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Showing results for "harms".

8441. 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-…

8442. 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…

8443. 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…

8444. 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…

8445. 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…

8446. 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…

8447. 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…

8448. 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…

8449. 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…

8450. 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…

8451. 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…

8452. 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…

8453. 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…

8454. 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…

8455. 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…

8456. 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):…

8457. 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…

8458. 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…

8459. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/855436/psn-pdf
      November 15, 2023 - Medication Safety for Look-alike, Sound-alike Medicines. November 15, 2023 Galappatthy P, Mair A, Dhingra-Kumar N et al. Geneva, Switzerland: World Health Organization; 2023. ISBN 9789240058897. https://psnet.ahrq.gov/issue/medication-safety-look-alike-sound-alike-medicines Look-alike, sound-alike (LASA) medicines…

8460. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/34755/psn-pdf
      September 06, 2011 - Safe Practices for Better Healthcare: 2006 Update. September 6, 2011 Washington DC: National Quality Forum; 2007. https://psnet.ahrq.gov/issue/safe-practices-better-healthcare-2006-update The National Quality Forum used expert consensus and evidence review to identify 30 health care “safe practices” that should be…