-
psnet.ahrq.gov/node/865884/psn-pdf
May 29, 2024 - These barriers
include professional hierarchy, time pressure, challenging workloads, and inadequate
-
psnet.ahrq.gov/node/849679/psn-pdf
June 28, 2023 - Improving Safety
Tracheostomy tube leaks are problematic for patient management because they may cause inadequate
-
psnet.ahrq.gov/node/846169/psn-pdf
March 15, 2023 - The rapid assistance of the anesthesia technologist saved the day,
as inadequate resources such as the
-
psnet.ahrq.gov/node/49491/psn-pdf
September 01, 2005 - code—and managed
through better ACLS education and protocols, it is clear that it is also reflects inadequate
-
psnet.ahrq.gov/node/49723/psn-pdf
January 01, 2015 - infant subsequently had multiple seizures typical of hypoxic-ischemic encephalopathy (brain injury
from inadequate
-
psnet.ahrq.gov/sites/default/files/2022-08/final_spotlight_latex_allergies-slides.pdf
January 01, 2022 - latex gloves and products could not be eliminated from the
health care environment immediately due to inadequate
-
psnet.ahrq.gov/web-mm/cognitive-and-communication-blind-spot-contributes-permanent-paralysis
January 13, 2010 - their nursing leadership or senior physicians if they feel that management by junior physicians is inadequate
-
psnet.ahrq.gov/classics
August 01, 2023 - Fear of negative consequences was the most common barrier; other barriers included inadequate reporting
-
psnet.ahrq.gov/curated-library/diagnostic-safety-improvement
September 14, 2025 - identified included several manifestations of unprofessional behavior on the part of providers, e.g., inadequate
-
psnet.ahrq.gov/web-mm/anemia-and-delayed-colon-cancer-diagnosis
July 21, 2020 - circulatory function) is to attempt to discern the etiology—is it an iron deficiency anemia possibly due to inadequate
-
psnet.ahrq.gov/web-mm/hospital-acquired-diabetic-ketoacidosis
October 28, 2020 - The most common reason for HADKA was related to inadequate insulin administration, including withholding
-
psnet.ahrq.gov/web-mm/sudden-collapse-during-upper-gastrointestinal-endoscopy-expect-unexpected
September 25, 2024 - 2024
WebM&M Cases
Missed Connection: A Case of Inadequate
-
psnet.ahrq.gov/web-mm/multifactorial-medication-mishap
September 01, 2016 - These domains included lack of information about the patient, drug stocking and delivery problems, and inadequate
-
psnet.ahrq.gov/sites/default/files/2022-02/final_cme_reviewed_spotlight_loss_of_trust_and_a_missed_diagnosis_02.14.20221_-_clean_-_revised.pdf
January 01, 2022 - errors, which include technological or organizational
barriers
– Cognitive errors, which include inadequate
-
psnet.ahrq.gov/node/857258/psn-pdf
November 30, 2023 - psnet.ahrq.gov//#1
https://psnet.ahrq.gov//#3
Persistent neuromuscular blockade in the recovery room from inadequate
-
psnet.ahrq.gov/web-mm/dont-dismiss-dangerous-obstetric-hemorrhage
August 21, 2024 - This denial, often driven by inadequate estimation of actual blood lost, can lead to delays in care that
-
psnet.ahrq.gov/node/49721/psn-pdf
December 01, 2014 - Checklists and procedures create the foundation or infrastructure for safe processes, but are
completely inadequate
-
psnet.ahrq.gov/innovation/reducing-preventable-patient-harm-due-retained-surgical-items-rsi-bundle
July 23, 2024 - Organizational culture and inadequate communication were common underlying causes in many reports. 2
-
psnet.ahrq.gov/web-mm/time-death
January 03, 2017 - code—and managed through better ACLS education and protocols, it is clear that it is also reflects inadequate
-
psnet.ahrq.gov/web-mm/copy-and-paste-notes-and-autopopulated-text-electronic-health-record
May 26, 2021 - to facilitate other types of errors that may lead to patient harm, mediated by many factors, such as inadequate