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psnet.ahrq.gov/node/47322/psn-pdf
September 12, 2018 - Quality Chasm examines the human toll of poor-
quality care worldwide, with a particular focus on low … estimating that 134 million adverse events (resulting in
2.5 million deaths) occur in hospitals in low
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psnet.ahrq.gov/issue/iv-vincristine-survey-shows-safety-improvements-needed
March 14, 2023 - March 14, 2023
Smart pump custom concentrations without hard "low concentration" alerts … November 5, 2014
Drug shortages: national survey reveals high level of frustration, low
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psnet.ahrq.gov/issue/case-studies-medication-reconciliation
February 15, 2023 - November 16, 2022
Countering cognitive biases in minimising low value care. … September 29, 2017
Measuring hospital-acquired complications associated with low-value
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psnet.ahrq.gov/node/37063/psn-pdf
January 02, 2017 - Although the
study is hampered by a relatively low response rate, the authors note that these responses … housestaff-and-medical-student-attitudes-toward-medical-errors-and-adverse-events
https://psnet.ahrq.gov/primer/culture-safety
https://psnet.ahrq.gov/web-mm/low-totem-pole
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psnet.ahrq.gov/primer/medication-administration-errors
December 15, 2024 - Contributing factors to patient and caregiver error include low health literacy , poor provider–patient … Prevention Both low- and high-tech strategies have been designed to ensure safe medication administration … Many low-tech strategies support all nine rights, including the use of standardized communication strategies … Low-tech solutions Standardized communication : Health system communication standards are used to ensure … January 23, 2017
Just-in-time training for high-risk low-volume therapies: an approach
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psnet.ahrq.gov/node/49672/psn-pdf
January 01, 2013 - in whom a nodule has already been identified.(5,6)
Based on a patient's probability for malignancy (low … validated in other populations and is widely used in practice to distinguish between
nodules with a low … Fortunately, the surveillance strategy is typically selected when the probability of cancer is very low … or low,
so this type of error infrequently results in harm. … The risk of a fatal complication from VATS wedge resection is low (
In the case under discussion, the
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psnet.ahrq.gov/web-mm/patient-safety-and-adherence-self-administered-medications
September 29, 2011 - Everett Koop This case portrays low treatment adherence that is life-threatening. … Adherence, the extent to which patients take their treatments as prescribed, is surprisingly low with … medication adherence, with an estimated cost of $100 billion per year.( 4 ) Effectively managing low … While it is best to get to the root causes of low adherence for individuals, this may not be feasible … Take-Home Points Low adherence is ubiquitous and should be considered in all patients.
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psnet.ahrq.gov/node/46491/psn-pdf
August 20, 2018 - communication-training-program-encourage-speaking-behavior-surgical-oncology
https://psnet.ahrq.gov/web-mm/low-totem-pole … https://psnet.ahrq.gov/web-mm/low-totem-pole
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psnet.ahrq.gov/issue/computerized-physician-order-entry-critical-care-environment-review-current-literature
September 19, 2012 - Review
Computerized physician order entry in the critical care environment: a review of current literature.
Citation Text:
Maslove DM, Rizk NW, Lowe HJ. Computerized Physician Order Entry in the Critical Care Environment: A Review of Current Literature. J Intensive Care Med. 2011;26(3)…
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psnet.ahrq.gov/issue/patient-safety-obstetrics-what-aviators-firefighters-and-others-can-teach-us
January 22, 2017 - Commentary
Patient safety in obstetrics: what aviators, firefighters and others can teach us.
Citation Text:
Guise J-M, Lowe NK, Connell L. Patient Safety in Obstetrics: What Aviators, Firefighters and Others Can Teach Us. Nurs Womens Health. 2008;12(3):208-215. doi:10.1111/j.1751-486x…
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psnet.ahrq.gov/node/42333/psn-pdf
June 05, 2013 - has-improved-hand-hygiene-compliance-reduced-risk-hospital-acquired-
infections-among
Hand hygiene rates remain disappointingly low … At baseline, rates of the two HAIs were quite low, and hand
hygiene rates were relatively high, meaning
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psnet.ahrq.gov/node/33596/psn-pdf
January 29, 2025 - safety culture, and high technology capabilities.6,7,8 In a 2019 systematic review, hospitals
with low … Hospitals with low rates of FTR also reported higher rates of
overnight coverage and RRTs than hospitals … Multiple studies have since shown that
hospitals can have low complication rates but high failure-to-rescue … more experience
recognizing and responding to complications when they develop, whereas hospitals with low … high-risk surgery (e.g., trauma or burn surgery, organ transplants, intracranial hemorrhage) and very low
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psnet.ahrq.gov/issue/mobile-situ-obstetric-emergency-simulation-and-teamwork-training-improve-maternal-fetal
July 09, 2008 - Study
Mobile in situ obstetric emergency simulation and teamwork training to improve maternal–fetal safety in hospitals.
Citation Text:
Guise J-M, Lowe NK, Deering S, et al. Mobile in situ obstetric emergency simulation and teamwork training to improve maternal-fetal safety in hospitals.…
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psnet.ahrq.gov/issue/internal-reporting-system-improve-pharmacys-medication-distribution-process
October 31, 2017 - Study
Internal reporting system to improve a pharmacy's medication distribution process.
Citation Text:
Rickrode GA, Williams-Lowe ME, Rippe JL, et al. Internal reporting system to improve a pharmacy's medication distribution process. Am J Health Syst Pharm. 2007;64(11):1197-202.
Cop…
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psnet.ahrq.gov/issue/near-miss-audit-obstetrics
March 06, 2024 - the Same Author(s)
Towards a common framework to support decision-making in high-risk, low-time … November 4, 2020
Identifying safety practices perceived as low value: an exploratory
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psnet.ahrq.gov/node/49561/psn-pdf
May 01, 2008 - studies describing reduced risky behaviors following HIV
diagnosis are difficult to interpret due to low … Without secondary transmission benefits, routine screening is not cost effective (>$50,000/QALY) in low … However, studies assessing implementation of routine opt-out testing in low-risk,
low-prevalence settings … , low-prevalence settings.(26) Because the Task
Force found that potential benefits of routine screening … persons evaluated in low-prevalence hospitals, repeat screening at any interval
https://psnet.ahrq.gov
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psnet.ahrq.gov/node/846769/psn-pdf
March 29, 2023 - Her basic metabolic
panel showed a low serum sodium of 130 mmol/L and a borderline-high serum potassium … A low threshold for outreach to a subspecialist in endocrinology. … including rare and dangerous conditions in the initial differential diagnosis, it is crucial to have a
low … that cortisol secretion is both diurnal and pulsatile, so cortisol
levels at random times are often low … A low cortisol level (<5 ug/dl) paired with an ACTH level greater
than two times the upper limit of
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psnet.ahrq.gov/print/pdf/node/73848
July 01, 2022 - Distinguishing high-performing from low-performing hospitals for severe maternal morbidity: a focus
on … frontline nurses and physicians, chief medical officers, and quality and safety
officers, from high- and low-performing … https://psnet.ahrq.gov/issue/distinguishing-high-performing-low-performing-hospitals-severe-maternal-morbidity-focus … All Library Content
Distinguishing high-performing from low-performing hospitals for severe maternal … https://psnet.ahrq.gov/issue/distinguishing-high-performing-low-performing-hospitals-severe-maternal-morbidity-focus
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psnet.ahrq.gov/web-mm/lung-nodule-refused-grow
March 01, 2004 - whom a nodule has already been identified.( 5,6 ) Based on a patient's probability for malignancy (low … validated in other populations and is widely used in practice to distinguish between nodules with a low … Fortunately, the surveillance strategy is typically selected when the probability of cancer is very low … or low, so this type of error infrequently results in harm. … For sub-solid nodules, which often represent low-grade cancers, the optimal frequency and duration of
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psnet.ahrq.gov/issue/piece-my-mind-patient-you-least-want-see
August 14, 2024 - June 19, 2019
Prevalence and predictability of low-yield inpatient laboratory diagnostic … 2, 2024
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