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Showing results for "happened".

  1. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/838180/psn-pdf
    January 01, 2023 - To err is human, but what happens when surgeons err? September 28, 2022 Lin JS, Olutoye OO, Samora JB. To err is human, but what happens when surgeons err? J Pediatr Surg. 2023;58(3):496-502. doi:10.1016/j.jpedsurg.2022.06.019. https://psnet.ahrq.gov/issue/err-human-what-happens-when-surgeons-err Clinicians involv…
  2. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/42567/psn-pdf
    September 11, 2013 - What happens to the medication regimens of older adults during and after an acute hospitalization? September 11, 2013 Harris CM, Sridharan A, Landis R, et al. What happens to the medication regimens of older adults during and after an acute hospitalization? J Patient Saf. 2013;9(3):150-3. doi:10.1097/PTS.0b013e3182…
  3. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/850356/psn-pdf
    June 14, 2023 - Prescribing errors in children: why they happen and how to prevent them. June 14, 2023 Conn R, Fox A, Carrington A, et al. Prescribing errors in children: why they happen and how to prevent them. Pharmaceutical Journal. 2023;310:7973. doi:10.1211/pj.2023.1.184013. https://psnet.ahrq.gov/issue/prescribing-errors-ch…
  4. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/36149/psn-pdf
    September 29, 2010 - When incidents happen. September 29, 2010 Newfield JS. When Incidents Happen. Home Health Care Manag Pract. 2006;18(5). doi:10.1177/1084822306287998. https://psnet.ahrq.gov/issue/when-incidents-happen The author discusses post-incident documentation for the home care setting and addresses legal issues. https://ps…
  5. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/39923/psn-pdf
    September 03, 2014 - Sued for misdiagnosis? It could happen to you. September 3, 2014 Lippman H, Davenport J. Sued for misdiagnosis? It could happen to you. J Fam Pract. 2010;59(9):498-508. https://psnet.ahrq.gov/issue/sued-misdiagnosis-it-could-happen-you This article explains how to avoid diagnostic error, minimize litigation, and pr…
  6. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/45874/psn-pdf
    February 22, 2017 - Ethics in the pediatric emergency department: when mistakes happen: an approach to the process, evaluation, and response to medical errors. February 22, 2017 Dreisinger N, Zapolsky N. Ethics in the Pediatric Emergency Department: When Mistakes Happen: An Approach to the Process, Evaluation, and Response to Medical…
  7. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/40194/psn-pdf
    June 20, 2011 - What happens when things go wrong? June 20, 2011 Brandom BW, Callahan P, Micalizzi DA. What happens when things go wrong? Paediatr Anaesth. 2011;21(7):730-6. doi:10.1111/j.1460-9592.2010.03513.x. https://psnet.ahrq.gov/issue/what-happens-when-things-go-wrong This commentary reveals a personal story of loss and dis…
  8. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/38215/psn-pdf
    November 14, 2011 - Could it happen here? Learning from other organizations' safety errors. November 14, 2011 Conway JB. Could it happen here? Learning from other organizations' safety errors. Healthcare Executive. 2008;23(6):64, 66-67. https://psnet.ahrq.gov/issue/could-it-happen-here-learning-other-organizations-safety-errors This…
  9. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/39489/psn-pdf
    June 11, 2010 - What happens between visits? Adverse and potential adverse events among a low-income, urban, ambulatory population with diabetes. June 11, 2010 Sarkar U, Handley MA, Gupta R, et al. What happens between visits? Adverse and potential adverse events among a low-income, urban, ambulatory population with diabetes. Qua…
  10. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/35181/psn-pdf
    June 23, 2009 - Communication during trauma resuscitation: do we know what is happening? June 23, 2009 Bergs EAG, Rutten FLPA, Tadros T, et al. Communication during trauma resuscitation: do we know what is happening? Injury. 2005;36(8):905-11. https://psnet.ahrq.gov/issue/communication-during-trauma-resuscitation-do-we-know-what-…
  11. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/44359/psn-pdf
    January 06, 2016 - What happens when healthcare innovations collide? January 6, 2016 Pendharkar SR, Woiceshyn J, da Silveira GJC, et al. What happens when healthcare innovations collide? BMJ Qual Saf. 2016;25(1):9-13. doi:10.1136/bmjqs-2015-004441. https://psnet.ahrq.gov/issue/what-happens-when-healthcare-innovations-collide Innovat…
  12. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/44132/psn-pdf
    May 13, 2015 - Adverse outcomes: why bad things happen to good people. May 13, 2015 Sonnenberg A. Adverse outcomes: why bad things happen to good people. Clin Gastroenterol Hepatol. 2015;13(5):820-3.e1. doi:10.1016/j.cgh.2014.07.064. https://psnet.ahrq.gov/issue/adverse-outcomes-why-bad-things-happen-good-people This commentary…
  13. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/50677/psn-pdf
    November 20, 2019 - What Happens When Doctors Make Diagnostic Errors? November 20, 2019 The Peoples Pharmacy. Show 1186: National Public Radio. October 24, 2019. https://psnet.ahrq.gov/issue/what-happens-when-doctors-make-diagnostic-errors Misdiagnosis growing area of concern in health care. This radio feature explores three commonly …
  14. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/47757/psn-pdf
    February 06, 2019 - Doctors make mistakes. A new documentary explores what happens when they do—and how to fix it. February 6, 2019 Park A. Time Magazine. January 24, 2019. https://psnet.ahrq.gov/issue/doctors-make-mistakes-new-documentary-explores-what-happens-when-they- do-and-how-fix-it This news article reports on the documentar…
  15. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/46506/psn-pdf
    October 11, 2017 - Getting Ahead of Harm Before It Happens: A Guide About Proactive Analysis for Improving Surgical Care Safety. October 11, 2017 Wiley K, Davies JM. Edmonton, AB: Canadian Patient Safety Institute; 2017. https://psnet.ahrq.gov/issue/getting-ahead-harm-it-happens-guide-about-proactive-analysis-improving- surgical-car…
  16. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/50719/psn-pdf
    December 04, 2019 - A lot happens when you report a hazard or error to ISMP—there’s no “black hole” here! December 4, 2019 ISMP Medication Safety Alert! Acute Care Edition. November 7, 2019 https://psnet.ahrq.gov/issue/lot-happens-when-you-report-hazard-or-error-ismp-theres-no-black-hole-here The reporting and analysis of incidents i…
  17. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/39080/psn-pdf
    November 04, 2009 - How could this happen? November 4, 2009 Westfall SS; Mascia K. People. October 5, 2009. https://psnet.ahrq.gov/issue/how-could-happen This story discusses an instance of mistakenly implanted embryos and the impact of the error on the two families involved. https://psnet.ahrq.gov/issue/how-could-happen
  18. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/47914/psn-pdf
    May 22, 2019 - Hospitals look to computers to predict patient emergencies before they happen. May 22, 2019 Ross C. STAT. May 13, 2019. https://psnet.ahrq.gov/issue/hospitals-look-computers-predict-patient-emergencies-they-happen Nuisance alarms, interruptions, and insufficient staff availability can hinder effective monitoring …
  19. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/40815/psn-pdf
    September 28, 2011 - Program encourages reporting accidents waiting to happen: the Good Catch Awards. September 28, 2011 Minnesota Hospital Association. https://psnet.ahrq.gov/issue/program-encourages-reporting-accidents-waiting-happen-good-catch-awards This news article highlights a program at Johns Hopkins Medicine that engages clin…
  20. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/47678/psn-pdf
    December 19, 2018 - When mistakes happen. December 19, 2018 Beck DL. ASH Clinical News. December 1, 2018. https://psnet.ahrq.gov/issue/when-mistakes-happen This article provides an overview of efforts to understand and improve patient safety and covers topics such as the epidemiology of error, its impact on the individuals involved, …