Results

Total Results: 1,459 records

Showing results for "inadequate".

1281. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49870/psn-pdf
      August 10, 2019 - circulatory function) is to attempt to discern the etiology—is it an iron deficiency anemia possibly due to inadequate

1282. Dangerous Shift | PSNet
      psnet.ahrq.gov/web-mm/dangerous-shift
      July 24, 2013 - Consequences of inadequate sign-out for patient care. Arch Intern Med. 2008;168:1755-1760.

1283. Signout Fallout | PSNet
      psnet.ahrq.gov/web-mm/signout-fallout
      November 16, 2022 - Fatal Airway Occlusion After Inadequate Post-Tracheostomy Care May 29, 2024

1284. Peripheral IV in Too Long | PSNet
      psnet.ahrq.gov/web-mm/peripheral-iv-too-long
      September 15, 2011 - In addition, there was inadequate and delayed recognition of the catheter infection; by the time it was

1285. A Painful Medication Reconciliation Mishap | PSNet
      psnet.ahrq.gov/web-mm/painful-medication-reconciliation-mishap
      May 01, 2008 - Predictably, the naltrexone blocked the opioid analgesic effects, resulting in inadequate pain control

1286. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/854849/psn-pdf
      October 31, 2023 - facilitate other types of errors that may lead to patient harm, mediated by many factors, such as inadequate

1287. Spotlight
      psnet.ahrq.gov/sites/default/files/2024-05/spotlight_case_managing_complexity_in_diagnosis_-_slides_final.pptx
      January 01, 2024 - These barriers include professional hierarchy, time pressure, challenging workloads, and inadequate structures

1288. Pre-analytical pitfalls: Missing and mislabeled specimens | PSNet
      psnet.ahrq.gov/web-mm/pre-analytical-pitfalls-missing-and-mislabeled-specimens
      April 18, 2018 - as mislabeling of specimens, delayed transportation, collection into the wrong specimen container, inadequate

1289. Spotlight (pdf file)
      psnet.ahrq.gov/sites/default/files/2020-05/final_may-spotlight-fatal_pca_slides_05.01.2020_cme_review-revised.pdf
      January 01, 2020 - transplant surgery • Prolonged surgery (> 2 hours) • Patient-controlled analgesia (with basal rate) • Inadequate

1290. Microsoft PowerPoint - FINAL Spotlight Case_Under Pressure.pptx (pdf file)
      psnet.ahrq.gov/sites/default/files/2023-06/under_pressure.pdf
      January 01, 2023 - Safety (1) • Tracheostomy tube air leaks are problematic for patient management because they may cause inadequate

1291. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49735/psn-pdf
      June 01, 2015 - A third bias is the inadequate adjustment of probabilities as new disconfirming information becomes

1292. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/846915/psn-pdf
      March 29, 2023 - suicide risk assessment remains frustratingly imprecise.13 As illustrated in this case, the risks of inadequate

1293. Missed Diagnosis of Addison’s Disease in Adolescent Presenting with Fatigue. | PSNet
      psnet.ahrq.gov/web-mm/missed-diagnosis-addisons-disease-adolescent-presenting-fatigue
      October 28, 2020 - As secondary and tertiary AI result from inadequate production of adrenocorticotropic hormone (ACTH),

1294. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49651/psn-pdf
      May 01, 2012 - It identified inadequate signout to the night float team as the primary reason why that team did not

1295. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/842919/psn-pdf
      February 01, 2023 - The most common reason for HADKA was related to inadequate insulin administration, including withholding

1296. 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 root cause analysis of “never events” occurring in the VA system between 2010 and 2017 found that inadequate

1297. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49852/psn-pdf
      February 01, 2019 - allow sharing of clinical data across systems, which may help mitigate discontinuity of care, remains inadequate

1298. Recurrent Hypoglycemia: A Care Transition Failure? | PSNet
      psnet.ahrq.gov/web-mm/recurrent-hypoglycemia-care-transition-failure
      December 23, 2020 - These are inadequate solutions because they present information to, and about, patients at discrete points

1299. False Assumptions Result in a Missed Pneumothorax after Bronchoscopy with Transbronchial Biopsy. | PSNet
      psnet.ahrq.gov/web-mm/false-assumptions-result-missed-pneumothorax-after-bronchoscopy-transbronchial-biopsy
      March 15, 2023 - Fatal Airway Occlusion After Inadequate Post-Tracheostomy Care May 29, 2024

1300. Open wider: Failure to use an interpreter results in fractured teeth and hypoxia during a simple elective operation. | PSNet
      psnet.ahrq.gov/web-mm/open-wider-failure-use-interpreter-results-fractured-teeth-and-hypoxia-during-simple
      January 29, 2021 - Adverse Outcomes July 8, 2022 WebM&M Cases Inadequate