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psnet.ahrq.gov/web-mm/add-case-and-missing-checklist
September 01, 2012 - addressed through a thorough understanding of the barriers to adherence.( 16 ) Sometimes a process will fall … Perioperative management of antithrombotic therapy: Antithrombotic Therapy and Prevention of Thrombosis
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psnet.ahrq.gov/web-mm/myasthenia-crisis-after-delayed-diagnosis-medically-complex-patient
February 21, 2020 - October 18, 2023
Assessment of a wearable fall prevention system at a Veterans Health
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psnet.ahrq.gov/node/49799/psn-pdf
July 01, 2017 - with confirmation is mandated by accreditation bodies, but even with
mandates in place, results can fall … Notification of public health authorities allows for monitoring, control, and prevention of communicable
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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/periodic-issue/periodic-issue-431
March 27, 2024 - March 13, 2024 Weekly Issue
PSNet highlights the latest patient safety literature, news, and expert commentary, including Weekly
Updates, WebM&M, and Perspectives on Safety. The current issue highlights what's new this week in patient
safety literature, news, conferences, reports,…
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psnet.ahrq.gov/web-mm/check-twice-transport-once
March 15, 2023 - Hole
October 1, 2003
WebM&M Cases
Another Fall
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psnet.ahrq.gov/node/841139/psn-pdf
December 14, 2022 - Open wider: Failure to use an interpreter results in
fractured teeth and hypoxia during a simple elective
operation.
December 14, 2022
Bohringer C, Godoy L. Open wider: Failure to use an interpreter results in fractured teeth and hypoxia
during a simple elective operation. PSNet [internet]. 2022.
https://psnet.ah…
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psnet.ahrq.gov/perspective/safety-across-board
August 31, 2020 - When I began looking for my next position in 2005/2006, I was already very focused on safety, prevention … December 18, 2024
Patient Safety Innovations
Suicide Prevention
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psnet.ahrq.gov/perspective/conversation-edwin-loftin-dnp-mba-rn-nea-bc-fache
August 31, 2020 - When I began looking for my next position in 2005/2006, I was already very focused on safety, prevention … December 18, 2024
Patient Safety Innovations
Suicide Prevention
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psnet.ahrq.gov/node/49754/psn-pdf
February 01, 2016 - Use of designated nurse PICC teams and CLABSI prevention
practices among U.S. hospitals: a survey-based
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psnet.ahrq.gov/web-mm/diagnostic-overshadowing-dangers
February 12, 2020 - Paulozzi LJ, Strickler GK, Kreiner PW, Koris CM; Centers for Disease Control and Prevention (CDC).
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psnet.ahrq.gov/perspective/care-transitions
December 01, 2007 - know health care delivery backwards and forwards—are themselves not immune from seeing these issues fall
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psnet.ahrq.gov/periodic-issue/periodic-issue-293
May 26, 2021 - Level III trauma center to a Level I trauma center with lower extremity paralysis after a ground level fall
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psnet.ahrq.gov/web-mm/impatient-inpatient-dosing
June 24, 2020 - 20 hours before there is any significant change in the INR (because factor VII levels first have to fall
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psnet.ahrq.gov/node/861738/psn-pdf
January 31, 2024 - Human errors and their prevention in healthcare. … Human errors and their prevention in healthcare.
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psnet.ahrq.gov/sites/default/files/2024-01/spotlight_case_laceration_needed_exam_not_x-ray_final.pdf
January 01, 2024 - Human errors and their prevention in
healthcare. … Human errors and their prevention in healthcare.
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psnet.ahrq.gov/perspective/conversation-withgeri-amori-phd
December 01, 2010 - remember most vividly was that the focus of people in the C-suite was very much on lawsuits: lawsuit prevention … First, in the mid-1990s, RMF's loss prevention staff saw an alarming trend in malpractice cases related … More recent evidence comes from the Malpractice Insurers Medical Error Prevention Study, a large study … MA
William Berry, MD, MPH Surgical Consultant, CRICO/RMF
Kathy Dwyer Program Director, Loss Prevention … MS
August 1, 2009
Council recommendation on patient safety, including the prevention
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psnet.ahrq.gov/web-mm/shortcuts-acetaminophen-induced-liver-failure
July 01, 2017 - dL) postingestion than at 4 hours (150 mg/dL).( 11 ) This is because the measured concentration will fall
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psnet.ahrq.gov/web-mm/wandering-floors-safety-and-security-risks-patient-wandering
August 21, 2007 - SPOTLIGHT CASE
Wandering Off the Floors: Safety and Security Risks of Patient Wandering
Citation Text:
Smith TA. Wandering Off the Floors: Safety and Security Risks of Patient Wandering. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Huma…
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psnet.ahrq.gov/node/33788/psn-pdf
June 01, 2015 - In Conversation With… Christine Cassel, MD
June 1, 2015
In Conversation With… Christine Cassel, MD. PSNet [internet]. 2015.
https://psnet.ahrq.gov/perspective/conversation-christine-cassel-md
Editor's note: Christine Cassel, MD, is President and CEO of the National Quality Forum (NQF). Dr.
Cassel, one of the foun…