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psnet.ahrq.gov/node/50802/psn-pdf
January 15, 2020 - Use of error management theory to quantify and
characterize residents' error recovery strategies. … Use of error management theory to quantify and characterize
residents’ error recovery strategies. … https://psnet.ahrq.gov/issue/use-error-management-theory-quantify-and-characterize-residents-error- … detection and error recovery. … https://psnet.ahrq.gov/issue/use-error-management-theory-quantify-and-characterize-residents-error-recovery-strategies
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psnet.ahrq.gov/node/48129/psn-pdf
August 14, 2019 - When there's no one to whom an error can be disclosed,
how should an error be handled? … When There's No One to Whom an Error Can Be Disclosed, How Should an Error Be Handled? … https://psnet.ahrq.gov/issue/when-theres-no-one-whom-error-can-be-disclosed-how-should-error-be-
handled … https://psnet.ahrq.gov/issue/when-theres-no-one-whom-error-can-be-disclosed-how-should-error-be-handled … https://psnet.ahrq.gov/issue/when-theres-no-one-whom-error-can-be-disclosed-how-should-error-be-handled
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psnet.ahrq.gov/node/73534/psn-pdf
July 28, 2021 - "It's a big part of being good surgeons": surgical trainees'
perceptions of error recovery in the operating … -
operating-room
An essential part of resident training is error recovery- recognizing an error has … occurred and strategizing
how to correct the error to maximize patient safety. … Focusing on these factors may enhance residents’ ability to develop their error recovery skills. … surgical-errors-happen-are-learners-trained-recover-them-survey-north-american-surgical
https://psnet.ahrq.gov/issue/use-error-management-theory-quantify-and-characterize-residents-error-recovery-strategies
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psnet.ahrq.gov/issue/proceedings-summit-preventing-patient-harm-and-death-iv-medication-errors
June 16, 2019 - June 16, 2019
ISMP medication error report analysis. … June 16, 2019
ISMP medication error report analysis. … June 16, 2019
ISMP medication error report analysis. … June 16, 2019
ISMP medication error report analysis. … June 16, 2019
ISMP medication error report analysis.
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psnet.ahrq.gov/issue/lack-standard-dosing-methods-contributes-iv-errors
December 07, 2022 - June 16, 2019
ISMP medication error report analysis. … June 16, 2019
ISMP medication error report analysis. … June 16, 2019
ISMP medication error report analysis. … June 16, 2019
ISMP medication error report analysis. … June 16, 2019
ISMP medication error report analysis.
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psnet.ahrq.gov/issue/medication-errors-related-product-names
January 02, 2017 - June 16, 2019
ISMP medication error report analysis. … June 16, 2019
ISMP medication error report analysis. … June 16, 2019
ISMP medication error report analysis. … June 16, 2019
ISMP medication error report analysis. … June 16, 2019
ISMP medication error report analysis.
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psnet.ahrq.gov/node/866565/psn-pdf
August 21, 2024 - Crowdsourced feedback to improve resident physician
error disclosure skills: a randomized clinical trial … Crowdsourced feedback to improve resident physician error
disclosure skills: a randomized clinical trial … https://psnet.ahrq.gov/issue/crowdsourced-feedback-improve-resident-physician-error-disclosure-skills … that internal medicine and
family medicine residents who received individual feedback on simulated error … https://psnet.ahrq.gov/issue/teaching-medical-error-disclosure-physicians-training-scoping-review
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psnet.ahrq.gov/node/867229/psn-pdf
January 01, 2025 - Feasibility of prospective error reporting in home
palliative care: a mixed methods study. … Feasibility of prospective error reporting in home palliative care: a
mixed methods study. … https://psnet.ahrq.gov/issue/feasibility-prospective-error-reporting-home-palliative-care-mixed-methods … -
study
Error reporting and analysis is a mainstay of patient safety improvement, but voluntary reporting … in interviews approximately 1 year after an error reporting system was implemented.
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psnet.ahrq.gov/node/33560/psn-pdf
June 15, 2024 - Background
Many patients harmed by a medical error never learn of the error. … These include:
Disclosure of all harmful errors
An explanation as to why the error occurred
How the … Increasing the amount and quality of error disclosure will require addressing physician discomfort with … This may also require changes in how organizations approach error
disclosure. … disclosure of an error may be admissible in a malpractice lawsuit.
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psnet.ahrq.gov/print/pdf/node/865864
January 01, 2024 - PSNet
Curated Library
AHRQ: Agency for Healthcare Research and Quality
Diagnostic Error
Curated … More than 5,300 closed claims with at least one diagnostic error were analyzed. … The patient is in: patient involvement strategies for diagnostic error mitigation. … More than 5,300 closed claims with at least one diagnostic error were analyzed. … Patients' perspectives of diagnostic error: a qualitative study.
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psnet.ahrq.gov/node/838926/psn-pdf
October 26, 2022 - Position Statement on Criminalization of Medical Error
and Call for Action to Prevent Patient Harm from … Error. … -
patient-harm-error
Criminalizing human error can deter the transparency necessary to learn from incidents … https://psnet.ahrq.gov/issue/position-statement-criminalization-medical-error-and-call-action-prevent-patient-harm-error … https://psnet.ahrq.gov/issue/position-statement-criminalization-medical-error-and-call-action-prevent-patient-harm-error
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psnet.ahrq.gov/issue/2024-network-patient-safety-databases-chartbook-medication-and-other-substance-events
September 11, 2024 - June 16, 2019
ISMP medication error report analysis. … June 16, 2019
ISMP medication error report analysis. … June 16, 2019
ISMP medication error report analysis. … June 16, 2019
ISMP medication error report analysis. … June 16, 2019
ISMP medication error report analysis.
-
psnet.ahrq.gov/node/836754/psn-pdf
March 16, 2022 - State of science: evolving perspectives on ‘human error’. … State of science: evolving perspectives on ‘human error’. … https://psnet.ahrq.gov/issue/state-science-evolving-perspectives-human-error
Human error can affect … prevent, and mitigate human error, and the role of
ergonomics and human factors in reducing error. … https://psnet.ahrq.gov/issue/operating-sharp-end-complexity-human-error
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psnet.ahrq.gov/issue/wrong-drug-and-wrong-dose-dispensing-errors-identified-pharmacist-professional-liability
August 31, 2016 - June 16, 2019
ISMP medication error report analysis. … June 16, 2019
ISMP medication error report analysis. … June 16, 2019
ISMP medication error report analysis. … June 16, 2019
ISMP medication error report analysis. … June 16, 2019
ISMP medication error report analysis.
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psnet.ahrq.gov/node/860389/psn-pdf
January 10, 2024 - Error codes at autopsy to study potential biases in
diagnostic error. … Error codes at autopsy to study potential biases in diagnostic
error. … https://psnet.ahrq.gov/issue/error-codes-autopsy-study-potential-biases-diagnostic-error
Autopsies are … https://psnet.ahrq.gov/issue/error-codes-autopsy-study-potential-biases-diagnostic-error
https://psnet.ahrq.gov
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psnet.ahrq.gov/node/866690/psn-pdf
September 11, 2024 - The effectiveness of checklists and error reporting
systems in enhancing patient safety and reducing … The effectiveness of checklists and error reporting systems in
enhancing patient safety and reducing … https://psnet.ahrq.gov/issue/effectiveness-checklists-and-error-reporting-systems-enhancing-patient-safety … -
and-reducing
Checklists and error reporting systems are designed to improve patient safety. … psnet.ahrq.gov/issue/effects-leadership-self-worth-inclusion-trust-and-psychological-safety-medical-error
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psnet.ahrq.gov/node/867639/psn-pdf
February 26, 2025 - Framing diagnostic error: an epidemiological perspective. … Framing diagnostic error: an epidemiological perspective. … https://psnet.ahrq.gov/issue/framing-diagnostic-error-epidemiological-perspective
Diagnostic error continues … This narrative review presents ways to improve
epidemiological research into diagnostic error. … Definitions of "diagnostic error" vary greatly between
studies.
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psnet.ahrq.gov/node/47586/psn-pdf
March 20, 2019 - Wrong-patient blood transfusion error: leveraging
technology to overcome human error in intraoperative … Wrong-Patient Blood Transfusion Error: Leveraging Technology
to Overcome Human Error in Intraoperative … https://psnet.ahrq.gov/issue/wrong-patient-blood-transfusion-error-leveraging-technology-overcome-
human-error … https://psnet.ahrq.gov/issue/wrong-patient-blood-transfusion-error-leveraging-technology-overcome-human-error … https://psnet.ahrq.gov/issue/wrong-patient-blood-transfusion-error-leveraging-technology-overcome-human-error
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psnet.ahrq.gov/node/45346/psn-pdf
November 18, 2016 - How do simulated error experiences impact attitudes
related to error prevention? … How Do Simulated Error Experiences Impact Attitudes Related to
Error Prevention? … https://psnet.ahrq.gov/issue/how-do-simulated-error-experiences-impact-attitudes-related-error-prevention … One
group participated in simulated error experiences while the other watched movies about error; both … https://psnet.ahrq.gov/issue/how-do-simulated-error-experiences-impact-attitudes-related-error-prevention
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psnet.ahrq.gov/node/866244/psn-pdf
July 10, 2024 - Optimizing the use of dose error reduction software on
intravenous infusion pumps. … Optimizing the use of dose error reduction software on intravenous
infusion pumps. … https://psnet.ahrq.gov/issue/optimizing-use-dose-error-reduction-software-intravenous-infusion-pumps … Smart pumps with dose error reduction software (DERS) can reduce adverse drug events, but alert fatigue … https://psnet.ahrq.gov/issue/optimizing-use-dose-error-reduction-software-intravenous-infusion-pumps