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Showing results for "identifying".

5601. Rapid Response Teams: Lessons from the Early Experience | PSNet
      psnet.ahrq.gov/perspective/rapid-response-teams-lessons-early-experience
      November 01, 2005 - world have identified Rapid Response Teams (RRTs) as a powerful intervention aimed at saving lives by identifying

5602. Lack of Sepsis Recognition Leads to Delay in Care Following Cesarean Delivery. | PSNet
      psnet.ahrq.gov/web-mm/lack-sepsis-recognition-leads-delay-care-following-cesarean-delivery
      November 30, 2021 - In contrast, Type 2 thinking is more deliberate and requires identifying features from a diagnostic category

5603. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/841306/psn-pdf
      December 14, 2022 - Resilient Healthcare and the Safety-I and Safety-II Frameworks December 14, 2022 Deutsch ES, Van CM, Mossburg SE. Resilient Healthcare and the Safety-I and Safety-II Frameworks. PSNet [internet]. 2022. https://psnet.ahrq.gov/perspective/resilient-healthcare-and-safety-i-and-safety-ii-frameworks Resilient healthca…

5604. Spotlight Case July 2008 (ppt file)
      psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.233_slideshow.ppt
      February 01, 2011 - Spotlight Case July 2008 Spotlight Case One Toxic Drug Is Not Like Another * * Source and Credits This presentation is based on the February 2011 AHRQ WebM&M Spotlight Case See the full article at http://webmm.ahrq.gov CME credit is available Commentary by: Eric S. Holmboe, MD, American Board of Internal…

5605. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49496/psn-pdf
      December 01, 2005 - Discharged Blindly December 1, 2005 Iezzoni LI. Discharged Blindly. PSNet [internet]. 2005. https://psnet.ahrq.gov/web-mm/discharged-blindly The Case An elderly blind man developed a deep vein thrombosis during his hospital stay. At discharge, he was to receive enoxaparin (Lovenox) for self-administration at home…

5606. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/37110/psn-pdf
      October 06, 2011 - Seeing systems in health care organizations. October 6, 2011 Friedman LH, King JB, Bella D. Seeing systems in health care organizations. Physician Exec. 2007;33(4):20-9. https://psnet.ahrq.gov/issue/seeing-systems-health-care-organizations Using a hypothetical scenario, the authors illustrate how to use the system…

5607. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/41714/psn-pdf
      September 26, 2012 - 2011 Annual Benchmarking Report: Malpractice Risks in Emergency Medicine.  September 26, 2012 Ruoff G, ed. Cambridge, MA: CRICO Strategies; 2012. https://psnet.ahrq.gov/issue/2011-annual-benchmarking-report-malpractice-risks-emergency-medicine This report analyzes malpractice claims from 90 hospitals across the Un…

5608. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/41248/psn-pdf
      March 29, 2012 - Measuring safety climate in elderly homes. March 29, 2012 Yeung K-C, Chan CC. Measuring safety climate in elderly homes. J Safety Res. 2012;43(1):9-20. doi:10.1016/j.jsr.2011.10.009. https://psnet.ahrq.gov/issue/measuring-safety-climate-elderly-homes This study utilized a modified safety climate scale to identify …

5609. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/37884/psn-pdf
      November 03, 2008 - Epidemiology of malpractice lawsuits in paediatrics. November 3, 2008 Najaf-Zadeh A, Dubos F, Aurel M, et al. Epidemiology of malpractice lawsuits in paediatrics. Acta Paediatr. 2008;97(11):1486-91. doi:10.1111/j.1651-2227.2008.00898.x. https://psnet.ahrq.gov/issue/epidemiology-malpractice-lawsuits-paediatrics Thi…

5610. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/38684/psn-pdf
      September 29, 2017 - Global priorities for patient safety research. September 29, 2017 Bates DW, Larizgoitia I, Prasopa-Plaizier N, et al. Global priorities for patient safety research. BMJ. 2009;338:b1775. doi:10.1136/bmj.b1775. https://psnet.ahrq.gov/issue/global-priorities-patient-safety-research This article describes the results …

5611. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/35052/psn-pdf
      May 04, 2015 - "Near injury" alters procedures at Virginia Mason. May 4, 2015 Ostrom CM. Seattle Times. May 21, 2005. https://psnet.ahrq.gov/issue/near-injury-alters-procedures-virginia-mason This article reports how one medical center changed their preoperative procedures after a "near miss." The hospital's patient-safety …

5612. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/40082/psn-pdf
      December 15, 2010 - Achieving Strong Teamwork Practices in Hospital Labor and Delivery Units. December 15, 2010 Farley DO, Sorbero ME, Lovejoy SL, Salisbury M. Santa Monica, CA: Rand Corporation; 2010. ISBN: 9780833050557. https://psnet.ahrq.gov/issue/achieving-strong-teamwork-practices-hospital-labor-and-delivery-units This report …

5613. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/42730/psn-pdf
      September 02, 2016 - Strategic Plan for Preventing and Mitigating Drug Shortages. September 2, 2016 Silver Spring, MD: Food and Drug Administration; October 2013. https://psnet.ahrq.gov/issue/strategic-plan-preventing-and-mitigating-drug-shortages This report outlines the FDA's plans to address drug shortages, including streamlining t…

5614. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/37291/psn-pdf
      May 02, 2018 - Error-prone conditions that lead to student nurse-related errors. May 2, 2018 ISMP Medication Safety Alert! Acute care edition. October 18, 2007. https://psnet.ahrq.gov/issue/error-prone-conditions-lead-student-nurse-related-errors Reporting on survey results that identified common errors that student nurses make,…

5615. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/38800/psn-pdf
      July 22, 2009 - Medication error reporting and the work environment in a military setting. July 22, 2009 Patrician PA; Brosch LR. https://psnet.ahrq.gov/issue/medication-error-reporting-and-work-environment-military-setting This study describes nurses' reasons for medication errors and the barriers to reporting them and then sha…

5616. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/50681/psn-pdf
      November 20, 2019 - The wrong goodbye. November 20, 2019 Sexton J, Schweber N. ProPublica. October 31, 2019. https://psnet.ahrq.gov/issue/wrong-goodbye Misidentification of patients can cause harm. This news investigation explores an unique case of patient misidentification that resulted in unplanned removal of life support and a sub…

5617. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/36519/psn-pdf
      March 28, 2011 - Medication errors in mental healthcare: a systematic review. March 28, 2011 Maidment ID, Lelliott P, Paton C. Medication errors in mental healthcare: a systematic review. Qual Saf Health Care. 2006;15(6):409-13. https://psnet.ahrq.gov/issue/medication-errors-mental-healthcare-systematic-review The authors identif…

5618. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/38775/psn-pdf
      April 16, 2018 - Beyond the count: preventing the retention of foreign objects. April 16, 2018 PA-PSRS Patient Saf Advis. June 2009;6:39-45. https://psnet.ahrq.gov/issue/beyond-count-preventing-retention-foreign-objects This piece identifies risk factors associated with retention of foreign objects and suggests several tactics to …

5619. A Double “Never Event”: Wrong Patient and Wrong Side. | PSNet
      psnet.ahrq.gov/web-mm/double-never-event-wrong-patient-and-wrong-side
      August 20, 2018 - A proper time-out includes identifying the patient, indicating the procedure and the site with confirmation

5620. Microsoft PowerPoint - FINAL Spotlight Case_Under Pressure.pptx (pdf file)
      psnet.ahrq.gov/sites/default/files/2023-06/under_pressure.pdf
      January 01, 2023 - ventilator settings were applied, or the patient’s body habitus, but this information would be useful in identifying