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Showing results for "harms".

8281. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/60765/psn-pdf
      August 05, 2020 - Coronavirus: can this California prison save itself from Covid-19? August 5, 2020 Honderich H, Popat S. Coronavirus: Can this California prison save itself from Covid-19? BBC News, Washington. 2020;Jul 27. https://psnet.ahrq.gov/issue/coronavirus-can-california-prison-save-itself-covid-19 Omissions in standard pr…

8282. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/855003/psn-pdf
      November 01, 2023 - The hospital ran out of her child's cancer drug. Now she's fighting to end shortages. November 1, 2023 Noguchi Y. Health Shots and All Things Considered. National Public Radio. October 23, 2023. https://psnet.ahrq.gov/issue/hospital-ran-out-her-childs-cancer-drug-now-shes-fighting-end-shortages Drug shortages…

8283. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/46641/psn-pdf
      December 20, 2017 - A review of best practices for intravenous push medication administration. December 20, 2017 Lenz JR, Degnan DD, Hertig JB, et al. A Review of Best Practices for Intravenous Push Medication Administration. J Infus Nurs. 2017;40(6):354-358. doi:10.1097/NAN.0000000000000247. https://psnet.ahrq.gov/issue/review-best-…

8284. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/850176/psn-pdf
      June 07, 2023 - Care Post-Roe: Documenting Cases of Poor-quality Care Since the Dobbs Decision. June 7, 2023 Grossman D, Joffe C, Kaller S, et al. Advancing New Standards in Reproductive Health, University of California, San Francisco; 2023. https://psnet.ahrq.gov/issue/care-post-roe-documenting-cases-poor-quality-care-dobbs-deci…

8285. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/73911/psn-pdf
      October 06, 2021 - Misdiagnosis of acute myocardial infarction: a systematic review of the literature. October 6, 2021 Kwok CS, Bennett S, Azam Z, et al. Misdiagnosis of acute myocardial infarction: a systematic review of the literature. Crit Pathw Cardiol. 2021;20(3):155-162. doi:10.1097/hpc.0000000000000256. https://psnet.ahrq.gov…

8286. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/50925/psn-pdf
      February 19, 2020 - Report of the Independent Inquiry into the Issues Raised by Paterson. February 19, 2020 James G. House Commons Report 31. Department of Health and Social Care. London, England: Crown Copyright; 2020. ISBN 9781528617284. https://psnet.ahrq.gov/issue/report-independent-inquiry-issues-raised-paterson Shari…

8287. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/837744/psn-pdf
      July 27, 2022 - Medication orders with future start dates: how far away is too far? July 27, 2022 ISMP Medication Safety Alert! Acute care edition. July 14, 2022:27(14):1-4. https://psnet.ahrq.gov/issue/medication-orders-future-start-dates-how-far-away-too-far Human errors that occur while interacting with electronic health recor…

8288. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/44032/psn-pdf
      April 01, 2015 - ACOG Committee Opinion #621: patient safety and health information technology. April 1, 2015 Improvement C on PS and Q, Management C on P. Committee opinion no. 621: Patient safety and health information technology. Obstet Gynecol. 2015;125(1):282-3. doi:10.1097/01.AOG.0000459867.14114.7a. https://psnet.ahrq.gov/i…

8289. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/47051/psn-pdf
      October 18, 2018 - Errors and discrepancies in the administration of intravenous infusions: a mixed methods multihospital observational study. October 18, 2018 Lyons I, Furniss D, Blandford A, et al. Errors and discrepancies in the administration of intravenous infusions: a mixed methods multihospital observational study. BMJ Qual S…

8290. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/37151/psn-pdf
      January 02, 2017 - The impact of abbreviations on patient safety. January 2, 2017 Brunetti L, Santell JP, Hicks RW. The impact of abbreviations on patient safety. Jt Comm J Qual Patient Saf. 2007;33(9):576-83. https://psnet.ahrq.gov/issue/impact-abbreviations-patient-safety Avoiding use of unclear or misleading abbreviations is a ke…

8291. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/73147/psn-pdf
      April 14, 2021 - Endometriosis affects 1 out of 10 women like me. Yet it often takes a decade to get diagnosed. April 14, 2021 Peikoff L. NBC News. March 31, 2021. https://psnet.ahrq.gov/issue/endometriosis-affects-1-out-10-women-me-yet-it-often-takes-decade-get- diagnosed Patients with endometriosis often experience care de…

8292. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/47577/psn-pdf
      January 16, 2019 - Reversing the rise in maternal mortality. January 16, 2019 Kozhimannil KB. Reversing The Rise In Maternal Mortality. Health Aff (Millwood). 2018;37(11):1901-1904. doi:10.1377/hlthaff.2018.1013. https://psnet.ahrq.gov/issue/reversing-rise-maternal-mortality Maternal harm is a sentinel event that is gaining increase…

8293. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/838637/psn-pdf
      October 19, 2022 - Patient safety and legal regulations: a total-scale analysis of the scientific literature. October 19, 2022 Yeung AWK, Kletecka-Pulker M, Klager E, et al. Patient safety and legal regulations: a total-scale analysis of the scientific literature. J Patient Saf. 2022;18(7):e1116-e1123. doi:10.1097/pts.000000000000104…

8294. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/866411/psn-pdf
      July 31, 2024 - Simulation to Improve Patient Safety: Getting Started. July 31, 2024 Deutsch ES, Bajaj K. Simulation To Improve Patient Safety: Getting Started. Rockville, MD: Agency for Healthcare Research and Quality; July 2024. Publication No. 24-0055. https://psnet.ahrq.gov/issue/simulation-improve-patient-safety-getting-start…

8295. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/43178/psn-pdf
      July 28, 2014 - Safety measurement and monitoring in healthcare: a framework to guide clinical teams and healthcare organisations in maintaining safety. July 28, 2014 Vincent CA, Burnett S, Carthey J. Safety measurement and monitoring in healthcare: a framework to guide clinical teams and healthcare organisations in maintaining s…

8296. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/43119/psn-pdf
      April 16, 2014 - Still outside the bull's eye: 2014–2015 Targeted Medication Safety Best Practices. April 16, 2014 ISMP Medication Safety Alert! Acute care edition. March 27, 2014;19:1-5. https://psnet.ahrq.gov/issue/still-outside-bulls-eye-2014-2015-targeted-medication-safety-best-practices This newsletter article reports results…

8297. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/852805/psn-pdf
      August 23, 2023 - Unstoppable: this doctor has been investigated at every level of government. How is he still practicing? August 23, 2023 Waldman A. ProPublica. August 9, 2023 https://psnet.ahrq.gov/issue/unstoppable-doctor-has-been-investigated-every-level-government-how-he- still-practicing Systemic failures can enable poo…

8298. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/45066/psn-pdf
      February 18, 2017 - Improving feedback on junior doctors' prescribing errors: mixed-methods evaluation of a quality improvement project. February 18, 2017 Reynolds M, Jheeta S, Benn J, et al. Improving feedback on junior doctors' prescribing errors: mixed- methods evaluation of a quality improvement project. BMJ Qual Saf. 2017;26(3):…

8299. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/45782/psn-pdf
      January 18, 2017 - Standardization of inpatient handoff communication. January 18, 2017 Jewell JA. Standardization of Inpatient Handoff Communication. Pediatrics. 2016;138(5):e20162681. doi:10.1542/peds.2016-2681. https://psnet.ahrq.gov/issue/standardization-inpatient-handoff-communication Handoffs at shift changes are vulnerable to…

8300. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/43048/psn-pdf
      April 02, 2014 - Building a Culture of Candour: a Review of the Threshold for the Duty of Candour and of the Incentives for Care Organisations to Be Candid. April 2, 2014 Dalton D, Williams N. London, UK: The Royal College of Surgeons of England; March 2014.  https://psnet.ahrq.gov/issue/building-culture-candour-review-thresh…