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Showing results for "harm".

241. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/72803/psn-pdf
     March 03, 2021 - First do no harm: practitioners' ability to 'diagnose' system weaknesses and improve safety is a critical … First do no harm: practitioners’ ability to ‘diagnose’ system weaknesses and improve safety is a critical … https://psnet.ahrq.gov/issue/first-do-no-harm-practitioners-ability-diagnose-system-weaknesses-and- … https://psnet.ahrq.gov/issue/how-do-no-harm-empowering-local-leaders-make-care-safer-low-resource-settings … /psnet.ahrq.gov/issue/patient-safety-developing-countries-retrospective-estimation-scale-and-nature-harm-patients

242. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/836916/psn-pdf
     April 13, 2022 - Implementing a robust process improvement program in the neonatal intensive care unit to reduce harm … Implementing a robust process improvement program in the neonatal intensive care unit to reduce harm … psnet.ahrq.gov/issue/implementing-robust-process-improvement-program-neonatal-intensive-care- unit-reduce-harm … improvement tools to support staff skill development and identify sustainable improvements) to reduce harm … psnet.ahrq.gov/issue/implementing-robust-process-improvement-program-neonatal-intensive-care-unit-reduce-harm

243. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/73536/psn-pdf
     July 28, 2021 - Epidemiology of healthcare harm in New Zealand general practice: a retrospective records review study … https://psnet.ahrq.gov/issue/epidemiology-healthcare-harm-new-zealand-general-practice-retrospective- … records-review-study In this retrospective study, researchers examined patient records to describe patient harm … https://psnet.ahrq.gov/issue/epidemiology-healthcare-harm-new-zealand-general-practice-retrospective-records-review-study … https://psnet.ahrq.gov/issue/incidence-nature-and-causes-avoidable-significant-harm-primary-care-england-retrospective

244. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/854987/psn-pdf
     January 01, 2024 - Frequency, type, and degree of potential harm of adverse safety events among pediatric emergency medical … Frequency, type, and degree of potential harm of adverse safety events among pediatric emergency medical … https://psnet.ahrq.gov/issue/frequency-type-and-degree-potential-harm-adverse-safety-events-among- pediatric-emergency … More than 20% of encounters contained at least one ASE, although most were unlikely to cause harm (e.g … https://psnet.ahrq.gov/issue/frequency-type-and-degree-potential-harm-adverse-safety-events-among-pediatric-emergency

245. The Hidden Harms of Hand Sanitizer | PSNet
     psnet.ahrq.gov/web-mm/hidden-harms-hand-sanitizer
     March 04, 2020 - information places the patient at risk for withdrawal, which if untreated can lead to significant patient harm … If there is concern for intentional self-harm behavior, a psychiatrist should be engaged immediately. … How do we prevent serious harm or death from ingestion of these sanitizers in the health care setting

246. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/72566/psn-pdf
     January 01, 2021 - Incidence, nature and causes of avoidable significant harm in primary care in England: retrospective … Incidence, nature and causes of avoidable significant harm in primary care in England: retrospective … https://psnet.ahrq.gov/issue/incidence-nature-and-causes-avoidable-significant-harm-primary-care- england-retrospective … Their analysis identified three primary types of avoidable harm in primary care – problems with diagnoses … The authors suggest several methods to reduce avoidable harm in primary care, including optimizing existing

247. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/73066/psn-pdf
     March 24, 2021 - Patient harm resulting from medication reconciliation process failures: a study of serious events reported … Patient harm resulting from medication reconciliation process failures: a study of serious events reported … https://psnet.ahrq.gov/issue/patient-harm-resulting-medication-reconciliation-process-failures-study- … The most common process failures contributing to patient harm occurred during order entry/transcription … prescribed medications, and adding anticonvulsants to processes for medication with high risk for harm

248. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/73158/psn-pdf
     April 21, 2021 - Better understanding the downsides of low value healthcare could reduce harm. … Better understanding the downsides of low value healthcare could reduce harm. … https://psnet.ahrq.gov/issue/better-understanding-downsides-low-value-healthcare-could-reduce-harm Overuse … of healthcare services can result in financial, physical, and emotional harm to the patient. … Research is needed to quantify harm resulting from overuse of healthcare services, including the number

249. Preventing Falls in Hospitals
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/fallprevention-training/module1/module1_slides_fallprev.pptx
     June 16, 2017 - Falls harm patients. 30% to 51% of falls result in injury. … per 1000 pt days JAH VAMC Med-Surg Falls with Harm by Quarter per 1000 pt days (Includes all harm categories … per 1000 pt days JAH VAMC Med-Surg Falls with Harm by Quarter per 1000 pt days (Includes all harm categories … 0 Quarter harm from falls Pilot Unit (5 South) Harm from Falls per 1000 pt days by Quarter JAH VAMC … 0 Quarter harm from falls Pilot Unit (7 North) Harm from Falls per 1000 pt days by Quarter

250. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/851665/psn-pdf
     July 26, 2023 - Medical record review is a primary tactic to identify health care actions that contribute to patient harm … process used in the 2018 report  Adverse Events in Hospitals: A Quarter of Medicare Patients Experienced Harm … It is a companion toolkit to the Clinical Guidance for Identifying Harm publication. … -2018 https://psnet.ahrq.gov/issue/adverse-events-hospitals-quarter-medicare-patients-experienced-harm-october … -2018 https://psnet.ahrq.gov/issue/adverse-events-toolkit-clinical-guidance-identifying-harm

251. Relationship Between Patient Harm and Reported Medical Errors in Primary Care: A Report from the ASIPS Collaborative (pdf file)
     ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol1/Advances-West_102.pdf
     March 31, 2008 - and frequency of harm classified hierarchically into five categories: (1) unknown or no known harm … Harm classification Harm category Example Known clinical harm to the patient A positive herpes simplex … as “known clinical harm.” … As previously stated, in describing the likelihood of clinical harm or future risk of clinical harm … Reports of the errors themselves and any clinical harm (or lack of harm) associated with each error

252. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/867449/psn-pdf
     March 13, 2025 - Medication Related Harm. March 13, 2025 Medication Related Harm. … Health Services Safety Investigations Body. 2024-2025 https://psnet.ahrq.gov/issue/medication-related-harm … Omitted or delayed medication therapy can contribute to patient discomfort, stress, and harm. … https://psnet.ahrq.gov/issue/medication-related-harm https://psnet.ahrq.gov/web-mm/delayed-clozapine-prescription-elderly-man-dementia

253. Blood Dashboard Data (xls file)
     www.qualitymeasures.ahrq.gov/sites/default/files/wysiwyg/npsd/Blood_Dashboard_Data_2023.xlsx
     January 01, 2023 - reports by type of blood product, by the process of care involved, and by the extent of residual patient harm … Blood_2 Blood_2: Type of Blood Product by Extent of Residual Harm Type of Blood Product No Harm Percentage … No Harm Frequency Harm Percentage Harm Frequency Total Red blood cells 96.5% 2,013 3.5% 73 3,003 … Stage of Process When Blood or Blood Product Event Originated No Harm Percentage No Harm Frequency … Harm Percentage Harm Frequency Total Post-transfusion or administration 99.0% 392 1.0% 4 1,927 Sample

254. NPSD Dashboards | Agency for Healthcare Research and Quality
     pbrn.ahrq.gov/npsd/data/dashboard/index.html
     October 01, 2023 - The dashboard charts detail event type, report type by event type, extent of harm by event type, event … type by extent of harm, and extent of harm.   … Falls Dashboard Details the extent of harm due to falls, the presence of fall assistance, presence … of fall assistance by patient harm, type of fall injury, and fall location.     … to the patient, type of incorrect dose, type of incorrect dose by residual harm to the patient, stage

255. NPSD Dashboards | Agency for Healthcare Research and Quality
     pcmh.ahrq.gov/npsd/data/dashboard/index.html
     October 01, 2023 - The dashboard charts detail event type, report type by event type, extent of harm by event type, event … type by extent of harm, and extent of harm.   … Falls Dashboard Details the extent of harm due to falls, the presence of fall assistance, presence … of fall assistance by patient harm, type of fall injury, and fall location.     … to the patient, type of incorrect dose, type of incorrect dose by residual harm to the patient, stage

256. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/860715/psn-pdf
     January 17, 2024 - Development of prescribing indicators related to opioid- related harm in patients with chronic pain … Development of prescribing indicators related to opioid-related harm in patients with chronic pain in … https://psnet.ahrq.gov/issue/development-prescribing-indicators-related-opioid-related-harm-patients- … Fifteen out of the 21 scenarios were rated as inappropriate (i.e., could result in harm to patients) … https://psnet.ahrq.gov/issue/development-prescribing-indicators-related-opioid-related-harm-patients-chronic-pain-primary

257. Silence A Commentary | Agency for Healthcare Research and Quality
     www.ahrq.gov/patient-safety/resources/liability/silence.html
     August 01, 2017 - Patients and families realize no provider comes to work with the intent to cause harm. … Yet, when harm does occur, and honest and transparent conversations are not conducted, you harm us again … There are four things patients and families want after medical harm has occurred: tell us what happened … . 5 I believe there is a fifth desire for some patients and families after harm has occurred, and it … RCA: Improving Root Cause analyses and Actions to Prevent Harm.

258. Silence A Commentary | Agency for Healthcare Research and Quality
     www.ahrq.gov/patient-safety/reports/liability/silence.html
     August 01, 2017 - Patients and families realize no provider comes to work with the intent to cause harm. … Yet, when harm does occur, and honest and transparent conversations are not conducted, you harm us again … There are four things patients and families want after medical harm has occurred: tell us what happened … . 5 I believe there is a fifth desire for some patients and families after harm has occurred, and it … RCA: Improving Root Cause analyses and Actions to Prevent Harm.

259. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/847724/psn-pdf
     April 19, 2023 - Defining avoidable healthcare-associated harm in prisons: a mixed-method development study. … Defining avoidable healthcare-associated harm in prisons: a mixed-method development study. … https://psnet.ahrq.gov/issue/defining-avoidable-healthcare-associated-harm-prisons-mixed-method- development-study … article describes structures and processes within prison systems that may contribute to avoidable harm … https://psnet.ahrq.gov/issue/defining-avoidable-healthcare-associated-harm-prisons-mixed-method-development-study

260. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/864372/psn-pdf
     March 13, 2024 - To do no harm - and the most good - with AI in health care. … To do no harm - and the most good - with AI in health care. … https://psnet.ahrq.gov/issue/do-no-harm-and-most-good-ai-health-care Artificial intelligence (AI) is … https://psnet.ahrq.gov/issue/do-no-harm-and-most-good-ai-health-care https://psnet.ahrq.gov/perspective … psnet.ahrq.gov/issue/diagnostic-errors-health-disparities-and-artificial-intelligence-combination-health-or-harm