Results

Total Results: 7,150 records

Showing results for "involving".

3221. In Conversation With... Jeffrey Shuren, MD, JD | PSNet
      psnet.ahrq.gov/perspective/conversation-jeffrey-shuren-md-jd
      May 28, 2020 - Since 1990, all clinical sites have been required to report all adverse events involving devices under … July 5, 2023 More than algorithms: an analysis of safety events involving ML-enabled

3222. Microsoft PowerPoint - FINAL Spotlight_Falls in Skilled Nursing Units_04.12.2023.pptx (pdf file)
      psnet.ahrq.gov/sites/default/files/2023-04/failure_to_ensure_patient_safety_leads_to_patient_falls_in_nursing_homes.pdf
      January 01, 2023 - most common reason for filing malpractice claims against NHs, and the average costs of these claims, involving … (9) • Whether team discussions were held to consider a more comprehensive personalized approach, involving

3223. A Room Without Orders | PSNet
      psnet.ahrq.gov/web-mm/room-without-orders
      September 01, 2011 - Key personnel to consider involving when developing a system to streamline planned admissions are listed … Take-Home Points Planned direct admissions are complex processes involving information exchanges

3224. Spotlight
      psnet.ahrq.gov/sites/default/files/2025-01/spotlight_case_misdiagnosis_of_small_bowel_obstruction_-_slides_-_final.pptx
      January 01, 2025 - to 37.8% between 1997 and 2016.3 Background – Imaging (4) There are circumstances, such as those involving … the clinician should reassess all relevant data, reconsider the differential diagnoses, and consider involving

3225. A Laceration that Needed a Proper Exam, Not an X-Ray | PSNet
      psnet.ahrq.gov/web-mm/laceration-needed-proper-exam-not-x-ray
      November 25, 2020 - clinicians—including both emergency physicians and hand surgeons—missed 16 (3.2%) injuries, most (11/16, 69%) involving … Slips and lapses are common sources of medical error involving task execution.

3226. Too Many Cooks in the Kitchen | PSNet
      psnet.ahrq.gov/web-mm/too-many-cooks-kitchen
      March 07, 2018 - face of a difficult procedure is a common variant of perioperative fixation error, a  cognitive error  involving … A recent systematic review of 11 cardiac risk indices involving 2,910,297 adult patients who underwent

3227. Microsoft PowerPoint - Spotlight Case_Gabapentin Overdose_12.21.2022 FINAL.pptx (pdf file)
      psnet.ahrq.gov/sites/default/files/2023-01/spotlight_overdose_of_gabapentin_and_oxycodone_in_a_patient_with_end-stage_renal_disease.pdf
      January 01, 2023 - entering these orders. 5 Case Details (2) • On POD  7, the patient developed persistent myoclonus involving … neurological toxicities are usually reversible with dialysis or renal replacement therapy.8   • In this case involving

3228. Medical Devices in the "Wild" | PSNet
      psnet.ahrq.gov/web-mm/medical-devices-wild
      March 27, 2024 - An HFE approach for such a problem would be to redesign the system while involving the users throughout

3229. Caution, Interrupted | PSNet
      psnet.ahrq.gov/web-mm/caution-interrupted
      October 01, 2016 - genesis of success or failure in medical work.( 1 ) Viewing this case as only an issue of mislabeling involving

3230. Two Wrongs Don't Make a Right (Kidney) | PSNet
      psnet.ahrq.gov/web-mm/two-wrongs-dont-make-right-kidney
      April 01, 2010 - level.( 2 ) Wrong-site surgery has long been recognized as a sentinel event—an unexpected occurrence involving

3231. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/33645/psn-pdf
      February 01, 2007 - approach already seems to be working in the field of mammography, where participation in a program involving

3232. Sick and Pregnant | PSNet
      psnet.ahrq.gov/web-mm/sick-and-pregnant
      August 25, 2021 - August 7, 2024 Root cause analysis of cases involving diagnosis.

3233. To Dilute or Not Dilute: Drug Errors and Consequences in the Operating Room | PSNet
      psnet.ahrq.gov/web-mm/dilute-or-not-dilute-drug-errors-and-consequences-operating-room
      July 28, 2021 - Swap May 1, 2011 WebM&M Cases Vial Mistakes Involving

3234. Computerized Provider Order Entry | PSNet
      psnet.ahrq.gov/primer/computerized-provider-order-entry
      March 15, 2025 - Promising error reduction strategies in the setting of dispensing and administration include involving

3235. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49473/psn-pdf
      March 01, 2005 - Involving the patient in safety efforts. In: Leonard M, Frankel A, Simmonds T, eds.

3236. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/73365/psn-pdf
      June 09, 2021 - Enhancing psychological safety in mental health services. June 9, 2021 Hunt DF, Bailey J, Lennox BR, et al. Enhancing psychological safety in mental health services. Int J Ment Health Syst. 2021;15(1):33. doi:10.1186/s13033-021-00439-1. https://psnet.ahrq.gov/issue/enhancing-psychological-safety-mental-health-servi…

3237. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/858166/psn-pdf
      December 13, 2023 - Pay practices and safety organizing: evidence from hospital nursing units. December 13, 2023 Conroy SA, Vogus TJ. Pay practices and safety organizing: evidence from hospital nursing units. Health Care Manage Rev. 2023;49(1):68-73. doi:10.1097/hmr.0000000000000392. https://psnet.ahrq.gov/issue/pay-practices-and-saf…

3238. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/60842/psn-pdf
      August 26, 2020 - Longitudinal medication reconciliation at hospital admission, discharge and post-discharge. August 26, 2020 Daliri S, Bouhnouf M, van de Meerendonk HWPC, et al. Longitudinal medication reconciliation at hospital admission, discharge and post-discharge. Res Social Adm Pharm. 2020;17(4):677-684. doi:10.1016/j.saphar…

3239. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/866160/psn-pdf
      June 19, 2024 - Checking all the boxes: a checklist for when and how to use checklists effectively. June 19, 2024 Alfred M, Barg-Walkow LH, Keebler JR, et al. Checking all the boxes: a checklist for when and how to use checklists effectively. BMJ Qual Saf. 2024;33(10):673-681. doi:10.1136/bmjqs-2023-016934. https://psnet.ahrq.gov…

3240. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/50652/psn-pdf
      January 01, 2020 - Preventable adverse drug events: descriptive epidemiology. November 13, 2019 Woo SA, Cragg A, Wickham ME, et al. Preventable adverse drug events: Descriptive epidemiology. Br J Clin Pharmacol. 2020;86(2):291-302. doi:10.1111/bcp.14139. https://psnet.ahrq.gov/issue/preventable-adverse-drug-events-descriptive-epidem…