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psnet.ahrq.gov/issue/widows-mission-change-nc-dental-sedation-rules
March 10, 2021 - Here's how it happened.
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psnet.ahrq.gov/issue/he-thought-what-he-was-doing-was-good-people-why-it-so-difficult-prevent-unnecessary-medical
September 02, 2020 - View More
Related Resources
Inside the preventable deaths that happened
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psnet.ahrq.gov/issue/prescription-disaster-americas-broken-pharmacy-system-revolt-over-burnout-and-errors
May 17, 2023 - It happened to me, as a pregnant OB-GYN.
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psnet.ahrq.gov/issue/does-malpractice-liability-make-healthcare-safer-aligning-law-and-policy-evidence
August 26, 2020 - June 2, 2021
View More
Related Resources
Medication mix-up: what happened
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psnet.ahrq.gov/issue/ers-are-swamped-seriously-ill-patients-although-many-dont-have-covid
November 01, 2023 - It happened to me, as a pregnant OB-GYN.
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psnet.ahrq.gov/issue/checklists-safety-my-culture-and-me
June 19, 2019 - September 30, 2014
“I had no idea this happened”: electronic feedback on clinical reasoning
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psnet.ahrq.gov/issue/crisis-lakeshore-hospital-er
March 15, 2022 - Patient Safety Initiatives
July 10, 2024
Inside the preventable deaths that happened
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psnet.ahrq.gov/issue/discontinuity-and-disaster-gaps-and-negotiation-culpability-medication-delivery
June 24, 2020 - Patient Safety Initiatives
July 10, 2024
Inside the preventable deaths that happened
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psnet.ahrq.gov/issue/amid-covid-19-discipline-against-bad-doctors-plummets-more-medical-errors-may-slip-through
June 24, 2020 - It happened to me, as a pregnant OB-GYN.
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psnet.ahrq.gov/issue/premature-closure-not-so-fast
September 28, 2022 - February 27, 2019
What happened to my patient?
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psnet.ahrq.gov/issue/lessons-health-care-leaders-rethinking-and-reinvesting-patient-safety
May 01, 2019 - Summary
July 23, 2024
Events that inspired change: the importance of sharing what happened
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psnet.ahrq.gov/issue/made-whole-efficacy-legal-redress-black-women-who-have-suffered-injuries-medical-bias
February 23, 2022 - May 17, 2023
Medication mix-up: what happened at Vanderbilt and how it impacts health
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psnet.ahrq.gov/issue/report-focuses-risk-patients-ed-errors
June 26, 2019 - It happened to me, as a pregnant OB-GYN.
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psnet.ahrq.gov/issue/medical-errors-kill-thousands-people-each-year-are-hospitals-getting-any-safer
June 17, 2020 - It happened to me, as a pregnant OB-GYN.
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www.ahrq.gov/sites/default/files/wysiwyg/hai/tools/clabsi-cauti-icu/cusp-icu-slides.pptx
April 01, 2022 - Defects13
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AHRQ Safety Program for ICUs: Preventing CLABSI and CAUTI
Applying CUSP ׀ 13
What happened … AHRQ Safety Program for ICUs: Preventing CLABSI and CAUTI
Applying CUSP ׀ 14
Understand Why Defect Happened
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www.ahrq.gov/patient-safety/settings/labor-delivery/perinatal-care/modules/situ/sim-tool-guidance.html
July 01, 2023 - team members gain insight into one another's perspective, helps the team to reach consensus on what happened … Push the team to go beyond just describing what happened.
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www.ahrq.gov/funding/grantee-profiles/grtprofile-vogelmeier.html
December 01, 2023 - the story and that’s where these 24 nursing homes provide an in-depth understanding of what really happened
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psnet.ahrq.gov/issue/jama-professionalism-disclosure-medical-error
December 19, 2018 - Recommended best practices for error disclosure include being honest about what happened, explicitly
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www.ahrq.gov/hai/tools/ambulatory-surgery/sections/sustainability/training-tools/success-transcript.html
June 01, 2017 - use the checklist and ask about it, we decided to put up a bulletin board in the break room, which happened
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psnet.ahrq.gov/issue/respectful-trusting-relationships-are-essential-patient-safety-especially-surgeon
December 08, 2024 - How could it have happened?