Results

Total Results: over 10,000 records

Showing results for "incidents".

81. 2024 Network of Patient Safety Databases Chartbook (pdf file)
    www.ahrq.gov/sites/default/files/wysiwyg/npsd/data/npsd-medication-chartbook-2024.pdf
    January 01, 2024 - ■ The majority of medication events submitted were incidents (i.e., the event reached the patient … Among all Medication and Other Substance events, Incidents were the most commonly reported. … The majority of Medication or Other Substance Incidents are reported as Incorrect actions. … or Other Substance Incidents is examined below. … Incorrect actions include patient safety reports that are Incidents and Near Misses.

82. Medication safety incidents associated with the remote delivery of primary care: a rapid review. | PSNet
    psnet.ahrq.gov/issue/medication-safety-incidents-associated-remote-delivery-primary-care-rapid-review
    June 29, 2022 - Review Medication safety incidents associated with the remote delivery of primary … Medication safety incidents associated with the remote delivery of primary care: a rapid review. … This rapid review was conducted to determine the types and frequency of medication safety incidents associated … Medication safety incidents associated with the remote delivery of primary care: a rapid review. … June 29, 2022 Care coordination strategies and barriers during medication safety incidents

83. Psn-Pdf (pdf file)
    psnet.ahrq.gov/node/849121/psn-pdf
    May 17, 2023 - Thematic reviews of patient safety incidents as a tool for systems thinking: a quality improvement report … Thematic reviews of patient safety incidents as a tool for systems thinking: a quality improvement report … https://psnet.ahrq.gov/issue/thematic-reviews-patient-safety-incidents-tool-systems-thinking-quality- … improvement-report Learning from patient safety incidents can help health care organizations improve … This article provides a template for organizations to review patient safety incidents and classify them

84. Multimorbidity and patient safety incidents in primary care: a systematic review and meta-analysis. | PSNet
    psnet.ahrq.gov/issue/multimorbidity-and-patient-safety-incidents-primary-care-systematic-review-and-meta-analysis
    February 15, 2017 - Review Multimorbidity and patient safety incidents in primary care: a systematic … Multimorbidity and Patient Safety Incidents in Primary Care: A Systematic Review and Meta-Analysis. … This systematic review assessed the potential link between multimorbidity and patient safety incidents … health component, such as depression, were at particularly high risk for errors and patient safety incidents … Multimorbidity and Patient Safety Incidents in Primary Care: A Systematic Review and Meta-Analysis.

85. How can we improve the recognition, reporting and resolution of medical device-related incidents in hospitals? A qualitative study of physicians and registered nurses. | PSNet
    psnet.ahrq.gov/issue/how-can-we-improve-recognition-reporting-and-resolution-medical-device-related-incidents
    May 06, 2015 - How can we improve the recognition, reporting and resolution of medical device-related incidents … How can we improve the recognition, reporting and resolution of medical device-related incidents in hospitals … These results are consistent with prior studies of incident reports and suggest that device-related incidents … How can we improve the recognition, reporting and resolution of medical device-related incidents in hospitals … the Same Author(s) Factors that influence the recognition, reporting and resolution of incidents

86. Psn-Pdf (pdf file)
    psnet.ahrq.gov/node/867692/psn-pdf
    March 05, 2025 - Why is learning from patient safety incidents (still) so hard? … A sociocultural perspective on learning from incidents in healthcare organizations. … Why is learning from patient safety incidents (still) so hard? … A sociocultural perspective on learning from incidents in healthcare organizations. … https://psnet.ahrq.gov/issue/learning-incidents-healthcare-journey-not-arrival-matters

87. Exploring nursing-sensitive events in home healthcare: a national multicenter cohort study using a trigger tool. | PSNet
    psnet.ahrq.gov/issue/exploring-nursing-sensitive-events-home-healthcare-national-multicenter-cohort-study-using
    August 05, 2020 - records from ten Swedish home healthcare organizations, researchers found that 74% of patient safety incidents … of nursing-sensitive events were falls , pressure injuries, healthcare-associated infections , and incidents … August 5, 2020 Occurrence of no-harm incidents and adverse events in hospitalized patients … April 7, 2021 Identifying no-harm incidents in home healthcare: a cohort study using … July 1, 2016 Patient safety incidents in hospice care: observations from interdisciplinary

88. Psn-Pdf (pdf file)
    psnet.ahrq.gov/node/74256/psn-pdf
    January 19, 2022 - Potentially severe incidents during interhospital transport of critically ill patients, frequently occurring … Potentially severe incidents during interhospital transport of critically ill patients, frequently occurring … Reporting patient safety incidents is essential to improving patient safety. … This study compared the number of self-reported (to the study team) safety incidents during interhospital … transport and the number of incidents submitted to the hospital’s reporting system.

89. Learning from safety incidents in high reliability organizations: a systematic review of learning tools that could be adapted and used in healthcare. | PSNet
    psnet.ahrq.gov/issue/learning-safety-incidents-high-reliability-organizations-systematic-review-learning-tools
    May 26, 2021 - Review Learning from safety incidents in high reliability organizations: a systematic … Learning from safety incidents in high-reliability organizations: a systematic review of learning tools … Learning from safety incidents in high-reliability organizations: a systematic review of learning tools … May 26, 2021 A retrospective review of serious surgical incidents in 5 large UK teaching … Analysis of incidents resulting in patient injuries in a web-based system in Swedish health care.

90. Psn-Pdf (pdf file)
    psnet.ahrq.gov/node/60694/psn-pdf
    January 01, 2021 - Reporting incidents involving the use of advanced medical technologies by nurses in home care: a cross … Reporting incidents involving the use of advanced medical technologies by nurses in home care: a cross-sectional … https://psnet.ahrq.gov/issue/reporting-incidents-involving-use-advanced-medical-technologies-nurses- … The majority of incidents resulted in no or mild harm. … Most incidents were attributable to product failures, as well as organization of care (e.g., unclear

91. Psn-Pdf (pdf file)
    psnet.ahrq.gov/node/839815/psn-pdf
    November 09, 2022 - A longitudinal evaluation of computed tomography radiation incidents within a multisite NHS trust. … A longitudinal evaluation of computed tomography radiation incidents within a multisite NHS trust. … https://psnet.ahrq.gov/issue/longitudinal-evaluation-computed-tomography-radiation-incidents-within- … Researchers reviewed 133 radiation incidents reported to one NHS trust from 2015-2018. … Reported events included radiation incidents, near-miss incidents, and repeat scans.

92. Psn-Pdf (pdf file)
    psnet.ahrq.gov/node/856584/psn-pdf
    January 01, 2024 - Patient safety incidents in endoscopy: a human factors analysis of non-procedural significant harm incidents … Patient safety incidents in endoscopy: a human factors analysis of nonprocedural significant harm incidents … https://psnet.ahrq.gov/issue/patient-safety-incidents-endoscopy-human-factors-analysis-non-procedural … Kingdom to examine the human factors contributing to non- procedural endoscopy-related patient safety incidents … and Classification System coding, decision-based errors were the most common factor contributing to incidents

93. Medication or Other Substance Dashboard | Agency for Healthcare Research and Quality
    www.ahrq.gov/npsd/data/dashboard/medication.html
    September 01, 2024 - dashboard presents information on medication or other substance-related patient safety concerns, which span incidents … of safety concerns, and type of substance involved is presented, followed by further examination of incidents

94. An international perspective on definitions and terminology used to describe serious reportable patient safety incidents: a systematic review. | PSNet
    psnet.ahrq.gov/issue/international-perspective-definitions-and-terminology-used-describe-serious-reportable
    August 04, 2021 - international perspective on definitions and terminology used to describe serious reportable patient safety incidents … international perspective on definitions and terminology used to describe serious reportable patient safety incidents … This systematic review explored international approaches to defining serious reportable patient safety incidents … international perspective on definitions and terminology used to describe serious reportable patient safety incidents … Same Author(s) Medication safety in mental health hospitals: a mixed-methods analysis of incidents

95. Exploring changes in patient safety incidents during the COVID-19 pandemic in a Canadian regional hospital system: a retrospective time series analysis. | PSNet
    psnet.ahrq.gov/issue/exploring-changes-patient-safety-incidents-during-covid-19-pandemic-canadian-regional
    March 18, 2020 - Study Exploring changes in patient safety incidents during the COVID-19 pandemic … Exploring changes in patient safety incidents during the COVID-19 pandemic in a Canadian regional hospital … This retrospective study investigated the impact of the first wave of COVID-19 on patient safety incidents … Exploring changes in patient safety incidents during the COVID-19 pandemic in a Canadian regional hospital … 28, 2020 Medication safety in mental health hospitals: a mixed-methods analysis of incidents

96. Medication safety in mental health hospitals: a mixed-methods analysis of incidents reported to the National Reporting and Learning System. | PSNet
    psnet.ahrq.gov/issue/medication-safety-mental-health-hospitals-mixed-methods-analysis-incidents-reported-national
    December 18, 2017 - Study Medication safety in mental health hospitals: a mixed-methods analysis of incidents … Medication safety in mental health hospitals: a mixed-methods analysis of incidents reported to the National … organizational -, patient-, and equipment-related factors were identified as contributing to medication safety incidents … Medication safety in mental health hospitals: a mixed-methods analysis of incidents reported to the National … February 2, 2022 Learning from patient safety incidents involving acutely sick adults

97. A system factors analysis of "line, tube, and drain" incidents in the intensive care unit. | PSNet
    psnet.ahrq.gov/issue/system-factors-analysis-line-tube-and-drain-incidents-intensive-care-unit
    December 15, 2011 - Study A system factors analysis of "line, tube, and drain" incidents in the intensive … A system factors analysis of "line, tube, and drain" incidents in the intensive care unit. … intensive care unit and analyzed the systemic factors contributing to invasive line, tube, and drain incidents … A system factors analysis of "line, tube, and drain" incidents in the intensive care unit. … Citation Related Resources From the Same Author(s) Intensive care unit safety incidents

98. Psn-Pdf (pdf file)
    psnet.ahrq.gov/node/866311/psn-pdf
    January 01, 2025 - Systematic review of types of safety incidents and the processes and systems used for safety incident … Systematic review of types of safety incidents and the processes and systems used for safety incident … https://psnet.ahrq.gov/issue/systematic-review-types-safety-incidents-and-processes-and-systems-used- … The authors summarize how incidents are detected; common contributing, mitigating, and ameliorating … factors; as well as actions and interventions to reduce the risk of patient safety incidents.

99. Patient safety incidents in advance care planning for serious illness: a mixed-methods analysis | PSNet
    psnet.ahrq.gov/issue/patient-safety-incidents-advance-care-planning-serious-illness-mixed-methods-analysis
    February 22, 2019 - Study Patient safety incidents in advance care planning for serious illness: a mixed-methods … Patient safety incidents in advance care planning for serious illness: a mixed-methods analysis. … Patient safety incidents in advance care planning for serious illness: a mixed-methods analysis. … February 1, 2017 Safety incidents in the primary care office setting. … July 3, 2016 Classification of patient-safety incidents in primary care.

100. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/60757/psn-pdf
     August 05, 2020 - Identifying no-harm incidents in home healthcare: a cohort study using trigger tool methodology. … Identifying no-harm incidents in home healthcare: a cohort study using trigger tool methodology. … https://psnet.ahrq.gov/issue/identifying-no-harm-incidents-home-healthcare-cohort-study-using-trigger-tool … The most common incidents identified by the trigger tool were falls without injury, medication management … incidents, and moderate pain.