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Showing results for "lessons learned".

61. Psn-Pdf (pdf file)
    psnet.ahrq.gov/node/837000/psn-pdf
    May 06, 2022 - Lessons Learned about Human Fallibility, System Design, and Justice in the Aftermath of a Fatal Medication … https://psnet.ahrq.gov/issue/lessons-learned-about-human-fallibility-system-design-and-justice-aftermath … This webinar highlighted lessons learned in the aftermath of a fatal medication error, and strategies … https://psnet.ahrq.gov/issue/lessons-learned-about-human-fallibility-system-design-and-justice-aftermath-fatal-medication … https://psnet.ahrq.gov/issue/lessons-learned-about-human-fallibility-system-design-and-justice-aftermath-fatal-medication

62. Psn-Pdf (pdf file)
    psnet.ahrq.gov/node/74710/psn-pdf
    January 26, 2022 - The evolution of the Anesthesia Patient Safety Movement in America: lessons learned and considerations … The evolution of the Anesthesia Patient Safety Movement in America: lessons learned and considerations … https://psnet.ahrq.gov/issue/evolution-anesthesia-patient-safety-movement-america-lessons-learned-and … https://psnet.ahrq.gov/issue/evolution-anesthesia-patient-safety-movement-america-lessons-learned-and-considerations … https://psnet.ahrq.gov/issue/evolution-anesthesia-patient-safety-movement-america-lessons-learned-and-considerations

63. Psn-Pdf (pdf file)
    psnet.ahrq.gov/node/837069/psn-pdf
    January 01, 2024 - Usability of a human factors-based clinical decision support in the emergency department: lessons learned … Usability of a human factors-based clinical decision support in the emergency department: lessons learned … psnet.ahrq.gov/issue/usability-human-factors-based-clinical-decision-support-emergency- department-lessons-learned … //psnet.ahrq.gov/issue/usability-human-factors-based-clinical-decision-support-emergency-department-lessons-learned … //psnet.ahrq.gov/issue/usability-human-factors-based-clinical-decision-support-emergency-department-lessons-learned

64. Psn-Pdf (pdf file)
    psnet.ahrq.gov/node/853065/psn-pdf
    August 30, 2023 - Exploring the impact of safety culture on incident reporting: lessons learned from machine learning … Exploring the impact of safety culture on incident reporting: lessons learned from machine learning … https://psnet.ahrq.gov/issue/exploring-impact-safety-culture-incident-reporting-lessons-learned-machine … https://psnet.ahrq.gov/issue/exploring-impact-safety-culture-incident-reporting-lessons-learned-machine-learning-analysis … https://psnet.ahrq.gov/issue/exploring-impact-safety-culture-incident-reporting-lessons-learned-machine-learning-analysis

65. Psn-Pdf (pdf file)
    psnet.ahrq.gov/node/72848/psn-pdf
    March 17, 2021 - The development and piloting of the Ambulatory Electronic Health Record Evaluation Tool: lessons learned … The development and piloting of the Ambulatory Electronic Health Record Evaluation Tool: lessons learned … psnet.ahrq.gov/issue/development-and-piloting-ambulatory-electronic-health-record-evaluation-tool- lessons-learned … //psnet.ahrq.gov/issue/development-and-piloting-ambulatory-electronic-health-record-evaluation-tool-lessons-learned … //psnet.ahrq.gov/issue/development-and-piloting-ambulatory-electronic-health-record-evaluation-tool-lessons-learned

66. Psn-Pdf (pdf file)
    psnet.ahrq.gov/node/35369/psn-pdf
    July 20, 2009 - Regulatory and policy barriers to effective clinical data exchange: lessons learned from MedsInfo-ED … Regulatory And Policy Barriers To Effective Clinical Data Exchange: Lessons Learned From MedsInfo-ED … learned-medsinfo-ed Using lessons learned from a pilot project, the authors share strategies for addressing … https://psnet.ahrq.gov/issue/regulatory-and-policy-barriers-effective-clinical-data-exchange-lessons-learned-medsinfo-ed … https://psnet.ahrq.gov/issue/regulatory-and-policy-barriers-effective-clinical-data-exchange-lessons-learned-medsinfo-ed

67. Psn-Pdf (pdf file)
    psnet.ahrq.gov/node/36050/psn-pdf
    January 02, 2017 - Improving the safety of intravenous admixtures: lessons learned from a Pentostam® overdose. … Improving the safety of intravenous admixtures: lessons learned from a Pentostam overdose. … https://psnet.ahrq.gov/issue/improving-safety-intravenous-admixtures-lessons-learned-pentostamr- overdose … The authors share lessons learned from reviewing an adverse event with a rarely used medication and … https://psnet.ahrq.gov/issue/improving-safety-intravenous-admixtures-lessons-learned-pentostamr-overdose

68. Psn-Pdf (pdf file)
    psnet.ahrq.gov/node/50792/psn-pdf
    January 15, 2020 - Lessons learned implementing a complex and innovative patient safety learning laboratory project in … Lessons learned implementing a complex and innovative patient safety learning laboratory project in … https://psnet.ahrq.gov/issue/lessons-learned-implementing-complex-and-innovative-patient-safety-learning … https://psnet.ahrq.gov/issue/lessons-learned-implementing-complex-and-innovative-patient-safety-learning-laboratory … https://psnet.ahrq.gov/issue/lessons-learned-implementing-complex-and-innovative-patient-safety-learning-laboratory

69. Psn-Pdf (pdf file)
    psnet.ahrq.gov/node/46981/psn-pdf
    May 04, 2019 - Lessons learned from implementing a principled approach to resolution following patient harm. … Lessons learned from implementing a principled approach to resolution following patient harm. … https://psnet.ahrq.gov/issue/lessons-learned-implementing-principled-approach-resolution-following- … https://psnet.ahrq.gov/issue/lessons-learned-implementing-principled-approach-resolution-following-patient-harm … https://psnet.ahrq.gov/issue/lessons-learned-implementing-principled-approach-resolution-following-patient-harm

70. Psn-Pdf (pdf file)
    psnet.ahrq.gov/node/838249/psn-pdf
    October 05, 2022 - Rooting an error review process in just culture: lessons learned. … Rooting an error review process in just culture: lessons learned. … https://psnet.ahrq.gov/issue/rooting-error-review-process-just-culture-lessons-learned Shifting to a … Lessons learned highlight the importance of who performs error follow-up, skills for navigating difficult … https://psnet.ahrq.gov/issue/rooting-error-review-process-just-culture-lessons-learned https://psnet.ahrq.gov

71. Psn-Pdf (pdf file)
    psnet.ahrq.gov/node/74267/psn-pdf
    January 19, 2022 - Support opportunities for second victims lessons learned: a qualitative study of the top 20 US News … Support opportunities for second victims lessons learned: a qualitative study of the top 20 US News … https://psnet.ahrq.gov/issue/support-opportunities-second-victims-lessons-learned-qualitative-study-top … https://psnet.ahrq.gov/issue/support-opportunities-second-victims-lessons-learned-qualitative-study-top … -20-us-news-and https://psnet.ahrq.gov/issue/support-opportunities-second-victims-lessons-learned-qualitative-study-top

72. Psn-Pdf (pdf file)
    psnet.ahrq.gov/node/42919/psn-pdf
    February 05, 2014 - Implementing hospital-based communication-and- resolution programs: lessons learned in New York City … Implementing hospital-based communication-and-resolution programs: lessons learned in New York City. … https://psnet.ahrq.gov/issue/implementing-hospital-based-communication-and-resolution-programs- lessons-learned-new-york … https://psnet.ahrq.gov/issue/implementing-hospital-based-communication-and-resolution-programs-lessons-learned-new-york … https://psnet.ahrq.gov/issue/communication-and-resolution-programs-challenges-and-lessons-learned-six-early-adopters

73. Exploring the impact of safety culture on incident reporting: lessons learned from machine learning analysis of NHS England staff survey and incident data. | PSNet
    psnet.ahrq.gov/issue/exploring-impact-safety-culture-incident-reporting-lessons-learned-machine-learning-analysis
    February 21, 2024 - Study Exploring the impact of safety culture on incident reporting: lessons learned … Exploring the impact of safety culture on incident reporting: lessons learned from machine learning analysis … Exploring the impact of safety culture on incident reporting: lessons learned from machine learning analysis

74. Learning from morbidity and mortality conferences: focus and sustainability of lessons for patient care. | PSNet
    psnet.ahrq.gov/issue/learning-morbidity-and-mortality-conferences-focus-and-sustainability-lessons-patient-care
    April 13, 2022 - Learning from morbidity and mortality conferences: focus and sustainability of lessons … Learning from morbidity and mortality conferences: focus and sustainability of lessons for patient care … learned. … Clinicians ascribed most lessons to technical or individual-level issues, and observed the challenges … learned.

75. Psn-Pdf (pdf file)
    psnet.ahrq.gov/node/42702/psn-pdf
    January 09, 2014 - Developing a quality and safety curriculum for fellows: lessons learned from a neonatology fellowship … Developing a quality and safety curriculum for fellows: lessons learned from a neonatology fellowship … https://psnet.ahrq.gov/issue/developing-quality-and-safety-curriculum-fellows-lessons-learned-neonatology … https://psnet.ahrq.gov/issue/developing-quality-and-safety-curriculum-fellows-lessons-learned-neonatology-fellowship … https://psnet.ahrq.gov/issue/developing-quality-and-safety-curriculum-fellows-lessons-learned-neonatology-fellowship

76. Usability of a human factors-based clinical decision support in the emergency department: lessons learned for design and implementation. | PSNet
    psnet.ahrq.gov/issue/usability-human-factors-based-clinical-decision-support-emergency-department-lessons-learned
    January 08, 2020 - Usability of a human factors-based clinical decision support in the emergency department: lessons … learned for design and implementation. … Usability of a human factors-based clinical decision support in the emergency department: lessons learned … Usability of a human factors-based clinical decision support in the emergency department: lessons learned

77. Implementing hospital-based communication-and-resolution programs: lessons learned in New York City. | PSNet
    psnet.ahrq.gov/issue/implementing-hospital-based-communication-and-resolution-programs-lessons-learned-new-york
    September 01, 2018 - Study Implementing hospital-based communication-and-resolution programs: lessons … learned in New York City. … Implementing hospital-based communication-and-resolution programs: lessons learned in New York City. … Implementing hospital-based communication-and-resolution programs: lessons learned in New York City.

78. Psn-Pdf (pdf file)
    psnet.ahrq.gov/node/48054/psn-pdf
    June 26, 2019 - Lessons learned from a death outside a hospital's doorstep. June 26, 2019 Palmer J. … https://psnet.ahrq.gov/issue/lessons-learned-death-outside-hospitals-doorstep Organizations must learn … Reporting on lessons to be learned from the cascade of failures connected with the preventable death … https://psnet.ahrq.gov/issue/lessons-learned-death-outside-hospitals-doorstep https://psnet.ahrq.gov/

79. Psn-Pdf (pdf file)
    psnet.ahrq.gov/node/38478/psn-pdf
    March 11, 2009 - Medication administration process assessment: applying lessons learned from commercial aviation. … Medication administration process assessment: applying lessons learned from commercial aviation. … https://psnet.ahrq.gov/issue/medication-administration-process-assessment-applying-lessons-learned- … https://psnet.ahrq.gov/issue/medication-administration-process-assessment-applying-lessons-learned-commercial-aviation … https://psnet.ahrq.gov/issue/medication-administration-process-assessment-applying-lessons-learned-commercial-aviation

80. Psn-Pdf (pdf file)
    psnet.ahrq.gov/node/38639/psn-pdf
    May 20, 2009 - Eight CT lessons that we learned the hard way: an analysis of current patterns of radiological error … Eight CT lessons that we learned the hard way: an analysis of current patterns of radiological error … https://psnet.ahrq.gov/issue/eight-ct-lessons-we-learned-hard-way-analysis-current-patterns-radiological … https://psnet.ahrq.gov/issue/eight-ct-lessons-we-learned-hard-way-analysis-current-patterns-radiological-error-and … https://psnet.ahrq.gov/issue/eight-ct-lessons-we-learned-hard-way-analysis-current-patterns-radiological-error-and