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Showing results for "involving".

3081. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/847549/psn-pdf
      April 12, 2023 - Preventing home medication errors. April 12, 2023 Shaikh U, van der List L, Blumberg D. Kids Considered. March 27, 2023. https://psnet.ahrq.gov/issue/preventing-home-medication-errors Medication administration at home can be problematic especially for parents caring for children. This podcast highlights common rea…

3082. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/865820/psn-pdf
      May 08, 2024 - Breaking the silence on medical mistakes. May 8, 2024 Scott M. The Pulse. New York Public Radio; April 26, 2024. https://psnet.ahrq.gov/issue/breaking-silence-medical-mistakes Individuals involved in medical errors need time and support to process the incident and its consequences. This moderated podcast examines …

3083. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/39783/psn-pdf
      August 25, 2010 - Ethics, oversight and quality improvement initiatives. August 25, 2010 Taylor HA, Pronovost PJ, Sugarman J. Ethics, oversight and quality improvement initiatives. Quality and Safety in Health Care. 2010;19(4). doi:10.1136/qshc.2009.038034. https://psnet.ahrq.gov/issue/ethics-oversight-and-quality-improvement-initia…

3084. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/841774/psn-pdf
      December 21, 2022 - The prosecution of RaDonda Vaught: an ethical and legal mistake. December 21, 2022 Vogelstein E. The prosecution of RaDonda Vaught: An ethical and legal mistake. Nurs Forum. 2022;57(6):1571-1574. doi:10.1111/nuf.12838. https://psnet.ahrq.gov/issue/prosecution-radonda-vaught-ethical-and-legal-mistake The criminal …

3085. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/41038/psn-pdf
      February 10, 2012 - Activating knowledge for patient safety practices: a Canadian academic-policy partnership. February 10, 2012 Harrison MB, Nicklin W, Owen M, et al. Activating knowledge for patient safety practices: a Canadian academic-policy partnership. Worldviews Evid Based Nurs. 2012;9(1):49-58. doi:10.1111/j.1741- 6787.2011.0…

3086. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/46368/psn-pdf
      October 31, 2017 - A piece of my mind. Trials and tribulations. October 31, 2017 Brown JL. Trials and Tribulations. JAMA. 2017;318(7). doi:10.1001/jama.2017.7106. https://psnet.ahrq.gov/issue/piece-my-mind-trials-and-tribulations Personal experiences can inform understanding of medical error. This commentary describes a physician's …

3087. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/42651/psn-pdf
      October 09, 2013 - Origin of Adverse Drug Events in US Hospitals, 2011. October 9, 2013 Weiss AJ, Elixhauser A, Bae J, Encinosa W. HCUP Statistical Brief #158. Rockville, MD: Agency for Healthcare Research and Quality; September 2013.  https://psnet.ahrq.gov/issue/origin-adverse-drug-events-us-hospitals-2011 This report present…

3088. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/35414/psn-pdf
      May 21, 2014 - Assessment of the National Patient Safety Initiative: Context and Baseline Evaluation Report 1. May 21, 2014 Santa Monica, CA: RAND Corporation; 2005. ISBN 0833037870. https://psnet.ahrq.gov/issue/assessment-national-patient-safety-initiative-context-and-baseline-evaluation- report-1 The authors report on the his…

3089. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/43225/psn-pdf
      June 04, 2014 - Addressing the taboo of medical error through IGBOs: I got burnt once! June 4, 2014 Dumitrescu A, Ryan A. Addressing the taboo of medical error through IGBOs: I got burnt once!. Eur J Pediatr. 2014;173(4):503-8. doi:10.1007/s00431-013-2168-3. https://psnet.ahrq.gov/issue/addressing-taboo-medical-error-through-igbo…

3090. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/45336/psn-pdf
      September 21, 2016 - Medical misdiagnoses put pressure on patients to stay engaged. September 21, 2016 Innes S. Arizona Daily Star. September 12, 2016. https://psnet.ahrq.gov/issue/medical-misdiagnoses-put-pressure-patients-stay-engaged Delayed diagnoses can have serious consequences. This news article reviews several examples of mis…

3091. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/34823/psn-pdf
      April 06, 2011 - Use of medical emergency team (MET) responses to detect medical errors. April 6, 2011 Braithwaite RS, Devita MA, Mahidhara R, et al. Use of medical emergency team (MET) responses to detect medical errors. Qual Saf Health Care. 2004;13(4):255-259. https://psnet.ahrq.gov/issue/use-medical-emergency-team-met-response…

3092. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/44760/psn-pdf
      July 10, 2024 - Collaborative for Accountability and Improvement. July 10, 2024 University of Washington. https://psnet.ahrq.gov/issue/collaborative-accountability-and-improvement Communication-and-resolution programs (CRPs) are a promising strategy to improve respectful and effective discussions with patients and families after …

3093. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/37533/psn-pdf
      April 22, 2011 - Systematic evaluation of errors occurring during the preparation of intravenous medication. April 22, 2011 Parshuram CS, To T, Seto W, et al. Systematic evaluation of errors occurring during the preparation of intravenous medication. CMAJ. 2008;178(1):42-8. doi:10.1503/cmaj.061743. https://psnet.ahrq.gov/issue/sys…

3094. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/42284/psn-pdf
      May 22, 2013 - Current approaches to punitive action for medication errors by boards of pharmacy. May 22, 2013 Holdsworth M, Wittstrom K, Yeitrakis T. Current approaches to punitive action for medication errors by boards of pharmacy. Ann Pharmacother. 2013;47(4):475-81. doi:10.1345/aph.1R668. https://psnet.ahrq.gov/issue/current…

3095. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/38297/psn-pdf
      May 21, 2014 - Assessment of the AHRQ Patient Safety Initiative: Focus on Implementation and Dissemination Evaluation Report III. May 21, 2014 Farley DO, Damberg CL, Ridgely MS, et al. Santa Monica, CA: RAND Corporation; 2007. ISBN: 9780833042170 https://psnet.ahrq.gov/issue/assessment-ahrq-patient-safety-initiative-focus-imple…

3096. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/74733/psn-pdf
      February 02, 2022 - Prep, Stop, Block. February 2, 2022 RA-UK, the Faculty of Pain Medicine, RCoA Simulation and NHS Improvement https://psnet.ahrq.gov/issue/prep-stop-block Standardization is a common strategy for preventing practice deviations that can contribute to harm. This tool outlines a three-step process for minimizing the o…

3097. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/73897/psn-pdf
      September 29, 2021 - Peer Support Toolkit. September 29, 2021 Betsy Lehman Center for Patient Safety. September 2021. https://psnet.ahrq.gov/issue/peer-support-toolkit Clinicians involved in adverse events that harm patients can struggle to come to terms with error. This toolkit is designed to assist organizations in the development o…

3098. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/40771/psn-pdf
      June 15, 2012 - Medication prescribing errors in the prehospital setting and in the ED. June 15, 2012 Lifshitz AE, Goldstein LH, Sharist M, et al. Medication prescribing errors in the prehospital setting and in the ED. Am J Emerg Med. 2012;30(5):726-31. doi:10.1016/j.ajem.2011.04.023. https://psnet.ahrq.gov/issue/medication-presc…

3099. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/36049/psn-pdf
      January 02, 2017 - Improving health care quality and safety for people with disabilities: an interview with Lisa Iezzoni. January 2, 2017 Iezzoni LI. Improving health care quality and safety for people with disabilities: an interview with Lisa Iezzoni. Interview by Steven Berman. Jt Comm J Qual Patient Saf. 2006;32(7):400-6, 357. ht…

3100. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/41913/psn-pdf
      December 12, 2012 - Waking up the next morning: surgeons' emotional reactions to adverse events. December 12, 2012 Luu S, Patel P, St-Martin L, et al. Waking up the next morning: surgeons' emotional reactions to adverse events. Med Educ. 2012;46(12):1179-88. doi:10.1111/medu.12058. https://psnet.ahrq.gov/issue/waking-next-morning-sur…