-
psnet.ahrq.gov/node/49772/psn-pdf
October 01, 2016 - Lapse in Antibiotics Leads to Sepsis
October 1, 2016
Levy MM. … Lapse in Antibiotics Leads to Sepsis. PSNet [internet]. 2016. … https://psnet.ahrq.gov/web-mm/lapse-antibiotics-leads-sepsis
The Case
A 34-year-old near-term pregnant … handoffs and transitions, and the benefits and risks
https://psnet.ahrq.gov/web-mm/lapse-antibiotics-leads-sepsis
-
psnet.ahrq.gov/node/49595/psn-pdf
December 01, 2009 - "Superficial" Report Leads to "Deep" Problem
December 1, 2009
Dhaliwal G. … "Superficial" Report Leads to "Deep" Problem. PSNet [internet]. 2009. … https://psnet.ahrq.gov/web-mm/superficial-report-leads-deep-problem
The Case
A 35-year-old woman presented … The
https://psnet.ahrq.gov/web-mm/superficial-report-leads-deep-problem
patient returned promptly
-
www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/long-term-care/resources/ontime/fallsprev/fallspximpl-handouts.pdf
June 02, 2025 - The nurse manager leads both of these and the nursing assistants attend a shift
brief on each shift … Multidisciplinary team
DON or ADON
typically leads the
meeting. … Rehab Department
staff
Rehab director
typically leads the
meeting. … DON or ADON or
rehab director leads
the meeting. … Medical Director leads
the meeting.
-
psnet.ahrq.gov/node/865710/psn-pdf
May 01, 2024 - managers-perceptions-factors-affecting-resident-and-patient-safety-work-residential-settings
https://psnet.ahrq.gov/web-mm/failure-ensure-patient-safety-leads-patient-falls-nursing-homes
-
psnet.ahrq.gov/node/72572/psn-pdf
January 01, 2021 - home-care-lessons-new-york-city-home-based-primary-care-practices-managing-covid-19
https://psnet.ahrq.gov/issue/fear-covid-19-leads-other-patients-decline-critical-treatment
-
psnet.ahrq.gov/node/72471/psn-pdf
November 18, 2020 - deferral-care-serious-non-covid-19-conditions-hidden-harm-covid-19
https://psnet.ahrq.gov/issue/fear-covid-19-leads-other-patients-decline-critical-treatment
-
psnet.ahrq.gov/node/837807/psn-pdf
August 10, 2022 - root-cause-analysis-reports-help-identify-common-factors-delayed-diagnosis-and-treatment
https://psnet.ahrq.gov/web-mm/costly-colonoscopy-leads-delay-diagnosis
-
psnet.ahrq.gov/node/849319/psn-pdf
May 24, 2023 - attitudes-clinicians-and-patient-safety-culture-and-after-arrive-trial
https://psnet.ahrq.gov/web-mm/lack-sepsis-recognition-leads-delay-care-following-cesarean-delivery
-
psnet.ahrq.gov/node/40625/psn-pdf
August 25, 2011 - found that teaching medical students practical applications of previously taught safety principles
leads
-
psnet.ahrq.gov/node/44169/psn-pdf
November 06, 2015 - /errors-laboratory-medicine-and-patient-safety
https://psnet.ahrq.gov/issue/when-diagnostic-testing-leads-harm-new-outcomes-based-approach-laboratory-medicine
-
www.ahrq.gov/research/findings/nhqrdr/chartbooks/carecoordination/trends.html
June 01, 2018 - Coordination Benefits
Conscious, patient-centered coordination of care improves the person's experience and leads
-
www.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/chronic/chipra-201-asthma-section-5-table-3.pdf
February 19, 2016 - Checking and correcting inhaler
technique using a standardized
checklist takes only 2-3 minutes and
leads
-
psnet.ahrq.gov/node/41969/psn-pdf
July 02, 2014 - creation-and-impact-dedicated-section-quality-and-patient-safety-clinical-academic-department
https://psnet.ahrq.gov/issue/anesthesiology-department-leads-culture-change-hospital-system-level-improve-quality-and
-
psnet.ahrq.gov/node/45035/psn-pdf
January 23, 2017 - decision-making-trauma-settings-simulation-improve-diagnostic-skills
https://psnet.ahrq.gov/web-mm/superficial-report-leads-deep-problem
-
psnet.ahrq.gov/node/43994/psn-pdf
August 02, 2015 - primer/simulation-training
https://psnet.ahrq.gov/issue/learning-through-simulated-independent-practice-leads-better-future-performance-simulated
-
psnet.ahrq.gov/node/34816/psn-pdf
February 28, 2018 - personal characteristics, with interpersonal and intrapersonal mediators
playing a role, which ultimately leads
-
psnet.ahrq.gov/node/865429/psn-pdf
April 24, 2024 - (VF) may be
induced by attempted cardioversion.8 It is therefore very important to connect the ECG leads … This
may take place in the electrophysiology lab or in the operating room where pacing via epicardial leads … team forgetting to check that the cardioverter/defibrillator had been
hooked up correctly to the ECG leads … shown to prolong life by reducing rates of myocardial infarction.20
Connect defibrillators to the ECG leads … With this set-up, a separate pair of chest leads directly connected to the defibrillator is no
longer
-
psnet.ahrq.gov/issue/shakespeare-was-target-dont-be-borrower-or-lender
May 11, 2022 - May 5, 2018
Misprogramming PCA concentration leads to dosing errors.
-
psnet.ahrq.gov/node/47502/psn-pdf
June 02, 2019 - psnet.ahrq.gov/primer/communication-between-clinicians
https://psnet.ahrq.gov/web-mm/miscommunication-or-leads-anticoagulation-mishap
-
psnet.ahrq.gov/node/50370/psn-pdf
January 01, 2020 - analysis-surgical-errors-closed-malpractice-claims-4-liability-insurers
https://psnet.ahrq.gov/web-mm/miscommunication-or-leads-anticoagulation-mishap