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Showing results for "harms".

  1. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49868/psn-pdf
    July 02, 2019 - Delayed Clozapine Prescription in an Elderly Man With Dementia July 2, 2019 Tsourounis C, Ghomeshi KK. Delayed Clozapine Prescription in an Elderly Man With Dementia. PSNet [internet]. 2019. https://psnet.ahrq.gov/web-mm/delayed-clozapine-prescription-elderly-man-dementia The Case An 86-year-old man with neurode…

  2. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/867427/psn-pdf
    December 18, 2024 - The Ongoing Journey to Prevent Patient Falls December 18, 2024 Dykes PC, Sousane Z, Mossburg SE. The Ongoing Journey to Prevent Patient Falls. PSNet [internet]. 2024. https://psnet.ahrq.gov/perspective/ongoing-journey-prevent-patient-falls Falls are not a new issue, especially among older adults. The Centers for D…

  3. Survey on Patient Safety (facility version) (pdf file)

    www.ahrq.gov/sites/default/files/wysiwyg/sops/surveys/hospital/facilscanform.pdf
    June 02, 2025 - Survey on Patient Safety (facility version) 1 Survey on Patient Safety Instructions This survey asks for your opinions about patient safety issues, medical error, and event reporting in your facility and will take about 10 to 15 minutes to complete. If you do not wish to answer a question, or if a question …

  4. Hospital Survey on Patient Safety (doc file)

    www.ahrq.gov/sites/default/files/wysiwyg/sops/quality-patient-safety/patientsafetyculture/hospitalscanform.doc
    June 02, 2025 - Hospital Survey on Patient Safety SOPSTM Hospital Survey Version: 1.0 Language: English Note · For more information on getting started, selecting a sample, determining data collection methods, establishing data collection procedures, conducting a Web-based survey, and preparing and analyzing data, and producing re…

  5. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49781/psn-pdf
    January 01, 2017 - Hazards of Loading Doses January 1, 2017 Mucksavage JJ, Tesoro EP. Hazards of Loading Doses. PSNet [internet]. 2017. https://psnet.ahrq.gov/web-mm/hazards-loading-doses The Case A 40-year-old woman was recently discharged after a prolonged hospitalization for seizures and a cardiac arrest. Two days after discharg…

  6. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49842/psn-pdf
    September 01, 2018 - The Wrong Blade: A Lack of Familiarity With Pediatric Emergency Equipment September 1, 2018 Katznelson J. The Wrong Blade: A Lack of Familiarity With Pediatric Emergency Equipment. PSNet [internet]. 2018. https://psnet.ahrq.gov/web-mm/wrong-blade-lack-familiarity-pediatric-emergency-equipment The Case As part of…

  7. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49505/psn-pdf
    March 01, 2006 - Collegiality vs. Competence March 1, 2006 Sagin T. Collegiality vs. Competence. PSNet [internet]. 2006. https://psnet.ahrq.gov/web-mm/collegiality-vs-competence The Case A 91-year-old man with coronary artery disease was taken to the operating room (OR) for semi-elective repair of a 10-cm abdominal aortic aneurys…

  8. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49839/psn-pdf
    August 01, 2018 - Mixup Beyond the Medication Label August 1, 2018 Pervanas H, VanValkenburgh D. Mixup Beyond the Medication Label. PSNet [internet]. 2018. https://psnet.ahrq.gov/web-mm/mixup-beyond-medication-label The Case An 80-year-old man was admitted to a hospital for recurrent hypoglycemia. He had been seen at another hospi…

  9. Combined Proactive Risk Assessment (CPRA) – 4-Step Technique Innovation Summary | PSNet

    psnet.ahrq.gov/innovation/combined-proactive-risk-assessment-cpra-4-step-technique-innovation-summary
    February 26, 2025 - Combined Proactive Risk Assessment (CPRA) – 4-Step Technique Innovation Summary Save Save to your library Print Download PDF Share Facebook Twitter Linkedin Copy URL February 26, 2025 Innovation Contact …

  10. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/867845/psn-pdf
    February 26, 2025 - Combined Proactive Risk Assessment (CPRA) – 4-Step Technique Innovation Summary February 26, 2025 https://psnet.ahrq.gov/innovation/combined-proactive-risk-assessment-cpra-4-step-technique-innovation- summary Summary This innovation describes the Veteran Health Administration (VHA) National Center for Patient Saf…

  11. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/33602/psn-pdf
    March 15, 2025 - Individual Clinician Performance Issues March 15, 2025 Individual Clinician Performance Issues. PSNet [internet]. 2019. https://psnet.ahrq.gov/primer/individual-clinician-performance-issues PSNet primers are regularly reviewed and updated by the UC Davis PSNet Editorial Team to ensure that they reflect current res…

  12. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/33579/psn-pdf
    September 15, 2024 - Systems Approach September 15, 2024 Systems Approach. PSNet [internet]. 2019. https://psnet.ahrq.gov/primer/systems-approach PSNet primers are regularly reviewed and updated by the UC Davis PSNet Editorial Team to ensure that they reflect current research and practice in the patient safety field. Last reviewed in …

  13. The Soil, Not the Seed: The Real Problem with Root Cause Analysis | PSNet

    psnet.ahrq.gov/perspective/soil-not-seed-real-problem-root-cause-analysis
    March 01, 2007 - The Soil, Not the Seed: The Real Problem with Root Cause Analysis Patrice Spath, BA, RHIT, and William Minogue, MD | July 1, 2008  View more articles from the same authors. Citation Text: Spath P, Minogue W. The Soil, Not the Seed: The Real Problem with Root Cause …

  14. Patient Safety in the United Kingdom: Evolution and Progress | PSNet

    psnet.ahrq.gov/perspective/patient-safety-united-kingdom-evolution-and-progress
    May 01, 2007 - Patient Safety in the United Kingdom: Evolution and Progress Susan Burnett and Charles Vincent, PhD | May 1, 2007  Also Read a Conversation View more articles from the same authors. Citation Text: Burnett S, Vincent CA. Patient Safety in the United Kingdom: Evol…

  15. In Conversation With… Gregg S. Meyer, MD, MSc | PSNet

    psnet.ahrq.gov/perspective/conversation-gregg-s-meyer-md-msc
    June 01, 2016 - In Conversation With… Gregg S. Meyer, MD, MSc June 1, 2016  Also Read an Essay Also Read an Essay Citation Text: In Conversation With… Gregg S. Meyer, MD, MSc. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health…

  16. Pharmacotherapy for Adults With Alcohol-Use Disorders in Outpatient Settings | Effective Health Care (EHC) Program

    effectivehealthcare.ahrq.gov/products/alcohol-misuse-drug-therapy/research

  17. AHRQ-Funded Patient Safety (pdf file)

    www.ahrq.gov/sites/default/files/wysiwyg/patient-safety/highlights/ps-project-highlights-hit-hie.pdf
    June 01, 2023 - . ■ Reduce patient harms and errors within hospital settings (e.g., falls, adverse drug interactions, … Care (CEC) Patient Safety Learning Lab 2018- 2022 $2,435,858 Purpose: Reduce health and financial harms

  18. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/43309/psn-pdf
    August 02, 2015 - Wrong-side thoracentesis: lessons learned from root cause analysis. August 2, 2015 Miller K, Mims M, Paull DE, et al. Wrong-side thoracentesis: lessons learned from root cause analysis. JAMA Surg. 2014;149(8):774-9. doi:10.1001/jamasurg.2014.146. https://psnet.ahrq.gov/issue/wrong-side-thoracentesis-lessons-learne…

  19. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/60641/psn-pdf
    July 01, 2020 - Predictors and triggers of incivility within healthcare teams: a systematic review of the literature. July 1, 2020 Keller S, Yule S, Zagarese V, et al. Predictors and triggers of incivility within healthcare teams: a systematic review of the literature. BMJ Open. 2020;10(6):e035471. doi:10.1136/bmjopen-2019-035471.…

  20. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/61057/psn-pdf
    October 28, 2020 - Improving Diagnostic Quality and Safety/Reducing Diagnostic Error: Measurement Considerations. Final Report October 28, 2020 Washington DC; National Quality Forum: October 6, 2020. https://psnet.ahrq.gov/issue/improving-diagnostic-quality-and-safetyreducing-diagnostic-error- measurement-considerations With input…
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