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Showing results for "incidents".

  1. Final Progress Report: Developing a Medical Biometric Identification System with a Secure Database Network That Can Access Electronic Medical Databases (pdf file)

    www.ahrq.gov/sites/default/files/2024-07/sohn-report.pdf
    January 01, 2024 - The  sentinel  report  update  in  December  2001  from  The  Joint  Commission  analyzed  126  incidents … Of  the  126  incidents,  only  81%  were  self‐ reported[2]. 

  2. Post-Acute Transitional Services: Safety in Home-Based Care Programs | PSNet

    psnet.ahrq.gov/primer/post-acute-transitional-services-safety-home-based-care-programs
    April 24, 2024 - Managing Care Challenges in a Group Home Setting: Is Staffing Adequate for Unplanned Incidents … June 8, 2016 Patient safety incidents in hospice care: observations from interdisciplinary

  3. Version 2_Risk of Reinfection From SARS-CoV-2 -- An Update of an Antibody Response Following SARS-CoV-2 Infection and Implications for Immunity: A Living Rapid Review (pdf file)

    effectivehealthcare.ahrq.gov/sites/default/files/related_files/version-2-risk-of-reinfection-from-SARSCoV2_0.pdf
    December 31, 2022 - Version 2_Risk of Reinfection From SARS-CoV-2 -- An Update of an Antibody Response Following SARS-CoV-2 Infection and Implications for Immunity: A Living Rapid Review Rapid Evidence Product Version 2.0 (January 2022) Risk of Reinfection From SARS-CoV-2 – An Update of an Antibody Response Following SARS-Co…

  4. Tjdzc7Rzm3Wzcdhfc4Sjhq (pdf file)

    www.uspreventiveservicestaskforce.org/home/getfilebytoken/TjDzC7rzm3WzCDHFC4sJhQ
    June 01, 2015 - Screening for Type 2 Diabetes Mellitus: A Systematic Review for the U.S. Preventive Services Task Force Shelley Selph, MD, MPH; Tracy Dana, MLS; Ian Blazina, MPH; Christina Bougatsos, MPH; Hetal Patel, MD; and Roger Chou, MD Background: Screening for type 2 diabetes mellitus could lead to earlier identification and tr…

  5. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/40532/psn-pdf
    June 15, 2011 - Safety in Anaesthesia. June 15, 2011 Staender S, ed. Best Pract Res Clin Anaesthesiol. 2011;25(2):109-304.   https://psnet.ahrq.gov/issue/safety-anaesthesia This special issue explores safety in anesthesia, including safety culture, incident reporting, and handoffs. https://psnet.ahrq.gov/issue/safety-anaesth…

  6. Adverse health events related to self-medication practices among elderly: a systematic review. | PSNet

    psnet.ahrq.gov/issue/adverse-health-events-related-self-medication-practices-among-elderly-systematic-review
    June 15, 2022 - Review Adverse health events related to self-medication practices among elderly: a systematic review. Citation Text: Locquet M, Honvo G, Rabenda V, et al. Adverse health events related to self-medication practices among elderly: a systematic review. Drugs Aging. 2017;34(5):359-365. doi:1…

  7. A July spike in fatal medication errors: a possible effect of new medical residents. | PSNet

    psnet.ahrq.gov/issue/july-spike-fatal-medication-errors-possible-effect-new-medical-residents
    February 15, 2011 - Study Classic A July spike in fatal medication errors: a possible effect of new medical residents. Citation Text: Phillips DP, Barker GEC. A July spike in fatal medication errors: a possible effect of new medical residents. J Gen Intern Med. 2010;25(8):774-9. …

  8. Conclusion | Agency for Healthcare Research and Quality

    www.ahrq.gov/patient-safety/settings/long-term-care/resource/facilities/ltc/mod3concl.html
    October 01, 2014 - Module 3: Falls Prevention and Management Conclusion Previous Page Next Page Table of Contents Module 3: Falls Prevention and Management Learning and Performance Objectives Session 1 Session 2 Conclusion Appendix. Additional Tools and Resources In Summary Falls prevention…

  9. Final Research Plan: Syphilis Infection During Pregnancy: Screening | United States Preventive Services Taskforce

    www.uspreventiveservicestaskforce.org/uspstf/document/final-research-plan/syphilis-infection-pregnant-persons
    March 02, 2023 - Share to Facebook Share to X Share to WhatsApp Share to Email Print in progress Final Research Plan Syphilis Infection During Pregnancy: Screening March 02, 2023 Recommendations made by the USPSTF are independent of the U.S. government. The…

  10. Opening Materials: Attribution, Objectives, Introduction, and Main Menu | Agency for Healthcare Research and Quality

    www.ahrq.gov/hai/cauti-tools/ena-slides/preface.html
    October 01, 2015 - The Emergency Nurses Association Presents CAUTI Slides and Transcript Opening Materials: Attribution, Objectives, Introduction, and Main Menu Previous Page Next Page Table of Contents The Emergency Nurses Association Presents CAUTI Slides and Transcript Opening Materials: Attribution, Objectives, …

  11. 093-Universal-Targeted-Decolonization-One-Pager (doc file)

    www.ahrq.gov/sites/default/files/wysiwyg/hai/tools/mrsa-2/093-universal-targeted-decolonization-one-pager.docx
    April 01, 2025 - Comparison of Decolonization Strategies This document defines the types of decolonization strategies and what is needed to implement either approach. Mid- to high-level administrative managers and clinical leaders who are interested in implementing decolonization programs at their site may use this document to compare …

  12. Common contributing factors of diagnostic error: a retrospective analysis of 109 serious adverse event reports from Dutch hospitals. | PSNet

    psnet.ahrq.gov/issue/common-contributing-factors-diagnostic-error-retrospective-analysis-109-serious-adverse-event
    September 14, 2022 - Study Common contributing factors of diagnostic error: a retrospective analysis of 109 serious adverse event reports from Dutch hospitals. Citation Text: Hooftman J, Dijkstra AC, Suurmeijer I, et al. Common contributing factors of diagnostic error: a retrospective analysis of 109 serious…

  13. The impact of transition to a digital hospital on medication errors (TIME study). | PSNet

    psnet.ahrq.gov/issue/impact-transition-digital-hospital-medication-errors-time-study
    March 27, 2024 - Study The impact of transition to a digital hospital on medication errors (TIME study). Citation Text: Engstrom T, McCourt E, Canning M, et al. The impact of transition to a digital hospital on medication errors (TIME study). NPJ Digit Med. 2023;6(1):133. doi:10.1038/s41746-023-00877-w. …

  14. Identifying risk in the use of tumor markers to improve patient safety. | PSNet

    psnet.ahrq.gov/issue/identifying-risk-use-tumor-markers-improve-patient-safety
    March 09, 2022 - Study Identifying risk in the use of tumor markers to improve patient safety. Citation Text: Moreno-Campoy EE, De la Torre FJM-, Martos-Crespo F, et al. Identifying risk in the use of tumor markers to improve patient safety. Clin Chem Lab Med. 2016;54(12):1947-1953. doi:10.1515/cclm-2015…

  15. Cluster randomized trial to evaluate the impact of team training on surgical outcomes. | PSNet

    psnet.ahrq.gov/issue/cluster-randomized-trial-evaluate-impact-team-training-surgical-outcomes
    April 24, 2018 - Study Cluster randomized trial to evaluate the impact of team training on surgical outcomes. Citation Text: Duclos A, Peix JL, Piriou V, et al. Cluster randomized trial to evaluate the impact of team training on surgical outcomes. Br J Surg. 2016;103(13):1804-1814. doi:10.1002/bjs.10295.…

  16. Impact of an inpatient electronic prescribing system on prescribing error causation: a qualitative evaluation in an English hospital. | PSNet

    psnet.ahrq.gov/issue/impact-inpatient-electronic-prescribing-system-prescribing-error-causation-qualitative
    February 16, 2022 - Study Impact of an inpatient electronic prescribing system on prescribing error causation: a qualitative evaluation in an English hospital. Citation Text: Puaar SJ, Franklin BD. Impact of an inpatient electronic prescribing system on prescribing error causation: a qualitative evaluation …

  17. Effectiveness of N95 respirators versus surgical masks against influenza: a systematic review and meta-analysis. | PSNet

    psnet.ahrq.gov/issue/effectiveness-n95-respirators-versus-surgical-masks-against-influenza-systematic-review-and
    March 24, 2019 - Review Classic Effectiveness of N95 respirators versus surgical masks against influenza: a systematic review and meta-analysis. Citation Text: Long Y, Hu T, Liu L, et al. Effectiveness of N95 respirators versus surgical masks against influenza: a systematic revi…

  18. "Change is what can actually make the tough times better": a patient-centred patient safety intervention delivered in collaboration with hospital volunteers. | PSNet

    psnet.ahrq.gov/issue/change-what-can-actually-make-tough-times-better-patient-centred-patient-safety-intervention
    September 24, 2017 - Study "Change is what can actually make the tough times better": a patient-centred patient safety intervention delivered in collaboration with hospital volunteers. Citation Text: Louch G, Mohammed MA, Hughes L, et al. "Change is what can actually make the tough times better": A patient-c…

  19. Impact of electronic chemotherapy order forms on prescribing errors at an urban medical center: results from an interrupted time-series analysis. | PSNet

    psnet.ahrq.gov/issue/impact-electronic-chemotherapy-order-forms-prescribing-errors-urban-medical-center-results
    June 13, 2011 - Study Impact of electronic chemotherapy order forms on prescribing errors at an urban medical center: results from an interrupted time-series analysis. Citation Text: Elsaid K, Truong T, Monckeberg M, et al. Impact of electronic chemotherapy order forms on prescribing errors at an urban …

  20. Inter-professional clinical handover in post-anaesthetic care units: tools to improve quality and safety. | PSNet

    psnet.ahrq.gov/issue/inter-professional-clinical-handover-post-anaesthetic-care-units-tools-improve-quality-and
    April 24, 2013 - Study Inter-professional clinical handover in post-anaesthetic care units: tools to improve quality and safety. Citation Text: Redley B, Bucknall T, Evans S, et al. Inter-professional clinical handover in post-anaesthetic care units: tools to improve quality and safety. Int J Qual Health…
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