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Showing results for "incident".

  1. One Dose, Fifty Pills | PSNet

    psnet.ahrq.gov/web-mm/one-dose-fifty-pills
    January 13, 2021 - October 25, 2023 Self-Reported Learning (SRL), a voluntary incident reporting system

  2. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/33626/psn-pdf
    January 01, 2006 - We also had another incident where one team member present during a surgery felt empowered to actually

  3. Haste Makes Care Unsafe | PSNet

    psnet.ahrq.gov/web-mm/haste-makes-care-unsafe
    January 07, 2015 - The remainder of the CABG was completed without incident, and the patient was weaned off cardiopulmonary

  4. A Seasonal Care Transition Failure | PSNet

    psnet.ahrq.gov/web-mm/seasonal-care-transition-failure
    June 01, 2016 - Communication failures in patient sign-out and suggestions for improvement: a critical incident analysis

  5. PowerPoint Presentation (ppt file)

    psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.344_slideshow.ppt
    April 01, 2015 - PowerPoint Presentation Spotlight Dissecting the Presentation * This presentation is based on the April 2015 AHRQ WebM&M Spotlight Case See the full article at http://webmm.ahrq.gov CME credit is available Commentary by: Shirley Beng Suat Ooi, MBBS (S'pore), Emergency Medicine Department, National Univers…

  6. To Resuscitate or Not? | PSNet

    psnet.ahrq.gov/web-mm/resuscitate-or-not
    November 01, 2011 - To Resuscitate or Not? Citation Text: Wu AW, Pronovost P. To Resuscitate or Not?. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2004. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endnote tag…

  7. Hazards of Loading Doses | PSNet

    psnet.ahrq.gov/web-mm/hazards-loading-doses
    December 01, 2003 - Hazards of Loading Doses Citation Text: Mucksavage JJ, Tesoro EP. Hazards of Loading Doses. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2017. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNote 7 XML E…

  8. Situational (Un)Awareness | PSNet

    psnet.ahrq.gov/web-mm/situational-unawareness
    August 01, 2009 - Situational (Un)Awareness Citation Text: Abramson EL, Kaushal R. Situational (Un)Awareness. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2011. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNote 7 XML E…

  9. Hold the tPA | PSNet

    psnet.ahrq.gov/web-mm/hold-tpa
    July 29, 2020 - Hold the tPA Citation Text: Fagan SC. Hold the tPA. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2005. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged PubMedId RIS Dow…

  10. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49772/psn-pdf
    October 01, 2016 - Lapse in Antibiotics Leads to Sepsis October 1, 2016 Levy MM. Lapse in Antibiotics Leads to Sepsis. PSNet [internet]. 2016. https://psnet.ahrq.gov/web-mm/lapse-antibiotics-leads-sepsis The Case A 34-year-old near-term pregnant woman presented to the emergency department (ED) with abdominal pain, fevers, and short…

  11. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/33628/psn-pdf
    February 01, 2006 - In Conversation with…John Banja, PhD February 1, 2006 In Conversation with…John Banja, PhD. PSNet [internet]. 2006. https://psnet.ahrq.gov/perspective/conversation-withjohn-banja-phd Editor's Note: John Banja, PhD, is Assistant Director for Health Sciences and Clinical Ethics and Associate Professor of Clinical Et…

  12. Misplaced Vial: Medication Kit Variability Contributes to Medication Error During Patient Transport | PSNet

    psnet.ahrq.gov/web-mm/misplaced-vial-medication-kit-variability-contributes-medication-error-during-patient
    March 12, 2021 - Misplaced Vial: Medication Kit Variability Contributes to Medication Error During Patient Transport Citation Text: MacDowell P, McGee E. Misplaced Vial: Medication Kit Variability Contributes to Medication Error During Patient Transport. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Q…

  13. To LP or Not LP | PSNet

    psnet.ahrq.gov/web-mm/lp-or-not-lp
    February 01, 2018 - To LP or Not LP Citation Text: Landrigan CP. To LP or Not LP. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2003. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged PubMedId RIS …

  14. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49724/psn-pdf
    January 01, 2015 - Bowel Injury After Laparoscopic Surgery January 1, 2015 Moorthy K. Bowel Injury After Laparoscopic Surgery. PSNet [internet]. 2015. https://psnet.ahrq.gov/web-mm/bowel-injury-after-laparoscopic-surgery The Case A 30-year-old man presented to the hospital for a scheduled laparoscopic inguinal hernia repair with mes…

  15. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49572/psn-pdf
    October 01, 2008 - Mistaken Identity October 1, 2008 Hall LW. Mistaken Identity. PSNet [internet]. 2008. https://psnet.ahrq.gov/web-mm/mistaken-identity The Case An 85-year-old Cantonese-speaking woman was admitted to the medical service with altered mental status and a reported fall. After finding tenderness in her left hip, the p…

  16. Management and patient safety of complex elderly patients in primary care during the COVID-19 pandemic in the UK-Qualitative assessment. | PSNet

    psnet.ahrq.gov/issue/management-and-patient-safety-complex-elderly-patients-primary-care-during-covid-19-pandemic
    April 20, 2022 - Study Management and patient safety of complex elderly patients in primary care during the COVID-19 pandemic in the UK-Qualitative assessment. Citation Text: Alboksmaty A, Kumar S, Parekh R, et al. Management and patient safety of complex elderly patients in primary care during the COVID…

  17. Do medical inpatients who report poor service quality experience more adverse events and medical errors? | PSNet

    psnet.ahrq.gov/issue/do-medical-inpatients-who-report-poor-service-quality-experience-more-adverse-events-and
    July 14, 2021 - Study Classic Do medical inpatients who report poor service quality experience more adverse events and medical errors? Citation Text: Taylor BB, Marcantonio ER, Pagovich O, et al. Do medical inpatients who report poor service quality experience more adverse ev…

  18. The Stoplight Mobility Alert System for safety and prevention of falls in children with physical and cognitive impairments. | PSNet

    psnet.ahrq.gov/innovation/stoplight-mobility-alert-system-safety-and-prevention-falls-children-physical-and
    September 14, 2022 - EMERGING INNOVATIONS The Stoplight Mobility Alert System for safety and prevention of falls in children with physical and cognitive impairments. Citation Text: The Stoplight Mobility Alert System for safety and prevention of falls in children with physical and cognitive impairments. Mullen JB,&nbs…

  19. Evaluating the safety of mental health-related prescribing in UK primary care: a cross-sectional study using the Clinical Practice Research Datalink (CPRD). | PSNet

    psnet.ahrq.gov/issue/evaluating-safety-mental-health-related-prescribing-uk-primary-care-cross-sectional-study
    August 14, 2019 - Study Evaluating the safety of mental health-related prescribing in UK primary care: a cross-sectional study using the Clinical Practice Research Datalink (CPRD). Citation Text: Khawagi WY, Steinke DT, Carr MJ, et al. Evaluating the safety of mental health-related prescribing in UK prima…

  20. US public opinion regarding proposed limits on resident physician work hours. | PSNet

    psnet.ahrq.gov/issue/us-public-opinion-regarding-proposed-limits-resident-physician-work-hours
    February 18, 2011 - Study US public opinion regarding proposed limits on resident physician work hours. Citation Text: Blum AB, Raiszadeh F, Shea S, et al. US public opinion regarding proposed limits on resident physician work hours. BMC Med. 2010;8:33. doi:10.1186/1741-7015-8-33. Copy Citation Form…
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