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Showing results for "happen".

241. Application of Safety-II Principles | PSNet
     psnet.ahrq.gov/perspective/application-safety-ii-principles
     August 28, 2024 - Safety-I uses a traditional, reactive, and failure-focused approach to managing safety events when they happen … The assumption here is that the system is not complex, is inherently safe, and that bad things only happen … We should not ignore those instances when they happen, but we should also really be mindful that the

242. In Conversation with Chalapathy Venkatesan and Kathy Helak about Application of Safety-II Principles | PSNet
     psnet.ahrq.gov/perspective/conversation-chalapathy-venkatesan-and-kathy-helak-about-application-safety-ii
     August 28, 2024 - Safety-I uses a traditional, reactive, and failure-focused approach to managing safety events when they happen … The assumption here is that the system is not complex, is inherently safe, and that bad things only happen … We should not ignore those instances when they happen, but we should also really be mindful that the

243. Safety Culture in EMS | PSNet
     psnet.ahrq.gov/perspective/safety-culture-ems
     May 26, 2021 - 12 Conclusion Increasing the transition of EMS to a Just Culture is not something that can happen … How do we shift the thinking to the idea that these are harms that may happen to the patient, be it a … for bringing something forward that only makes the organization better, but unfortunately that does happen … Why did this error happen?

244. In Conversation With... Chris Cebollero, BS, CCEMT-P | PSNet
     psnet.ahrq.gov/perspective/conversation-chris-cebollero-bs-ccemt-p
     May 26, 2021 - How do we shift the thinking to the idea that these are harms that may happen to the patient, be it a … for bringing something forward that only makes the organization better, but unfortunately that does happen … Why did this error happen? … 12 Conclusion Increasing the transition of EMS to a Just Culture is not something that can happen

245. A piece of my mind. Trials and tribulations. | PSNet
     psnet.ahrq.gov/issue/piece-my-mind-trials-and-tribulations
     October 19, 2022 - It could happen to you.

246. The lurking danger in the “business case” for patient safety | PSNet
     psnet.ahrq.gov/issue/lurking-danger-business-case-patient-safety
     May 13, 2020 - June 2, 2010 When mistakes happen.

247. Algorithm that detects sepsis cut deaths by nearly 20 percent. | PSNet
     psnet.ahrq.gov/issue/algorithm-detects-sepsis-cut-deaths-nearly-20-percent
     October 12, 2022 - May 20, 2020 Hospitals look to computers to predict patient emergencies before they happen

248. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/867651/psn-pdf
     February 26, 2025 - Hollnagel terms this the causality credo, which he defines as “the belief that adverse outcomes happen … “Work-as-imagined" describes what is expected to happen under anticipated normal working conditions, … Nonetheless, because these events are frequent, if we can understand how and why they happen, we can

249. Hospital-Acquired Diabetic Ketoacidosis. | PSNet
     psnet.ahrq.gov/web-mm/hospital-acquired-diabetic-ketoacidosis
     October 28, 2020 - of basal and/or nutritional insulin in a patient with type 1 diabetes is an event that should never happen … Ask what will happen with your medicines. Know what will happen with your diet. … Find out what will happen when you go home.

250. Error in medicine. | PSNet
     psnet.ahrq.gov/issue/error-medicine
     November 02, 2014 - human errors will occur and that are designed to minimize their occurrence and absorb them when they happen

251. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/841306/psn-pdf
     December 14, 2022 - All these situations happen while considering the conditions, capabilities, and preferences of individual … begin by looking for what goes right, and the greatest benefit may arise from focusing on events that happen

252. Spotlight Case July 2008 (ppt file)
     psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.239_slideshow.ppt
     May 01, 2011 - Angry and upset, the parents asked repeatedly, “How could this happen?

253. Wired hospitals: can high tech save your life? | PSNet
     psnet.ahrq.gov/issue/can-high-tech-save-your-life
     August 07, 2024 - 31, 2023 Hospitals look to computers to predict patient emergencies before they happen

254. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/840256/psn-pdf
     November 16, 2022 - of diagnostic accuracy and antibiotic stewardship, and lots of different patient safety issues can happen … department and skilled nursing facility staff had some disconnected and conflicting ideas of what needed to happen … We don’t know what they are, but we know that stuff is going to happen.

255. In Conversation With... Remle P. Crowe, PhD | PSNet
     psnet.ahrq.gov/perspective/conversation-remle-p-crowe-phd
     May 16, 2022 - in the prehospital setting, or the context of care delivery, impact the patient safety events that happen

256. Identifying Safety Events in the Prehospital Setting | PSNet
     psnet.ahrq.gov/perspective/identifying-safety-events-prehospital-setting
     May 16, 2022 - in the prehospital setting, or the context of care delivery, impact the patient safety events that happen

257. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/33760/psn-pdf
     February 01, 2014 - Enrico Coiera: Interruptions happen every day to every clinician, nurse, and doctor. … EC: I think what will happen is that we'll increasingly be able to use computer systems for information … A lot of such intelligence can happen in the background once technology focuses on the physical context

258. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/33828/psn-pdf
     March 01, 2017 - Errors can happen, but probably a million drug errors are made today. … That will happen when we can say we've optimized the technical intervention, we've optimized the implementation

259. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/855058/psn-pdf
     October 31, 2023 - violence occurs, it can spill over and make others—patients, visitors, and staff—fearful about what might happen … Patients may worry about what could happen to them during their stay, and the uncertainty and at times … careful not to rely solely on how healthcare workers can fix violence in the moment just because they happen … What can happen is that organizations may fear having any reports released that indicates their system … leaders to champion initiatives that address worker safety, protect and support staff when incidents happen

260. IOM panel reviews lessons for medication safety. | PSNet
     psnet.ahrq.gov/issue/iom-panel-reviews-lessons-medication-safety
     September 30, 2009 - November 25, 2020 Surgical errors happen, but are learners trained to recover from them