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psnet.ahrq.gov/node/60284/psn-pdf
April 29, 2020 - Efforts funded through the programs
include maternal morbidity review committees and safety bundle use
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psnet.ahrq.gov/node/837347/psn-pdf
June 08, 2022 - Areas of focus include workforce shortages, system
inequities and burnout.
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psnet.ahrq.gov/node/73151/psn-pdf
April 14, 2021 - Systemic problems arising from
the situation include disparities associated with antibiotic administration
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psnet.ahrq.gov/node/864352/psn-pdf
March 13, 2024 - Strategies include creating an accessible reporting
system, implementation of a "good catch" program
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psnet.ahrq.gov/node/860386/psn-pdf
January 10, 2024 - Descriptions include knowing what has happened; learning from
the factual; learning from experience;
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psnet.ahrq.gov/node/33590/psn-pdf
September 15, 2024 - Quality and Safety Activities
All hospitals are overseen by a board of directors, whose responsibilities include … These practices include structured use of
data to enhance care by setting specific quality goals and … organizations that have transformed their
practices and organizational culture to emphasize patient safety include
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psnet.ahrq.gov/node/867676/psn-pdf
February 26, 2025 - Steps in responding to patient safety events
include reporting, investigation, communication, remediation … As described in the CANDOR toolkit,
components of an apology should include acknowledging the gaps in … Other improvement efforts include continuing education of health professionals through simulation,
morbidity
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psnet.ahrq.gov/node/60745/psn-pdf
October 01, 2020 - ,
with up to one-third of these errors leading to observed patient harm.2,3 The most common errors include … five rights, with some organizations
suggesting up to nine total rights.10 These additional rights include … Common strategies to differentiate between products (i.e. look-alike
sound-alike medications) include … Solutions may vary but can
include documenting waste via automated dispensing cabinets or directly in … Challenges include
but are not limited to16
Decreased access to clinical decision support tools for
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psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.194_slideshow.ppt
March 01, 2009 - read-back techniques
Opportunities for the receiver to review relevant patient historical data, which may include … face-to-face verbal report on the patient should be required of EMS providers
This verbal report should include … Commission Patient Safety guidelines
ED-to-inpatient provider signout should be brief but thorough and include … Information to Include in ED-to-Inpatient Handoff
Presenting complaint and history of present illness … Take-Home Points (2)
The handoff between the ED and inpatient teams should be brief but standardized to include
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psnet.ahrq.gov/node/49812/psn-pdf
November 01, 2017 - This may include when specimens come from unusual locations, rare tests are
ordered, or special care … Other risk factors for specimen loss or misprocessing
include reliance on individuals to do the right … should be considered,
including those that may be costly, such as an overhaul of the EHR and LIS to include … and accessioned manually, risks associated with human error remain.(6)
Less costly systems solutions include … specimen time outs, which can be embedded into surgical or clinical checklists.(7) The
time out may include
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psnet.ahrq.gov/node/867015/psn-pdf
October 23, 2024 - Under the direction of a command center team, key elements include a structured team,
centralized communication
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psnet.ahrq.gov/node/866073/psn-pdf
June 05, 2024 - Challenges to these conversations include lack of time, language discordance,
and lack of clarity around
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psnet.ahrq.gov/node/866951/psn-pdf
October 16, 2024 - Key considerations include transparency, equity,
monitoring, and user training.
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psnet.ahrq.gov/web-mm/room-without-orders
September 01, 2011 - These actions usually include verifying admission orders, obtaining an admission history, performing … Responsibilities include ensuring adequate staffing to meet day-to-day care demands and facilitating … Potential strategies include: (i) establishing routine shift-to-shift communication about admissions … If nurses are changing shift during an admission, an ideal system would include standardized handoff … A well-designed system would also include a contingency plan for times of unanticipated stress such as
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psnet.ahrq.gov/web-mm/mobility-lost-icu
August 01, 2018 - Interventions include patient-specific exercises that increase flexibility, teach new movement strategies … The resulting plan of care may include exercises that foster beneficial physical adaptations through … These benefits include fewer short- and long-term complications, and reduced length of stay. … In addition, the commentary does not include information regarding investigational or off-label use of … When patients can follow simple commands, interventions can include active-assisted and active range
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psnet.ahrq.gov/node/50387/psn-pdf
September 25, 2019 - Topics covered
include the role of the pharmacist in addressing opioid misuse, physician–pharmacist
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psnet.ahrq.gov/node/855000/psn-pdf
November 01, 2023 - Topics discussed include team dynamics, operating room design, and high reliability.
-
psnet.ahrq.gov/node/60553/psn-pdf
June 03, 2020 - Topics include threat
perception, leadership, individual and collective interests, science communication
-
psnet.ahrq.gov/node/74166/psn-pdf
March 14, 2022 - This guideline suggests
strategies to enhance medication safety at home that include focusing on health
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psnet.ahrq.gov/node/50641/psn-pdf
November 06, 2019 - The authors share six recommendations for improvement which include
redesign of the learning environment