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Showing results for "involves".

6321. Medication Reconciliation Pitfalls | PSNet
      psnet.ahrq.gov/web-mm/medication-reconciliation-pitfalls
      May 01, 2006 - The Commentary This error involves a system failure in the proper identification, documentation, and

6322. Rethinking Root Cause Analysis | PSNet
      psnet.ahrq.gov/perspective/rethinking-root-cause-analysis
      August 21, 2016 - implementation of the corrective actions is often incomplete; and, at the end of the RCA process (which often involves

6323. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/44787/psn-pdf
      January 20, 2016 - Medication errors involving overrides of healthcare technology. January 20, 2016 Grissinger M. PA-PSRS Patient Saf Advis. December 2015;12:141-148. https://psnet.ahrq.gov/issue/medication-errors-involving-overrides-healthcare-technology Users often bypass alerts meant to enhance safety of medication ordering and d…

6324. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/45009/psn-pdf
      March 30, 2016 - Fatal mistakes. March 30, 2016 Kliff S. Vox Media. March 15, 2016. https://psnet.ahrq.gov/issue/fatal-mistakes Health professionals involved in medical errors experience psychological stress, which can have serious consequences if they are unable to cope with their mistake. Reporting on the second victim phenomeno…

6325. Health care professionals as second victims after adverse events: a systematic review. | PSNet
      psnet.ahrq.gov/issue/health-care-professionals-second-victims-after-adverse-events-systematic-review
      September 19, 2016 - Review Health care professionals as second victims after adverse events: a systematic review. Citation Text: Seys D, Wu AW, Gerven EV, et al. Health Care Professionals as Second Victims after Adverse Events. Eval Health Prof. 2012;36(2). doi:10.1177/0163278712458918. Copy Citation …

6326. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/47411/psn-pdf
      December 12, 2018 - Patterns of disrespectful physician behavior at an academic medical center: implications for training, prevention, and remediation. December 12, 2018 Hopkins J, Hedlin H, Weinacker A, et al. Patterns of Disrespectful Physician Behavior at an Academic Medical Center: Implications for Training, Prevention, and Remed…

6327. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/44645/psn-pdf
      July 01, 2017 - Post-traumatic stress disorder amongst surgical trainees: an unrecognised risk? July 1, 2017 Thompson C, Naumann DN, Fellows JL, et al. Post-traumatic stress disorder amongst surgical trainees: An unrecognised risk? Surgeon. 2017;15(3):123-130. doi:10.1016/j.surge.2015.09.002. https://psnet.ahrq.gov/issue/post-tra…

6328. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/44316/psn-pdf
      March 20, 2017 - Improving Patient Safety: The Intersection of Safety Culture, Clinician and Staff Support, and Patient Safety Organizations. March 20, 2017 Miller RG, Scott SD, Hirschinger LE. Jefferson City, MO: Center for Patient Safety; September 2015. https://psnet.ahrq.gov/issue/improving-patient-safety-intersection-safety-c…

6329. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/44356/psn-pdf
      October 03, 2017 - Breaking the silence of the switch—increasing transparency about trainee participation in surgery. October 3, 2017 McAlister C. Breaking the Silence of the Switch--Increasing Transparency about Trainee Participation in Surgery. N Engl J Med. 2015;372(26):2477-9. doi:10.1056/NEJMp1502901. https://psnet.ahrq.gov/iss…

6330. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/46886/psn-pdf
      August 01, 2018 - Support strategies for health care professionals who are second victims. August 1, 2018 Hauk L. Support strategies for health care professionals who are second victims. AORN J. 2018;107(6):P7- P9. doi:10.1002/aorn.12291. https://psnet.ahrq.gov/issue/support-strategies-health-care-professionals-who-are-second-victi…

6331. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/35670/psn-pdf
      June 28, 2010 - Quality improvement implementation and hospital performance on patient safety indicators. June 28, 2010 Weiner BJ, Alexander JA, Baker LC, et al. Quality improvement implementation and hospital performance on patient safety indicators. Med Care Res Rev. 2006;63(1):29-57. https://psnet.ahrq.gov/issue/quality-improv…

6332. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/47187/psn-pdf
      September 05, 2018 - Supporting clinicians after adverse events: development of a clinician peer support program. September 5, 2018 Lane MA, Newman BM, Taylor MZ, et al. Supporting Clinicians After Adverse Events: Development of a Clinician Peer Support Program. J Patient Saf. 2018;14(3):e56-e60. doi:10.1097/PTS.0000000000000508. http…

6333. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49702/psn-pdf
      March 01, 2014 - Tough Call: Addressing Errors From Previous Providers March 1, 2014 Martinez W, Hickson GB. Tough Call: Addressing Errors From Previous Providers. PSNet [internet]. 2014. https://psnet.ahrq.gov/web-mm/tough-call-addressing-errors-previous-providers Case Objectives Define what it means to be a professional. Identi…

6334. An examination of opportunities for the active patient in improving patient safety. | PSNet
      psnet.ahrq.gov/issue/examination-opportunities-active-patient-improving-patient-safety
      October 04, 2011 - Review An examination of opportunities for the active patient in improving patient safety. Citation Text: Davis R, Sevdalis N, Jacklin R, et al. An examination of opportunities for the active patient in improving patient safety. J Patient Saf. 2012;8(1):36-43. doi:10.1097/PTS.0b013e318…

6335. Spotlight Case July 2008 (ppt file)
      psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.239_slideshow.ppt
      May 01, 2011 - Spotlight Case July 2008 Spotlight Case Duty to Disclose Someone Else’s Error * * Source and Credits This presentation is based on the May 2011 AHRQ WebM&M Spotlight Case See the full article at http://webmm.ahrq.gov CME credit is available Commentary by: Thomas H. Gallagher, MD University of Washington …

6336. If You Say So: Taking a Syringe at Face Value in the Operating Room | PSNet
      psnet.ahrq.gov/web-mm/if-you-say-so-taking-syringe-face-value-operating-room
      January 01, 2015 - Most research on the effects of hierarchy involves challenging formal authority, such as in the resident–attending

6337. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/36768/psn-pdf
      July 14, 2010 - Hospital leadership and quality improvement: rhetoric versus reality. July 14, 2010 Levey S, Vaughn T, Koepke M, et al. Hospital Leadership and Quality Improvement. J Patient Saf. 2008;3(1). doi:10.1097/pts.0b013e3180311256. https://psnet.ahrq.gov/issue/hospital-leadership-and-quality-improvement-rhetoric-versus-r…

6338. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/45969/psn-pdf
      January 07, 2019 - The surgeon as the second victim? Results of the Boston Intraoperative Adverse Events Surgeons' Attitude (BISA) study. January 7, 2019 Han K, Bohnen JD, Peponis T, et al. The surgeon as the second victim? Results of the Boston Intraoperative Adverse Events Surgeons' Attitude (BISA) study. J Am Coll Surg. 2017;224(…

6339. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49838/psn-pdf
      August 01, 2018 - An Untimely End Despite End-of-Life Care Planning August 1, 2018 Elia G, Barbour S, Anderson WG. An Untimely End Despite End-of-Life Care Planning. PSNet [internet]. 2018. https://psnet.ahrq.gov/web-mm/untimely-end-despite-end-life-care-planning The Case A 76-year-old man was admitted to the intensive care unit (…

6340. Increases in drug and opioid overdose deaths—United States, 2000–2015. | PSNet
      psnet.ahrq.gov/issue/increases-drug-and-opioid-overdose-deaths-united-states-2000-2015
      January 23, 2019 - Study Classic Increases in drug and opioid overdose deaths—United States, 2000–2015. Citation Text: Rudd RA, Seth P, David F, et al. Increases in Drug and Opioid-Involved Overdose Deaths - United States, 2010-2015. MMWR Morb Mortal Wkly Rep. 2016;65(50-51):1445-…