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Showing results for "incident".

8621. Reducing surgical errors: implementing a three-hinge approach to success. | PSNet
      psnet.ahrq.gov/issue/reducing-surgical-errors-implementing-three-hinge-approach-success
      December 08, 2021 - Commentary Reducing surgical errors: implementing a three-hinge approach to success. Citation Text: Landers R. Reducing surgical errors: implementing a three-hinge approach to success. AORN J. 2015;101(6):657-65. doi:10.1016/j.aorn.2015.04.013. Copy Citation Format: DOI Goo…

8622. Quality and patient safety teams in the perioperative setting. | PSNet
      psnet.ahrq.gov/issue/quality-and-patient-safety-teams-perioperative-setting
      October 19, 2022 - Commentary Quality and patient safety teams in the perioperative setting. Citation Text: Serino MF. Quality and Patient Safety Teams in the Perioperative Setting. AORN J. 2015;102(6):617-28. doi:10.1016/j.aorn.2015.10.006. Copy Citation Format: DOI Google Scholar PubMed Bib…

8623. Avoiding medical emergencies. | PSNet
      psnet.ahrq.gov/issue/avoiding-medical-emergencies
      April 07, 2021 - Commentary Avoiding medical emergencies. Citation Text: Omar Y. Avoiding medical emergencies. Br Dent J. 2013;214(5):255-9. doi:10.1038/sj.bdj.2013.217. Copy Citation Format: DOI Google Scholar PubMed BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged PubMedId RIS …

8624. Preventing complications of central venous catheterization. | PSNet
      psnet.ahrq.gov/issue/preventing-complications-central-venous-catheterization
      September 02, 2015 - Review Preventing complications of central venous catheterization. Citation Text: McGee DC, Gould MK. Preventing complications of central venous catheterization. N Engl J Med. 2003;348(12):1123-33. Copy Citation Format: Google Scholar PubMed BibTeX EndNote X3 XML EndNote …

8625. Sent home to die. | PSNet
      psnet.ahrq.gov/issue/sent-home-die
      April 22, 2020 - Newspaper/Magazine Article Sent home to die. Citation Text: Waldman A, Kaplan J. Sent home to die. ProPublica. 2020. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged PubMedId RIS Download Citation Save S…

8626. Preventing retained surgical items. | PSNet
      psnet.ahrq.gov/issue/preventing-retained-surgical-items
      December 07, 2022 - Commentary Preventing retained surgical items. Citation Text: Weston M, Chiodo C. Preventing retained surgical items. AORN J. 2022;115(6):569-575. doi:10.1002/aorn.13697. Copy Citation Format: DOI Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged PubMedId RI…

8627. Tracking intraoperative complications. | PSNet
      psnet.ahrq.gov/issue/tracking-intraoperative-complications
      April 30, 2014 - Study Tracking intraoperative complications. Citation Text: Platz J, Hyman N. Tracking intraoperative complications. J Am Coll Surg. 2012;215(4):519-23. doi:10.1016/j.jamcollsurg.2012.06.001. Copy Citation Format: DOI Google Scholar PubMed BibTeX EndNote X3 XML EndNote 7 …

8628. Errors originating in hospital and health-system outpatient pharmacies. | PSNet
      psnet.ahrq.gov/issue/errors-originating-hospital-and-health-system-outpatient-pharmacies
      December 19, 2016 - Newspaper/Magazine Article Errors originating in hospital and health-system outpatient pharmacies. Citation Text: Errors originating in hospital and health-system outpatient pharmacies. Straka M, Gaunt MJ, Grissinger M. PA-PSRS Patient Saf Advis. June 2017;14:55-63. Copy Citation …

8629. Complementary telephone strategies to improve postdischarge communication. | PSNet
      psnet.ahrq.gov/issue/complementary-telephone-strategies-improve-postdischarge-communication
      July 02, 2014 - Commentary Complementary telephone strategies to improve postdischarge communication. Citation Text: Rennke S, Kesh S, Neeman N, et al. Complementary telephone strategies to improve postdischarge communication. Am J Med. 2012;125(1):28-30. doi:10.1016/j.amjmed.2011.05.011. Copy Citat…

8630. FDA to end program that hid millions of reports on faulty medical devices. | PSNet
      psnet.ahrq.gov/issue/fda-end-program-hid-millions-reports-faulty-medical-devices
      May 17, 2017 - Newspaper/Magazine Article FDA to end program that hid millions of reports on faulty medical devices. Citation Text: FDA to end program that hid millions of reports on faulty medical devices. Jewett C. Kaiser Health News. May 3, 2019. Copy Citation Save Save to yo…

8631. Design for reliability: barcoded medication administration. | PSNet
      psnet.ahrq.gov/issue/design-reliability-barcoded-medication-administration
      July 21, 2021 - Newspaper/Magazine Article Design for reliability: barcoded medication administration. Citation Text: Design for reliability: barcoded medication administration. Hayden AC; Lanoue ET; Still CJ. Copy Citation Save Save to your library Print Download PDF …

8632. Audibility of patient clinical alarms to hospital nursing personnel. | PSNet
      psnet.ahrq.gov/issue/audibility-patient-clinical-alarms-hospital-nursing-personnel
      November 15, 2023 - Study Audibility of patient clinical alarms to hospital nursing personnel. Citation Text: Sobieraj J, Ortega C, West I, et al. Audibility of patient clinical alarms to hospital nursing personnel. Mil Med. 2006;171(4):306-10. Copy Citation Format: Google Scholar PubMed Bib…

8633. AHRQ’s Safety Program for Nursing Homes: On-Time Pressure Ulcer Prevention | Agency for Healthcare Research and Quality
      www.ahrq.gov/patient-safety/settings/long-term-care/resource/ontime/pruprev/intro.html
      November 01, 2014 - AHRQ’s Safety Program for Nursing Homes: On-Time Pressure Ulcer Prevention Introduction This document provides an overview of the components of On-Time Pressure Ulcer Prevention, reports, and implementation materials used in preventing pressure ulcers in nursing homes. On-Time Pressure Ulcer Prevention has be…

8634. Probability error in diagnosis: the conjunction fallacy among beginning medical students. | PSNet
      psnet.ahrq.gov/issue/probability-error-diagnosis-conjunction-fallacy-among-beginning-medical-students
      June 21, 2017 - Study Probability error in diagnosis: the conjunction fallacy among beginning medical students. Citation Text: Rao G. Probability error in diagnosis: the conjunction fallacy among beginning medical students. Fam Med. 2009;41(4):262-5. Copy Citation Format: Google Scholar P…

8635. Designing a safer radiology department. | PSNet
      psnet.ahrq.gov/issue/designing-safer-radiology-department
      March 04, 2015 - Commentary Designing a safer radiology department. Citation Text: Johnson D, Miranda R, Osborn HH, et al. Designing a safer radiology department. AJR Am J Roentgenol. 2012;198(2):398-404. doi:10.2214/AJR.11.7234. Copy Citation Format: DOI Google Scholar PubMed BibTeX EndNot…

8636. Resident and Family Engagement: What is my role as a leader? (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/quality-resources/tools/cauti-ltc/modules/resources/tools/engage/rfe-role-leader.pdf
      March 01, 2017 - Resident and Family Engagement: What is my role as a leader? • Resident and family engagement is one component of person-centered care, a philosophy that recognizes residents as individuals and as partners. • Effective resident and family partnerships are demonstrated by including the residents and family a…

8637. Community-Acquired Pneumonia in the Primary Care Setting (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/quality-resources/tools/cap-toolkit/cap_pc-pamphlet.pdf
      January 01, 2018 - Community-Acquired Pneumonia in the Primary Care Setting Community-Acquired Pneumonia in the Primary Care Setting Background on Community-Acquired Pneumonia Community-acquired pneumonia (CAP) is the eighth leading cause of death in the United States.1 Approximately 6 million cases are reported annually, resulting i…

8638. Research on Diagnostic Safety and Quality | Agency for Healthcare Research and Quality
      www.ahrq.gov/diagnostic-safety/research/index.html
      November 01, 2024 - Research on Diagnostic Safety and Quality Since 2007, AHRQ has invested in research to discover findings that advance the knowledge of diagnostic safety and to develop practical tools and resources to improve diagnostic safety. AHRQ funds research to better understand how diagnostic errors happen and what can b…

8639. Can you prevent adverse drug events after hospital discharge? | PSNet
      psnet.ahrq.gov/issue/can-you-prevent-adverse-drug-events-after-hospital-discharge
      September 09, 2009 - Commentary Can you prevent adverse drug events after hospital discharge? Citation Text: Forster AJ. Can you prevent adverse drug events after hospital discharge? CMAJ. 2006;174(7):921-2. Copy Citation Format: Google Scholar PubMed BibTeX EndNote X3 XML EndNote 7 XML Endno…

8640. Transcranial Doppler Screening for Children with Sickle Cell Anemia: Health Plan - Key Driver Diagram (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/pqmp/toolkits/healthplan-key-drive-diagram.pdf
      June 02, 2025 - Transcranial Doppler Screening for Children with Sickle Cell Anemia: Health Plan - Key Driver Diagram Transcranial Doppler Screening for Children with Sickle Cell Anemia Health Plan - Key Driver Diagram Key Drivers Strateg…