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Total Results: over 10,000 records

Showing results for "incidents".

441. Integrating the intensive care unit safety reporting system with existing incident reporting systems. | PSNet
     psnet.ahrq.gov/issue/integrating-intensive-care-unit-safety-reporting-system-existing-incident-reporting-systems
     January 12, 2011 - January 12, 2011 A system factors analysis of "line, tube, and drain" incidents in the … June 29, 2009 Intensive care unit safety incidents for medical versus surgical patients … January 15, 2014 Intensive care unit safety incidents for medical versus surgical patients … October 26, 2010 Medication-related patient safety incidents in critical care: a review

442. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/36604/psn-pdf
     June 04, 2024 - Since 2003, Minnesota hospitals have been required to report such incidents. … Unintentionally-retained foreign objects and fall-related injuries were common incidents recorded.

443. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/866527/psn-pdf
     August 14, 2024 - Investigating safety events can help healthcare organizations improve systems and processes to prevent future incidents … psnet.ahrq.gov/issue/apparent-cause-analysis-safety-tool https://psnet.ahrq.gov/issue/learning-safety-incidents-high-reliability-organizations-systematic-review-learning-tools

444. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/867232/psn-pdf
     January 01, 2025 - remediation influences decision-making in cases of serious clinician misconduct (e.g., patient safety incidents … role-remediation-cases-serious-misconduct-uk-healthcare-regulators-qualitative-study https://psnet.ahrq.gov/issue/successful-remediation-patient-safety-incidents-tale-two-medication-errors

445. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/844777/psn-pdf
     September 18, 2019 - Adapting cognitive task analysis to investigate clinical decision making and medication safety incidents … Adapting Cognitive Task Analysis to Investigate Clinical Decision Making and Medication Safety Incidents

446. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/864857/psn-pdf
     March 20, 2024 - This qualitative study examined 221 patient safety incidents experienced by physician trainees in the … The researchers concluded that incidents could generally be attributed to one of four factors – individual

447. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/858170/psn-pdf
     December 13, 2023 - accreditation assessments for long-term care facilities in Australia identified 2,267 patient safety incidents … Nearly 50% of incidents involved clinical processes or procedures, and 25% involved documentation errors

448. Nature of blame in patient safety incident reports: mixed methods analysis of a national database. | PSNet
     psnet.ahrq.gov/issue/nature-blame-patient-safety-incident-reports-mixed-methods-analysis-national-database
     October 12, 2016 - October 12, 2016 Classification of patient-safety incidents in primary care. … December 16, 2015 Patient safety incidents involving sick children in primary care in … February 1, 2017 Safety incidents in the primary care office setting. … September 24, 2017 A mixed-methods analysis of patient safety incidents involving opioid

449. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/836876/psn-pdf
     May 16, 2022 - patient records for review based on specific criteria, or triggers, with higher risk for potential incidents … Patient Safety Incidents Perhaps one sign of EMS’s emergence in the field of patient safety is the growth … A recent systematic review identified a median rate of 5.9 incidents per 100 records/transports/patients … authors noted that studies that used record review data had a higher prevalence of patient safety incidents … While the need still exists for a standard way to classify patient safety incidents in this setting,

450. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/33716/psn-pdf
     September 01, 2011 - Shojania: The most plausible hope was that by analyzing certain types of incidents, that you could learn … Incident reporting was designed to identify important incidents that need to be investigated ASAP, so … or identify incidents that need a quick or timely investigation. … It's tempting to want to pool across these incidents and then across institutions. … Whereas a lot of other incidents and serious things like wrong- site surgery where there will be so

451. Harms from discharge to primary care: mixed methods analysis of incident reports. | PSNet
     psnet.ahrq.gov/issue/harms-discharge-primary-care-mixed-methods-analysis-incident-reports
     October 12, 2016 - October 12, 2016 Patient safety incidents involving sick children in primary care in … February 1, 2017 Safety incidents in the primary care office setting. … December 15, 2021 A mixed-methods analysis of patient safety incidents involving opioid … December 16, 2020 Classification of patient-safety incidents in primary care.

452. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/838019/psn-pdf
     September 07, 2022 - Strength of safety measures introduced by medical practices to prevent a recurrence of patient safety incidents … Strength of safety measures introduced by medical practices to prevent a recurrence of patient safety incidents

453. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/74264/psn-pdf
     January 19, 2022 - of this study was to support future implementation of CIRS in primary care by discussing types of incidents … that should be reported; who can report incidents (e.g., nurses, physicians, patients); whether reporting

454. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/841762/psn-pdf
     December 21, 2022 - interhospital transfer with an intubated patient or where readiness for intubation is needed: a critical incidents … interhospital transfer with an intubated patient or where readiness for intubation is needed: a critical incidents

455. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/838074/psn-pdf
     January 01, 2023 - patient feedback as a safety valve: an automated language analysis of unnoticed and unresolved safety incidents … patient feedback as a safety valve: an automated language analysis of unnoticed and unresolved safety incidents

456. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/73540/psn-pdf
     January 01, 2022 - Staff reported incidents with linked patient complaints frequently described greater harm from the safety … that generated contested patient and staff accounts, and how differing interpretations of the same incidents

457. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/73980/psn-pdf
     October 20, 2021 - Patient identification incidents reported in one hospital were examined to identify errors and contributory … Of the 293 reported incidents, the most common errors were missing wristbands, wrong charts or notes

458. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/49639/psn-pdf
     November 01, 2011 - Combining these two factors yields: (i) incidents that never reached the patient, (ii) incidents that … reached the patient but did not cause harm, and (iii) incidents that reached the patient and caused … Reporting systems allow incidents to be analyzed in terms of contributing factors and to follow trends … It is desirable to have multiple channels by which frontline health care workers can report incidents … Learning from patient-reported incidents. J Gen Intern Med. 2005;20:830-836. [go to PubMed] 7.

459. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/47570/psn-pdf
     December 05, 2018 - By contrast, electronic health record–based trigger tools detect safety incidents in real time. … Improvement Global Trigger Tool and distilled this into a real-time risk score for patient safety incidents … The PSAM identified 10 times more safety incidents than were detected through retrospective techniques

460. Organisational paradoxes in speaking up for safety: implications for the interprofessional field. | PSNet
     psnet.ahrq.gov/issue/organisational-paradoxes-speaking-safety-implications-interprofessional-field
     March 08, 2023 - November 4, 2014 Why is learning from patient safety incidents (still) so hard? … A sociocultural perspective on learning from incidents in healthcare organizations. … February 28, 2024 Interventions to support nurses as second victims of patient safety incidents