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psnet.ahrq.gov/perspective/quality-and-safety-challenges-critical-care-preventing-and-treating-delirium-intensive
December 01, 2012 - As with these other important end-organ injuries, delirium is a clinical event for which prevention and … The next is to systematically implement effective screening, prevention, and management strategies. … The ABCDE model is an initial framework on which new prevention and treatment strategies can be added … Delirium often sets off a spiral where someone is very confused and a fall risk, so they get assigned … RW : Can you talk a little bit about what you've learned about prevention strategies?
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psnet.ahrq.gov/clinical-areas
March 24, 2025 - by Clinical Areas
In Conversation with Edwin Boudreaux about Suicide Prevention … Suicide Prevention
Edwin Boudreaux, PhD; Bryan Gale, MA; Sarah Mossburg, PhD |
March 25, … Perspectives on Safety
Suicide Prevention … This piece discusses the role that healthcare providers and organizations can play in suicide prevention … In Conversation with Edwin Boudreaux about Suicide Prevention
Edwin Boudreaux, PhD, is a Professor
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psnet.ahrq.gov/web-mm/syringe-swap-during-regional-block-case-medication-error-and-recovery
July 22, 2020 - In a strong safety culture, error prevention and recovery programs are well developed, updated regularly … errors: teaching strategies that increase nursing students’ awareness of medication errors and their prevention … July 1, 2019
Evaluation of clinical practice guidelines on fall prevention and management
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psnet.ahrq.gov/perspective/building-safety-program-using-principles-resilience-engineering
October 23, 2013 - Related Resources
Perspectives on Safety
Suicide Prevention … Interview
In Conversation with Edwin Boudreaux about Suicide Prevention
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psnet.ahrq.gov/node/73398/psn-pdf
June 30, 2021 - In healthcare design,
sometimes we can fall into a routine that we think we know the answer, but we … WHO [World
Health Organization] and CDC [Centers for Disease Control and Prevention] documents had mentioned … patient getting up to
go to the bathroom without calling a nurse and putting themselves at risk for a fall
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psnet.ahrq.gov/web-mm/mothers-milk-whose-mother
November 15, 2023 - The role of critical incident monitoring in detection and prevention of human breast milk confusions. … December 9, 2020
A randomized trial of a multifactorial strategy to prevent serious fall
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psnet.ahrq.gov/perspective/health-care-worker-presenteeism-challenge-patient-safety
November 03, 2015 - Although infection prevention efforts have traditionally focused on preventing transmission of infection
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psnet.ahrq.gov/innovation/reducing-preventable-patient-harm-due-retained-surgical-items-rsi-bundle
July 23, 2024 - This way, the innovators would know when problems with RSI prevention bundle compliance occurred and … Practices to aid in the prevention of unintentionally retained surgical items. … Novel computer-aided diagnosis software for the prevention of retained surgical items. … September 23, 2024
Patient Safety Innovations
Suicide Prevention … July 23, 2024
Patient Safety Innovations
Suicide Prevention
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psnet.ahrq.gov/perspective/workarounds-and-resiliency-front-lines-health-care
August 01, 2009 - Workarounds and Resiliency on the Front Lines of Health Care
Anita L. Tucker, DBA, MS | August 1, 2009
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Citation Text:
Tucker AL. Workarounds and Resiliency on the Front Lines of Health Care. PSN…
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psnet.ahrq.gov/node/60744/psn-pdf
July 29, 2020 - patients with MI,21 and
additional monitoring of cTn might have led to the recognition of a “rise and fall … psnet.ahrq.gov//#21
https://psnet.ahrq.gov//#20
https://psnet.ahrq.gov//#22
https://psnet.ahrq.gov//#22
Under-prevention … Blumenthal RS, Albert MA, Buroker AB, Goldberger ZD, Hahn EJ, et al. 2019 ACC/AHA
Guideline on the Primary Prevention … Summary of Updated
Recommendations for Primary Prevention of Cardiovascular Disease in Women. … Effectiveness-based
guidelines for the prevention of cardiovascular disease in women--2011 update: a
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psnet.ahrq.gov/web-mm/glucose-roller-coaster
February 02, 2022 - Innovations
Preventing Falls Through Patient and Family Engagement to Create Customized Prevention
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psnet.ahrq.gov/node/50756/psn-pdf
December 18, 2019 - , also requires a prescriber to provide education to a patient and his or her designee on
overdose prevention
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psnet.ahrq.gov/web-mm/primary-workaround-secondary-complication
January 24, 2018 - The prevention and management of complications associated with PEG tubes in adults.
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psnet.ahrq.gov/web-mm/which-line-ordering-provider-or-proceduralist
September 16, 2015 - The Lean management approach provides a useful taxonomy for such prevention of error propagation, termed … Innovations
Preventing Falls Through Patient and Family Engagement to Create Customized Prevention
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psnet.ahrq.gov/web-mm/critical-echocardiogram-result-lost-follow
July 31, 2023 - delivery. 17 Following up on pending tests or laboratory studies and informing providers of results may fall … Stopped Here
June 1, 2004
WebM&M Cases
Another Fall
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psnet.ahrq.gov/web-mm/reflexive-diagnosis-primary-care
April 01, 2008 - SPOTLIGHT CASE
A "Reflexive" Diagnosis in Primary Care
Citation Text:
Betjemann J, Josephson AS. A "Reflexive" Diagnosis in Primary Care. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2014.
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psnet.ahrq.gov/perspective/high-reliability-organization-hro-principles-and-patient-safety
February 26, 2025 - High Reliability Organization (HRO) Principles and Patient Safety
Timothy Vogus, PhD; Merton Lee, PharmD, PhD; Sarah E. Mossburg, RN, PhD | February 26, 2025
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Citation Text:
Vogus T, Lee M, Mos…
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February 26, 2025 - In Conversation with Timothy Vogus about High Reliability Organization (HRO) Principles and Patient Safety
Timothy Vogus, PhD; Merton Lee, PharmD, PhD; Sarah E. Mossburg, RN, PhD | February 26, 2025
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Ci…
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psnet.ahrq.gov/node/846564/psn-pdf
March 29, 2023 - A vision-based approach for fall detection using multiple
cameras and convolutional neural networks: … a case study using the UP-Fall detection dataset.
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psnet.ahrq.gov/node/72586/psn-pdf
December 23, 2020 - With the development of EHR, more clerical and administrative tasks fall on all healthcare
providers