-
psnet.ahrq.gov/web-mm/reconciling-doses
August 14, 2017 - An example can be found here . … For example, a physician, nurse, pharmacist, or pharmacy technician can collect the medication history … An example of a patient medication card, which can facilitate this process, can be found here . … For example, nurses or pharmacists may be used to collect a medication history based on available resources … For example, measuring the fraction of unreconciled medications at different transfer points can help
-
psnet.ahrq.gov/web-mm/hold-order
December 19, 2018 - For example, oral medications for diabetes (which can lead to hypoglycemia if patients are not eating … For example, breakdowns that occur during the transcribing or data entry process, as documented by the … For example, errors have occurred when hold orders were not communicated or transcribed until after the … For example, if the intern further clarified the order to indicate what should be done with the patient's … Example Hold Order.
-
psnet.ahrq.gov/node/49462/psn-pdf
October 01, 2004 - arrangement that precludes doing the wrong thing, like the gas-specific non-interchangeable
connector, is an example … For
example, I recently asked for an E-cylinder of oxygen to transport a critically ill patient, and … For
example, the anesthesia machine itself has flowmeters to control the flow of oxygen, nitrous oxide … For example, in another case I
asked for an oxygen cylinder, and was brought a CO2 cylinder with a CO2 … The requirement for a two-person check of blood
products before administration to the patient is an example
-
psnet.ahrq.gov/node/49621/psn-pdf
March 01, 2011 - overarching domains: physical characteristics, developmental issues, and minor legal status
issues.(2) For example … A simple example can best illustrate
this risk. … For
example, standard fluid requirements for children are 4 mL/kg body weight/hour for the first 10 … considered younger than 1 year of
age, oliguria (abnormally low urine output) is defined as 7) In our case example … The Figure shows an example of a pediatric early warning score card; a child is felt to be at risk if
-
psnet.ahrq.gov/perspective/patient-safety-office-based-care-settings
January 31, 2024 - For example, communication breakdowns in primary care can lead to failure to discuss abnormal test … For example, it may be necessary to reduce the data submission burden and mandate data reporting for … I’ll give you an example, a real-world example. … That is one real-world example. … For example, I prescribed a medication for a patient and the pharmacist called me and asked, “Did you
-
psnet.ahrq.gov/node/37261/psn-pdf
December 19, 2011 - creating-complex-health-improvement-programs-mindful-organizations-theory-
action
This article uses a case example
-
psnet.ahrq.gov/node/36147/psn-pdf
January 13, 2012 - The study provides a vivid
example of the authority gradient inherent in nurse-physician relationships
-
psnet.ahrq.gov/node/43609/psn-pdf
October 15, 2014 - This commentary
uses a case example to illustrate perspectives for both sides of the debate surrounding
-
psnet.ahrq.gov/node/46636/psn-pdf
January 24, 2018 - psnet.ahrq.gov/issue/drug-shortages
https://psnet.ahrq.gov/issue/impact-drug-shortages-children-cancer-example-mechlorethamine
-
psnet.ahrq.gov/node/856641/psn-pdf
January 01, 2009 - webairs-anesthesia-incident-reporting-system
https://psnet.ahrq.gov/issue/medication-errors-anesthesiology-it-time-train-example-vignettes-can-assess-error-awareness
-
psnet.ahrq.gov/node/46876/psn-pdf
August 15, 2018 - high-reliability
https://psnet.ahrq.gov/issue/promoting-patient-safety-through-prospective-risk-identification-example-peri-operative-care
-
psnet.ahrq.gov/node/866055/psn-pdf
May 29, 2024 - Near misses are either (a) no-harm good catches or (b) error, but no harm.2 An example of
a near miss … intraorganizational guidelines were not rooted in evidence and (2) policies varied within the organization.2
For example … 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,
-
psnet.ahrq.gov/node/33828/psn-pdf
March 01, 2017 - RW: Can you give an example of a piece of forbidden knowledge? … For example, junior doctors are supposed
to be given quiet time to complete their notes, but they never … What I'm seeing,
for example, is the notion of error increasingly receding and increasingly a focus … in which we need to think about protection that have nothing to do with error but to do with, for example … For example, with the use of routine beta-blockers in surgery, where that technical
intervention just
-
psnet.ahrq.gov/node/37505/psn-pdf
February 06, 2008 - Health Literacy Practices in Primary Care Settings:
Examples from the Field.
February 6, 2008
Barrett SE, Puryear JS, Westpheling K. Washington DC: The Commonweath Fund; January 1, 2008.
https://psnet.ahrq.gov/issue/health-literacy-practices-primary-care-settings-examples-field
This report describes tactics for cl…
-
psnet.ahrq.gov/node/49608/psn-pdf
August 01, 2010 - For example, under-triaged myocardial infarction patients in
one study were found to have delays in … For example, if treatment areas are full and patients backed up in the waiting room,
triage nurses may
-
psnet.ahrq.gov/node/60049/psn-pdf
March 18, 2020 - who-gets-benefit-doubt-performance-evaluations-medical-errors-and-
production-gender
Using medical residency as an example
-
psnet.ahrq.gov/node/60618/psn-pdf
June 24, 2020 - For example, incident reports most commonly identified
wrong dose and wrong time errors.
-
psnet.ahrq.gov/node/839817/psn-pdf
January 01, 2023 - This study describes the relationship of employees’ perception of
ethical leadership (manager sets an example
-
psnet.ahrq.gov/node/74705/psn-pdf
January 26, 2022 - For example, research on incident reporting and systems
approaches to improving safety are underrepresented
-
psnet.ahrq.gov/node/47882/psn-pdf
May 01, 2019 - establishing-international-baseline-medication-safety-oncology-findings-2012-ismp
https://psnet.ahrq.gov/issue/impact-drug-shortages-children-cancer-example-mechlorethamine