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Total Results: 2,881 records

Showing results for "examples".

341. IHI Framework for Improving Joy in Work. | PSNet
     psnet.ahrq.gov/issue/ihi-framework-improving-joy-work
     September 06, 2017 - This white paper highlights the importance of enabling joy at work , reviews examples of organizations

342. Guide to Reducing Unintended Consequences of Electronic Health Records. | PSNet
     psnet.ahrq.gov/issue/guide-reducing-unintended-consequences-electronic-health-records
     May 25, 2016 - This book discusses evidence, tools, and case examples to help prepare organizations for problems associated

343. Annals Clinical Decision Making: avoiding cognitive errors in clinical decision making. | PSNet
     psnet.ahrq.gov/issue/annals-clinical-decision-making-avoiding-cognitive-errors-clinical-decision-making
     May 25, 2016 - Using two case examples, this article discusses how the influences of cognitive biases  in clinical

344. Resilience and resilience engineering in health care. | PSNet
     psnet.ahrq.gov/issue/resilience-and-resilience-engineering-health-care
     September 19, 2013 - enhance patient safety, this commentary defines key elements of resilient organizations and provides examples

345. Responding to large-scale testing errors. | PSNet
     psnet.ahrq.gov/issue/responding-large-scale-testing-errors
     December 18, 2008 - Using two case examples, this article analyzes the causes and consequences of laboratory testing errors

346. Eight critical factors in creating and implementing a successful simulation program. | PSNet
     psnet.ahrq.gov/issue/eight-critical-factors-creating-and-implementing-successful-simulation-program
     August 27, 2014 - The authors also provide examples of hospitals that have implemented approaches incorporating science

347. Critical diagnoses (critical values) in anatomic pathology. | PSNet
     psnet.ahrq.gov/issue/critical-diagnoses-critical-values-anatomic-pathology
     September 29, 2010 - The authors recommend development of critical diagnosis guidelines for anatomic pathology and provide examples

348. Staying safe: simple tools for safe surgery. | PSNet
     psnet.ahrq.gov/issue/staying-safe-simple-tools-safe-surgery
     August 02, 2015 - The author uses examples from his experience as a pilot to discuss aviation safety strategies, such as

349. Safe labeling practices to minimize medication errors in anesthesia: 5 case reports and review of the literature. | PSNet
     psnet.ahrq.gov/issue/safe-labeling-practices-minimize-medication-errors-anesthesia-5-case-reports-and-review
     March 26, 2014 - This commentary uses case examples to illustrate how incorrect or incomplete labeling can affect care

350. Communication errors in dispatch of air medical transport. | PSNet
     psnet.ahrq.gov/issue/communication-errors-dispatch-air-medical-transport
     July 03, 2014 - Examples of major errors identified were commissions of allergies to medications and omissions of intubations

351. The normalization of deviance: do we (un)knowingly accept doing the wrong thing? | PSNet
     psnet.ahrq.gov/issue/normalization-deviance-do-we-unknowingly-accept-doing-wrong-thing
     May 23, 2018 - This commentary describes normalization of deviance and uses examples to illustrate how this problem

352. Medical Device Use Error: Root Cause Analysis. | PSNet
     psnet.ahrq.gov/issue/medical-device-use-error-root-cause-analysis
     January 10, 2018 - The book includes examples of RCAs to illustrate how the method can uncover flaws that contribute to

353. The incidence and severity of adverse events affecting patients after discharge from the hospital. | PSNet
     psnet.ahrq.gov/issue/incidence-and-severity-adverse-events-affecting-patients-after-discharge-hospital
     March 11, 2019 - authors describe the incidence, severity, and preventability of reported events along with specific examples

354. The next organizational challenge: finding and addressing diagnostic error. | PSNet
     psnet.ahrq.gov/issue/next-organizational-challenge-finding-and-addressing-diagnostic-error
     November 16, 2022 - This commentary provides two examples of organizational approaches to minimizing diagnostic error.

355. Systematic root cause analysis of adverse drug events in a tertiary referral hospital. | PSNet
     psnet.ahrq.gov/issue/systematic-root-cause-analysis-adverse-drug-events-tertiary-referral-hospital
     November 16, 2022 - Discussion includes a description of the RCA system employed, examples of events analyzed, and an informative

356. Judgment errors in surgical care. | PSNet
     psnet.ahrq.gov/issue/judgment-errors-surgical-care
     December 14, 2022 - Examples of errors in judgment included inappropriate operation, premature discharge, and premature removal

357. Errors in drug computations during newborn intensive care. | PSNet
     psnet.ahrq.gov/issue/errors-drug-computations-during-newborn-intensive-care
     December 15, 2021 - Based on a series of examples, study participants scored well if a high percentage of problems were answered

358. Safety of patients isolated for infection control. | PSNet
     psnet.ahrq.gov/issue/safety-patients-isolated-infection-control
     January 15, 2020 - Examples of the reported differences in care quality included absence of accurately recorded vital signs

359. Value of human factors to medication and patient safety in the intensive care unit. | PSNet
     psnet.ahrq.gov/issue/value-human-factors-medication-and-patient-safety-intensive-care-unit
     December 01, 2010 - illustrates the role of human factors in medication errors in the intensive care unit and provides examples

360. Medication safety issue brief. Small and rural hospitals—unique challenges, unique solutions. | PSNet
     psnet.ahrq.gov/issue/medication-safety-issue-brief-small-and-rural-hospitals-unique-challenges-unique-solutions
     June 17, 2014 - This safety brief provides examples of collaboration, outsourcing, and technology to address medication