurate Weight: A Case of Subtherapeutic Insulin Therapy
Citation … Don’t Wait to Collect an Accurate Weight: A Case of Subtherapeutic Insulin Therapy. … Don’t Wait to Collect an Accurate Weight: A Case of Subtherapeutic Insulin Therapy. … The Case A 16-year-old girl with type 1 diabetes presented to the emergency department (ED) complaining … WebM&M Cases
Inpatient Stroke Management in an Adolescent with Type 1 Diabetes
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psnet.ahrq.gov/periodic-issue/periodic-issue-408
September 27, 2023 - These system errors contributed to treatment delays and care omissions. … Special or Theme Issue
Complications and Errors in Periodontal and Implant Therapy … This special issue covers a range of adverse events and treatment mistakes associated with periodontal … September 27, 2023
A 14-year-old girl was admitted to the hospital with a new diagnosis of type 1 diabetes … standards, and the importance of clear communication between members of the care team if alternative therapies
-
psnet.ahrq.gov/web-mm/missed-diagnosis-addisons-disease-adolescent-presenting-fatigue
October 28, 2020 - Crisis may also occur in patients who are receiving treatment for AI if they miss their daily medications … Testing and treatment of adrenal insufficiency are complicated and best directed by an endocrinologist … WebM&M Cases
Inpatient Stroke Management in an Adolescent with Type 1 Diabetes … Cases
Don’t Wait to Collect an Accurate Weight: A Case of Subtherapeutic Insulin Therapy … May 1, 2011
WebM&M Cases
Adolescent Diabetes: A
-
psnet.ahrq.gov/node/49749/psn-pdf
December 01, 2015 - Diabetes care guidelines discuss the transition from intravenous (IV) to subcutaneous insulin in patients … with type 2 diabetes admitted with hyperglycemia.(2,3) Blood sugars should be in the target range of … Basal insulin is started before discontinuing the insulin infusion to
allow the former to reach therapeutic … Diabetes Care. 2005;28:2418-2423. [go
to PubMed]
7. Karsh BT. … just-in-time physician
and nurse training on
Glucommander use
Improved handoffs outlining
current treatment
-
psnet.ahrq.gov/web-mm/delayed-diagnosis-and-treatment-systemic-lupus-erythematosus-psychiatric-presentation
September 27, 2023 - SPOTLIGHT CASE
Delayed Diagnosis and Treatment of Systemic Lupus Erythematosus with a Psychiatric … Delayed Diagnosis and Treatment of Systemic Lupus Erythematosus with a Psychiatric Presentation. … : a Comparison of Rheumatoid Arthritis, Systemic Lupus Erythematosus, Multiple Sclerosis and Type 1 Diabetes … Anti-NMDA receptor encephalitis: diagnosis, psychiatric presentation, and treatment. … Neuropsychiatric lupus: new mechanistic insights and future treatment directions.
-
psnet.ahrq.gov/web-mm/mid-summer-fog
September 29, 2017 - The Case A 33-year-old woman with type I diabetes mellitus was admitted for symptoms of left flank … The patient responded quickly to treatment with D50 and had a full recovery once the error in insulin … ACE/ADA Task Force on Inpatient Diabetes. … diabetes and glycemic control: a call to action. … Diabetes Care. 2006;29:1955-1962. [go to PubMed] 2. Englesbe MJ, Pelletier SJ, Magee JC, et al.
-
psnet.ahrq.gov/sites/default/files/2024-03/delayed_diagnosis_and_treatment_of_sle.pdf
January 01, 2024 - Microsoft PowerPoint - Spotlight Case_Delayed Diagnosis and Treatment of Lupus_SLIDES - FINAL.pptx … Spotlight
Delayed Diagnosis and Treatment of Systemic Lupus
Erythematosus with a Psychiatric Presentation … a Comparison of Rheumatoid Arthritis, Systemic Lupus
Erythematosus, Multiple Sclerosis and Type 1 Diabetes … Anti-NMDA receptor encephalitis: diagnosis, psychiatric presentation, and treatment. … Neuropsychiatric lupus: new mechanistic insights and future treatment directions.