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Showing results for "initiatives".

2721. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/35406/psn-pdf
      September 10, 2009 - Maintain accountability in patient safety efforts. September 10, 2009 Spath P. Maintain accountability in patient safety efforts. Hospital peer review. 2005;30(9):129-32. https://psnet.ahrq.gov/issue/maintain-accountability-patient-safety-efforts To develop an accountability initiative, the author recommends settin…

2722. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/43314/psn-pdf
      August 15, 2018 - ISQua Fellowship Programme. August 15, 2018 International Society for Quality in Health Care. https://psnet.ahrq.gov/issue/isqua-fellowship-programme This announcement highlights a peer learning initiative that builds on existing programs and interdisciplinary networks to develop participants' understanding about …

2723. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/42490/psn-pdf
      August 14, 2013 - Sentinel Event Program. August 14, 2013 Division of Licensing and Regulatory Services; Maine Department of Health and Human Services. https://psnet.ahrq.gov/issue/sentinel-event-program This Web site provides information about Maine's statewide incident reporting initiative and includes annual sentinel event repor…

2724. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/43357/psn-pdf
      July 16, 2014 - Wake Up Safe. July 16, 2014 Society for Pediatric Anesthesia. https://psnet.ahrq.gov/issue/wake-safe This Web site provides information about a Patient Safety Organization initiative to develop an adverse event registry in perioperative care for pediatric patients, determine causes for errors, and design preventi…

2725. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/36607/psn-pdf
      February 28, 2015 - Consumer Guide to Adverse Health Events. February 28, 2015 St Paul, MN: Minnesota Department of Health; 2015. https://psnet.ahrq.gov/issue/consumer-guide-adverse-health-events This report provides background on the Minnesota Never Events reporting initiative, tips for patients on how to receive the safest care pos…

2726. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/38380/psn-pdf
      February 04, 2009 - Towards an International Classification for Patient Safety. February 4, 2009 Int J Qual Health Care. 2009;21:1-75.   https://psnet.ahrq.gov/issue/towards-international-classification-patient-safety This set of articles focuses on the World Alliance for Patient Safety initiative to develop an international tax…

2727. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/45424/psn-pdf
      September 21, 2016 - Shift to Safety. September 21, 2016 Canadian Patient Safety Institute. https://psnet.ahrq.gov/issue/shift-safety This initiative facilitates a patient safety approach that focuses on the roles of patients, clinicians, and organizations. The website provides tools and resources to inform and engage individuals as l…

2728. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/36766/psn-pdf
      August 09, 2011 - The impact of professionalism on safe surgical care. August 9, 2011 Whittemore A, Surgery NES for V. The impact of professionalism on safe surgical care. J Vasc Surg. 2007;45(2):415-9. https://psnet.ahrq.gov/issue/impact-professionalism-safe-surgical-care The author discusses disruptive, disrespectful behavior in …

2729. Missing a Large Vessel Occlusion Stroke in a Patient with a History of Seizures. | PSNet
      psnet.ahrq.gov/web-mm/missing-large-vessel-occlusion-stroke-patient-history-seizures
      August 31, 2022 - SPOTLIGHT CASE Missing a Large Vessel Occlusion Stroke in a Patient with a History of Seizures. Citation Text: Keenan KJ, Nishijima DK. Missing a Large Vessel Occlusion Stroke in a Patient with a History of Seizures.. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, U…

2730. Duty to Disclose Someone Else's Error? | PSNet
      psnet.ahrq.gov/web-mm/duty-disclose-someone-elses-error
      June 01, 2004 - SPOTLIGHT CASE Duty to Disclose Someone Else's Error? Citation Text: Gallagher TH. Duty to Disclose Someone Else's Error?. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2011. Copy Citation Format: Google Sch…

2731. Airway Obstruction during Anterior Cervical Spine Surgery | PSNet
      psnet.ahrq.gov/web-mm/airway-obstruction-during-anterior-cervical-spine-surgery
      January 29, 2021 - Airway Obstruction during Anterior Cervical Spine Surgery Citation Text: Bohringer C, Vo L. Airway Obstruction during Anterior Cervical Spine Surgery. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2024. Copy Citation Format: …

2732. Isolated Clot, Real Error | PSNet
      psnet.ahrq.gov/web-mm/isolated-clot-real-error
      December 01, 2013 - SPOTLIGHT CASE Isolated Clot, Real Error Citation Text: Parks A, Fang MC. Isolated Clot, Real Error. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2018. Copy Citation Format: Google Scholar BibTeX EndNote X3…

2733. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/35988/psn-pdf
      May 04, 2015 - Eliminating Serious, Preventable, and Costly Medical Errors - Never Events. May 4, 2015 Baltimore, MD: Centers for Medicare and Medicaid Services; May 18, 2006. https://psnet.ahrq.gov/issue/eliminating-serious-preventable-and-costly-medical-errors-never-events This fact sheet provides information regarding the Cen…

2734. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/38477/psn-pdf
      October 03, 2017 - Serious Adverse Events Reports. October 3, 2017 The Quality Improvement Committee. Wellington, New Zealand; 2006-2013. https://psnet.ahrq.gov/issue/serious-adverse-events-reports Considered a starting point for a national reporting initiative, this series of annual reports provides statistics on serious and sentin…

2735. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/38923/psn-pdf
      September 09, 2009 - Improving communication in the emergency department. September 9, 2009 Redfern E, Brown R, Vincent C. Improving communication in the emergency department. Emerg Med J. 2009;26(9):658-61. doi:10.1136/emj.2008.065623. https://psnet.ahrq.gov/issue/improving-communication-emergency-department Implementation of structu…

2736. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/36036/psn-pdf
      April 29, 2018 - Rapid response team activation by patients can mitigate errors. April 29, 2018 ISMP Medication Safety Alert! Acute care edition. June 1, 2006. https://psnet.ahrq.gov/issue/rapid-response-team-activation-patients-can-mitigate-errors This article discusses one hospital's initiative to empower patients and their fami…

2737. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/37762/psn-pdf
      May 14, 2008 - Revitalizing an established rapid response team. May 14, 2008 Genardi ME, Cronin SN, Thomas LD. Revitalizing an established rapid response team. Dimens Crit Care Nurs. 2008;27(3):104-9. doi:10.1097/01.DCC.0000286837.95720.8c. https://psnet.ahrq.gov/issue/revitalizing-established-rapid-response-team This commentary…

2738. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/41581/psn-pdf
      August 08, 2012 - How-to Guides: Improving Transitions from the Hospital to Reduce Avoidable Rehospitalizations. August 8, 2012 Cambridge, MA: Institute for Healthcare Improvement; June 2012. https://psnet.ahrq.gov/issue/how-guides-improving-transitions-hospital-reduce-avoidable-rehospitalizations This series, developed in conjunct…

2739. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/40698/psn-pdf
      August 17, 2011 - Improving patient safety in the office: The Institute for Safety in Office-Based Surgery. August 17, 2011 Urman RD, Shapiro FE. APSF Newsletter. 2011;3-4,9.   https://psnet.ahrq.gov/issue/improving-patient-safety-office-institute-safety-office-based-surgery This piece discusses an ambulatory surgery safety im…

2740. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/36212/psn-pdf
      February 02, 2010 - SafetyNet: Lessons Learned from Close Calls in the OR. February 2, 2010 AORN J. 2006;84(1S1):CO1-CO2,s6-s12. https://psnet.ahrq.gov/issue/safetynet-lessons-learned-close-calls-or This special issue includes a series of articles on SafetyNet, the Association of periOperative Registered Nurses (AORN) Web-based repor…