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Total Results: over 10,000 records

Showing results for "failures".

5481. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/43769/psn-pdf
      December 17, 2014 - Prospective risk analysis and incident reporting for better pharmaceutical care at paediatric hospital discharge. December 17, 2014 Kaestli L-Z, Cingria L, Fonzo-Christe C, et al. Prospective risk analysis and incident reporting for better pharmaceutical care at paediatric hospital discharge. Int J Clin Pharm. 2014…

5482. 125. Treatment Recommendations: Medications (Continued) | Agency for Healthcare Research and Quality
      www.ahrq.gov/prevention/guidelines/tobacco/clinicians/presentations/2008update-full/slide125.html
      October 01, 2014 - 125. Treatment Recommendations: Medications (Continued) Treating Tobacco Use and Dependence: 2008 Update Text version of slide presentation. Clinical guidelines for prescribing medication for treating tobacco use and dependence (Continued) Are there contraindications, warnings, precautions, other …

5483. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/47510/psn-pdf
      June 30, 2019 - Rethinking high reliability in healthcare: the role of error management theory towards advancing high reliability organizing. June 30, 2019 Guttman O, Keebler JR, Lazzara EH, et al. J Patient Saf Risk Manag. 2019;24:127–133. https://psnet.ahrq.gov/issue/rethinking-high-reliability-healthcare-role-error-management-…

5484. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/837728/psn-pdf
      July 27, 2022 - Trends in adverse event rates in hospitalized patients, 2010-2019. July 27, 2022 Eldridge N, Wang Y, Metersky M, et al. Trends in adverse event rates in hospitalized patients, 2010-2019. JAMA. 2022;328(2):173-183. doi:10.1001/jama.2022.9600. https://psnet.ahrq.gov/issue/trends-adverse-event-rates-hospitalized-pati…

5485. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/866168/psn-pdf
      January 02, 2000 - Missed diagnoses of acute cardiac ischemia in the emergency department. January 2, 2000 Pope JH, Aufderheide TP, Ruthazer R, et al. Missed diagnoses of acute cardiac ischemia in the emergency department. N Engl J Med. 2000;342(16):1163-1170. doi:10.1056/nejm200004203421603. https://psnet.ahrq.gov/issue/missed-diag…

5486. The Dropped Lung | PSNet
      psnet.ahrq.gov/web-mm/dropped-lung
      February 06, 2012 - The Dropped Lung Citation Text: Heffner JR. The Dropped Lung. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2003. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged PubMedId RIS …

5487. Missing Trauma | PSNet
      psnet.ahrq.gov/web-mm/missing-trauma
      March 03, 2011 - Missing Trauma Citation Text: Jurkovich GJ. Missing Trauma. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2009. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged PubMedId RIS …

5488. Is the "Surgical Personality" a Threat to Patient Safety? | PSNet
      psnet.ahrq.gov/web-mm/surgical-personality-threat-patient-safety
      February 24, 2021 - SPOTLIGHT CASE Is the "Surgical Personality" a Threat to Patient Safety? Citation Text: Bosk CL. Is the "Surgical Personality" a Threat to Patient Safety?. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2006. Copy Citati…

5489. Spotlight (pdf file)
      psnet.ahrq.gov/sites/default/files/2019-12/spotlight_code_status_dec_2019_powerpoint.pdf
      January 01, 2019 - Spotlight Spotlight "Do You Want Everything Done?": Clarifying Code Status Source and Credits • This presentation is based on the December 2019 AHRQ WebM&M Spotlight Case ○ See the full article at https://psnet.ahrq.gov/webmm ○ CME credit is available • Commentary by: Karl Steinberg MD, CMD, HMDC & Thaddeus M…

5490. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49817/psn-pdf
      January 01, 2018 - Slow Down: Right Drug, Wrong Formulation January 1, 2018 Amato MG, Schiff G. Slow Down: Right Drug, Wrong Formulation. PSNet [internet]. 2018. https://psnet.ahrq.gov/web-mm/slow-down-right-drug-wrong-formulation The Case A 65-year-old man presented to his primary care clinic for follow-up after a recent hospitaliz…

5491. Managing Ascites: Hazards of Fluid Removal | PSNet
      psnet.ahrq.gov/web-mm/managing-ascites-hazards-fluid-removal
      June 01, 2018 - Sepsis Management May 1, 2015 Inquiry into reporter's death finds multiple failures

5492. Deciphering the Code | PSNet
      psnet.ahrq.gov/web-mm/deciphering-code
      November 16, 2022 - Finally, there must be adequate back-up systems for managing computer slowdowns and power failures.

5493. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49512/psn-pdf
      May 01, 2006 - The multiple communication failures suggest the need for a formal protocol to delineate precisely how

5494. Final Progress Report: Do Safety Warnings Change Prescribing Among the US Dialysis Population? (pdf file)
      www.ahrq.gov/sites/default/files/2024-01/thamer-report.pdf
      January 01, 2024 - Final Progress Report: Do Safety Warnings Change Prescribing Among the US Dialysis Population? Principal Investigator: Thamer, Mae FINAL REPORT TITLE PAGE Title: Do Safety Warnings Change Prescribing among the US Dialysis Population? Principal Investigator and Team Members: M Thamer, PI, and other team members (…

5495. Methods – Applying HCUP Quality Indicators (pdf file)
      hcup-us.ahrq.gov/reports/methods/2016-01.pdf
      January 01, 2016 - Methods – Applying HCUP Quality Indicators HCUP Methods Series kbr33831 Contact Information: Healthcare Cost and Utilization Project (HCUP) Agency for Healthcare Research and Quality 5600 Fishers Lane Room 07W17B Mail Stop 7W25B Rockville, MD 20857 http://www.hcup-us.ahrq.gov For Technical Assis…

5496. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/44166/psn-pdf
      October 13, 2015 - Development and validation of electronic health record–based triggers to detect delays in follow-up of abnormal lung imaging findings. October 13, 2015 Murphy DR, Thomas EJ, Meyer AND, et al. Development and Validation of Electronic Health Record-based Triggers to Detect Delays in Follow-up of Abnormal Lung Imagin…

5497. Visiting Nurse Service of New York | Digital Healthcare Research
      digital.ahrq.gov/organization/visiting-nurse-service-new-york
      January 01, 2023 - Visiting Nurse Service of New York Development of Dashboards to Provide Feedback to Home Care Nurses Description This project designed and conducted a usability evaluation of dashboards that provide feedback to home care nurses to improve the care of patients with chronic hear…

5498. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/72593/psn-pdf
      January 01, 2021 - Patient harm during COVID-19 pandemic: using a human factors lens to promote patient and workforce safety. December 23, 2020 Alagha MA, Jaulin F, Yeung W, et al. Patient harm during COVID-19 pandemic: using a human factors lens to promote patient and workforce safety. J Patient Saf. 2021;17(2):87-89. doi:10.1097/p…

5499. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/837023/psn-pdf
      May 04, 2022 - Examining the effect of quality improvement initiatives on decreasing racial disparities in maternal morbidity. May 4, 2022 Davidson C, Denning S, Thorp K, et al. Examining the effect of quality improvement initiatives on decreasing racial disparities in maternal morbidity. BMJ Qual Saf. 2022;31(9):670-678. doi:10.…

5500. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/47932/psn-pdf
      August 21, 2019 - Ensuring effective care transition communication: implementation of an electronic medical record-based tool for improved cancer treatment handoffs between clinic and infusion nurses. August 21, 2019 Pandya C, Clarke T, Scarsella E, et al. Ensuring Effective Care Transition Communication: Implementation of an Elec…