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psnet.ahrq.gov/issue/cognitive-error-most-frequent-contributory-factor-cases-medical-injury-study-verdicts
September 25, 2013 - Study
Cognitive error as the most frequent contributory factor in cases of medical … Cognitive error as the most frequent contributory factor in cases of medical injury: a study on verdict's … Cognitive error as the most frequent contributory factor in cases of medical injury: a study on verdict's … March 21, 2017
'Tempos' management in primary care: a key factor for classifying adverse
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psnet.ahrq.gov/issue/psychometric-properties-ahrq-community-pharmacy-survey-patient-safety-culture-factor-analysis
February 07, 2018 - Psychometric properties of the AHRQ Community Pharmacy Survey on Patient Safety Culture: a factor … Psychometric properties of the AHRQ Community Pharmacy Survey on Patient Safety Culture: a factor analysis … Psychometric properties of the AHRQ Community Pharmacy Survey on Patient Safety Culture: a factor analysis … May 10, 2017
Operationalizing occupational fatigue in pharmacists: an exploratory factor
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psnet.ahrq.gov/issue/effectiveness-improving-healthcare-teams-human-factor-skills-using-simulation-based-training
June 08, 2022 - Review
The effectiveness of improving healthcare teams' human factor skills using … The effectiveness of improving healthcare teams’ human factor skills using simulation-based training: … The effectiveness of improving healthcare teams’ human factor skills using simulation-based training:
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psnet.ahrq.gov/node/40831/psn-pdf
October 05, 2011 - 'Alarm fatigue’ a factor in 2nd death.
October 5, 2011
Kowalczyk L. Boston Globe. …
https://psnet.ahrq.gov/issue/alarm-fatigue-factor-2nd-death
Reporting on a patient death involving … https://psnet.ahrq.gov/issue/alarm-fatigue-factor-2nd-death
https://psnet.ahrq.gov/issue/patient-alarms-often-unheard-unheeded
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psnet.ahrq.gov/node/39874/psn-pdf
September 29, 2010 - Medical malpractice: the fear factor.
September 29, 2010
Robeznieks A. Modern Physician. … https://psnet.ahrq.gov/issue/medical-malpractice-fear-factor
This piece discusses evidence collected … https://psnet.ahrq.gov/issue/medical-malpractice-fear-factor
https://psnet.ahrq.gov/issue/medical-malpractice-and-errors
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psnet.ahrq.gov/issue/use-safety-climate-questionnaire-uk-health-care-factor-structure-reliability-and-usability
June 15, 2011 - Study
Use of a safety climate questionnaire in UK health care: factor structure, … Use of a safety climate questionnaire in UK health care: factor structure, reliability and usability. … Use of a safety climate questionnaire in UK health care: factor structure, reliability and usability. … Opportunities for improvement in nursing homes: variance of six patient safety climate factor
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psnet.ahrq.gov/issue/post-hospital-medication-discrepancies-home-risk-factor-90-day-return-emergency-department
March 18, 2020 - Study
Post-hospital medication discrepancies at home: risk factor for 90-day return … Post-Hospital Medication Discrepancies at Home: Risk Factor for 90-Day Return to Emergency Department … Post-Hospital Medication Discrepancies at Home: Risk Factor for 90-Day Return to Emergency Department
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psnet.ahrq.gov/node/43661/psn-pdf
November 05, 2014 - The human factor.
November 5, 2014
Langewiesche W. … https://psnet.ahrq.gov/issue/human-factor
This magazine article provides a breakdown of the failures … https://psnet.ahrq.gov/issue/human-factor
https://psnet.ahrq.gov/issue/all-can-be-lost-risk-putting-our-knowledge-hands-machines
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psnet.ahrq.gov/issue/computerized-physician-order-entry-factor-medication-errors-descriptive-analysis-events
July 14, 2010 - Study
Computerized physician order entry, a factor in medication errors: descriptive … Citation Text:
Computerized physician order entry, a factor in medication errors: descriptive analysis … Cite
Citation
Citation Text:
Computerized physician order entry, a factor
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psnet.ahrq.gov/issue/understanding-medication-safety-involving-patient-transfer-intensive-care-hospital-ward
November 14, 2018 - safety involving patient transfer from intensive care to hospital ward: a qualitative sociotechnical factor … safety involving patient transfer from intensive care to hospital ward: a qualitative sociotechnical factor … safety involving patient transfer from intensive care to hospital ward: a qualitative sociotechnical factor
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psnet.ahrq.gov/issue/human-factor-improve-patients-safety-hospitals-urged-adjust-how-staff-use-new-technology
April 22, 2016 - Newspaper/Magazine Article
The human factor. … The human factor. … The human factor.
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psnet.ahrq.gov/issue/adverse-drug-reactions-and-therapeutic-errors-older-adults-hazard-factor-analysis-poison
September 09, 2013 - Study
Adverse drug reactions and therapeutic errors in older adults: a hazard factor … Adverse drug reactions and therapeutic errors in older adults: a hazard factor analysis of poison center … Adverse drug reactions and therapeutic errors in older adults: a hazard factor analysis of poison center
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psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.29_slideshow.ppt
September 01, 2003 - Perform “contributory factor analysis” using a checklist of items
4. … Design and implement countermeasures to actively “manage” this and similar errors
Contributory Factor … and use of protocols
Please refer to table in spotlight case for CFA of this case
Contributory Factor … attention of supervising MD
Verbal order—no briefing on roles/responsibilities
Contributory Factor … Take-Home Points
When evaluating medical errors, application of the Contributory Factor Analysis can
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psnet.ahrq.gov/node/850162/psn-pdf
June 07, 2023 - safety involving patient
transfer from intensive care to hospital ward: a qualitative
sociotechnical factor … safety involving patient transfer from
intensive care to hospital ward: a qualitative sociotechnical factor
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psnet.ahrq.gov/issue/opportunities-improvement-nursing-homes-variance-six-patient-safety-climate-factor-scores
September 29, 2017 - Opportunities for improvement in nursing homes: variance of six patient safety climate factor … Opportunities for improvement in nursing homes: Variance of six patient safety climate factor scores … Opportunities for improvement in nursing homes: Variance of six patient safety climate factor scores
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psnet.ahrq.gov/issue/child-specific-risk-factors-and-patient-safety
February 02, 2022 - While developmental attributes represented the most common factor associated with harm, the overall level … of harm was higher when given any child-specific factor.
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psnet.ahrq.gov/issue/human-factor-cardiac-surgery-errors-and-near-misses-high-technology-medical-domain
June 09, 2010 - Review
Classic
Human factor in cardiac surgery: errors … The human factor in cardiac surgery: errors and near misses in a high technology medical domain. … The human factor in cardiac surgery: errors and near misses in a high technology medical domain.
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psnet.ahrq.gov/node/842419/psn-pdf
January 11, 2023 - urgent care due to a fall who
receive an opioid prescription, particularly those with at least one risk factor … patients received a prescription for an opioid and/or benzodiazepine, and 11% had at least one risk factor
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psnet.ahrq.gov/issue/tempos-management-primary-care-key-factor-classifying-adverse-events-and-improving-quality
March 15, 2017 - Study
'Tempos' management in primary care: a key factor for classifying adverse events … 'Tempos' management in primary care: a key factor for classifying adverse events, and improving quality … 'Tempos' management in primary care: a key factor for classifying adverse events, and improving quality
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psnet.ahrq.gov/node/34981/psn-pdf
July 14, 2010 - While developmental attributes
represented the most common factor associated with harm, the overall … level of harm was higher
when given any child-specific factor.