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psnet.ahrq.gov/node/74729/psn-pdf
February 02, 2022 - involved in obstetric adverse events
can effectively support providers in short periods of time (for example
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psnet.ahrq.gov/node/60343/psn-pdf
May 20, 2020 - managing-cognitive-biases-during-disaster-response-development-aide-
memoire
Using marine spill disasters as an example
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psnet.ahrq.gov/web-mm/right-patient-wrong-sample
June 01, 2004 - For example, although peer-reviewed studies document overall error rates of approximately 0.1% ( 1 ) … They also identify best practices associated with better performance.( 5,7 ) For example, a Q probes … For example, a study of wristband errors from 217 institutions showed that the wristband error rate in … text results or to numeric results where large changes are expected in common clinical conditions (for example … Interventions with Specific Examples Related to Clinical Laboratory Services.( 14 )
Interventions
Example
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psnet.ahrq.gov/node/866808/psn-pdf
September 25, 2024 - definitions: 1)
safety leadership improves safety performance; 2) safety leaders lead by influence and example
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psnet.ahrq.gov/node/866279/psn-pdf
July 10, 2024 - Using Parkinson’s disease as an example, the authors present a framework for
systematically identifying
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psnet.ahrq.gov/node/846170/psn-pdf
March 15, 2023 - contact,
use relaxed body language, avoid complex medical jargon, and use open-ended questions.5 For example … For example, the prescribing physician could have included instructions on the “sig” to
stop lisinopril … For example, the retail pharmacy could adopt a policy to ensure discrepancies are
resolved within a … For example, in
some software, a cancellation message is automatically sent to the patient's local pharmacy … Additionally, they can assist other providers and specialists, for example, by making recommendations
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psnet.ahrq.gov/node/837748/psn-pdf
August 05, 2022 - For example, in the case described above, patient’s home insulin regimen was not adjusted
or discontinued … For example, asking “what
medications do you use for your diabetes?” … For example, ask how the patient checks their blood sugars instead of “do you
check your blood sugars … It may also be helpful to inquire what
medications a patient is taking based on the route, for example … For example, health factors that could have influenced
these results.
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psnet.ahrq.gov/node/60746/psn-pdf
July 29, 2020 - clinical
reasoning by individual physicians sits at the intersection of science and art in medicine, for example … One
example relevant to this case is referred to as “framing bias,” which is a tendency to be influenced … One pervasive
example was communication among the various providers. … teamwork, breaking
down silos, and involvement of patients in decision-making.7 Better communication, for example
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psnet.ahrq.gov/node/74253/psn-pdf
January 12, 2022 - Additionally, many COVID-19 patients develop sepsis,
further complicating the treatment approach.12 For example … For example, the Centers
for Disease Control and Prevention has produced guidance for optimizing PPE … For example, the use of baby monitors (which include
cameras) with patients in isolation can allow for … Another example of the initiative of frontline staff is the implementation of rapid-
cycle tests of
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psnet.ahrq.gov/node/74242/psn-pdf
January 07, 2022 - For example, if the sentinel lymph node was not correctly identified and instead a distant
lymph node … A very
well-known example, Atul Gawande’s “Checklist Manifesto” demonstrated a 19-item surgical safety … checklist reduced complications in high-income countries from 9.3% to 6.6%.8 Another example from the … One such example is
breast cancer reconstruction, here procedures are completed in sequence not concurrently
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psnet.ahrq.gov/perspective/conversation-elizabeth-salisbury-afshar-about-harm-reduction-strategies-improve-safety
October 30, 2024 - For example, I used to work in Baltimore City and then in Chicago, and neither of those cities saw high … For example, if you're working in a community that doesn't have a lot of opioids and predominantly uses … For example, if you're in a community where very few people inject substances, it’s still important to … For example, methadone treatment was created to try to reduce recidivism. … Naloxone is a great example, where we've seen tremendous improvements across most states.
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psnet.ahrq.gov/perspective/harm-reduction-strategies-improve-safety-people-who-use-substances
October 30, 2024 - For example, studies show that SSPs increase the percentage of people entering treatment 7 and do not … For example, harm reduction includes using non-stigmatizing and non-judgmental language when working … For example, methadone treatment was created to try to reduce recidivism. … For example, if someone came in for heartburn and I find out that they drink alcohol, I don’t jump to … Naloxone is a great example, where we've seen tremendous improvements across most states.
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psnet.ahrq.gov/node/37611/psn-pdf
February 15, 2011 - The author proposes reformulating
the SBAR model for patients and provides an example of the framework
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psnet.ahrq.gov/node/39474/psn-pdf
June 27, 2011 - describes a model to identify medication safety events that applies a systems
approach and provides an example
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psnet.ahrq.gov/innovation/reducing-preventable-patient-harm-due-retained-surgical-items-rsi-bundle
July 23, 2024 - For example, implement the use of a “wingman”. … Near misses are either (a) no-harm good catches or (b) error, but no harm. 2 An example of a near miss … For example, implement the use of a “wingman”. … For example, a goal of 90% adherence may be reasonable for a specific measure because 100% adherence … For example, Ascension implemented a Good Catch Award program to reinforce wins in patient safety, storytelling
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psnet.ahrq.gov/node/845653/psn-pdf
March 08, 2023 - Examples of Medical Device Misconnections.
March 8, 2023
Food and Drug Administration. February 23. 2023.
https://psnet.ahrq.gov/issue/examples-medical-device-misconnections
Mismatches of medical device connectors are known factors in therapeutic agent administration failures,
despite efforts to redesign equipment…
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psnet.ahrq.gov/node/37213/psn-pdf
October 13, 2011 - simulation to teach safety skills to nursing students
and illustrate the technique through a detailed example
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psnet.ahrq.gov/node/72712/psn-pdf
February 03, 2021 - This news feature
shares an example of depression misdiagnosis that masked the true problem of a neurological
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psnet.ahrq.gov/node/72554/psn-pdf
December 09, 2020 - hospitals
employed recommended strategies identified, implementation was suboptimal at times – for example
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psnet.ahrq.gov/node/60292/psn-pdf
May 06, 2020 - describes how human factors and ergonomics can contribute to the COVID-19 pandemic
response, using the example