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Showing results for "medicines".

6061. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/46997/psn-pdf
      July 25, 2018 - Gross Negligence Manslaughter in Healthcare: The Report of a Rapid Policy Review. July 25, 2018 Williams N. Department of Health and Social Care. London, England: Crown Copyright; 2018. https://psnet.ahrq.gov/issue/gross-negligence-manslaughter-healthcare-report-rapid-policy-review Accountability for errors and or…

6062. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/44783/psn-pdf
      January 13, 2016 - Black Box Thinking: Why Most People Never Learn From Their Mistakes—But Some Do. January 13, 2016 Syed M. New York, NY: Portfolio; 2015. ISBN: 9781591848226. https://psnet.ahrq.gov/issue/black-box-thinking-why-most-people-never-learn-their-mistakes-some-do Medicine and aviation are high-risk industries where failu…

6063. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/839330/psn-pdf
      November 02, 2022 - Diagnosis: Reducing Errors and Improving Quality. November 2, 2022 Schiff G. Chapter In: Loscalzo J, Fauci A, Kasper D, et al, eds. Harrison's Principles of Internal Medicine, 21e. New York, NY: McGraw Hill; 2022 https://psnet.ahrq.gov/issue/diagnosis-reducing-errors-and-improving-quality The task of performing a …

6064. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/38361/psn-pdf
      January 31, 2011 - IOM: shorten residents' work shifts to reduce fatigue, improve patient safety. January 31, 2011 Kuehn BM. IOM: Shorten residents' work shifts to reduce fatigue, improve patient safety. JAMA. 2009;301(3):259-61. doi:10.1001/jama.2008.940. https://psnet.ahrq.gov/issue/iom-shorten-residents-work-shifts-reduce-fatigue…

6065. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/42734/psn-pdf
      November 13, 2013 - Healthcare Inspection—Emergency Department Patient Deaths: Memphis VAMC, Memphis, Tennessee. November 13, 2013 Washington, DC: Department of Veterans Affairs, Office of Inspector General; October 23, 2013. Report No. 13-00505-348. https://psnet.ahrq.gov/issue/healthcare-inspection-emergency-department-patient-deat…

6066. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/43020/psn-pdf
      May 29, 2014 - Handoff practices in undergraduate medical education. May 29, 2014 Liston BW, Tartaglia KM, Evans D, et al. Handoff practices in undergraduate medical education. J Gen Intern Med. 2014;29(5):765-9. doi:10.1007/s11606-014-2806-0. https://psnet.ahrq.gov/issue/handoff-practices-undergraduate-medical-education This su…

6067. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/73454/psn-pdf
      June 30, 2021 - Poor physician-patient communication and medical error. June 30, 2021 Lazris A, Roth AR, Haskell H, et al. Am Fam Physician. 2021;103(12):757-759.   https://psnet.ahrq.gov/issue/poor-physician-patient-communication-and-medical-error Communication failures are primary threat to safe care. This comment…

6068. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/45659/psn-pdf
      November 16, 2016 - Misdiagnoses: a hidden risk of genetic testing. November 16, 2016 Howard J. CNN. October 31, 2016. https://psnet.ahrq.gov/issue/misdiagnoses-hidden-risk-genetic-testing Although genetic testing can provide proactive assessment for disease, it can also result in unnecessary care. This news article reports on the un…

6069. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/34882/psn-pdf
      February 28, 2011 - Fumbled handoffs: one dropped ball after another. February 28, 2011 Gandhi TK. Fumbled handoffs: one dropped ball after another. Ann Intern Med. 2005;142(5):352-358. https://psnet.ahrq.gov/issue/fumbled-handoffs-one-dropped-ball-after-another This case study discusses the chain of events surrounding the delayed dia…

6070. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/44964/psn-pdf
      March 09, 2016 - EHRs in the ER: as doctors adapt, concerns emerge about medical errors. March 9, 2016 Luthra S. https://psnet.ahrq.gov/issue/ehrs-er-doctors-adapt-concerns-emerge-about-medical-errors Many emergency departments have recently implemented electronic health records, which has introduced new safety hazards. This news…

6071. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/47070/psn-pdf
      June 25, 2018 - Time out—charting a path for improving performance measurement. June 25, 2018 MacLean CH, Kerr EA, Qaseem A. Time Out - Charting a Path for Improving Performance Measurement. N Engl J Med. 2018;378(19):1757-1761. doi:10.1056/NEJMp1802595. https://psnet.ahrq.gov/issue/time-out-charting-path-improving-performance-me…

6072. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/37527/psn-pdf
      August 24, 2015 - MEDMARX Data Report: A Report on the Relationship of Drug Names and Medication Errors in Response to the Institute of Medicine's Call to Action (2003-2006 Findings and Trends 2002-2006). August 24, 2015 Hicks RW, Becker SC, Cousins DD, eds. Rockville, MD: Center for the Advancement of Patient Safety, US Pharmacop…

6073. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/34757/psn-pdf
      November 18, 2015 - Unity of Mistakes: A Phenomenological Interpretation of Medical Work. November 18, 2015 Paget MA. Philadelphia: Temple University Press; 2004. https://psnet.ahrq.gov/issue/unity-mistakes-phenomenological-interpretation-medical-work In this often described landmark text on the nature of medical error, Marianne Page…

6074. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/46527/psn-pdf
      March 07, 2018 - When missing a 'zebra' can land you in court. March 7, 2018 Crane M. Medscape Business of Medicine. February 20, 2018. https://psnet.ahrq.gov/issue/when-missing-zebra-can-land-you-court Cognitive biases contribute to missed diagnoses. This article discusses how cognitive biases affect decision making associated wi…

6075. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/73576/psn-pdf
      August 04, 2021 - The 2020 John M. Eisenberg Patient Safety and Quality Awards. August 4, 2021 Jt Comm J Qual Patient Saf. 2021;47(8):463-488.  https://psnet.ahrq.gov/issue/2020-john-m-eisenberg-patient-safety-and-quality-awards The Eisenberg Award honors individuals and organizations who have made significant advancement…

6076. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/60260/psn-pdf
      April 22, 2020 - Joint Statement on Multiple Patients Per Ventilator. April 22, 2020 The Anesthesia Patient Safety Foundation, Society of Critical Care Medicine, American Association for Respiratory Care, American Society of Anesthesiologists, American Association of Critical?Care Nurses, and American College of Chest Physicians. M…

6077. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/46233/psn-pdf
      September 24, 2017 - Cutting-edge efforts in surgical patient safety. September 24, 2017 Varghese TK, Ghaferi AA. Cutting-edge Efforts in Surgical Patient Safety. JAMA Surg. 2017;152(8):719- 720. doi:10.1001/jamasurg.2017.0858. https://psnet.ahrq.gov/issue/cutting-edge-efforts-surgical-patient-safety Implementation science examines me…

6078. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/38339/psn-pdf
      January 31, 2011 - Physician autonomy and informed decision making: finding the balance for patient safety and quality. January 31, 2011 Mathews SC, Pronovost P. Physician autonomy and informed decision making: finding the balance for patient safety and quality. JAMA. 2008;300(24):2913-5. doi:10.1001/jama.2008.846. https://psnet.ahr…

6079. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/73669/psn-pdf
      September 01, 2021 - Infection Prevention Compendium For Long-Term Care Facilities. September 1, 2021 Center for Healthy Aging--New York Academy of Medicine, Yale School of Nursing. https://psnet.ahrq.gov/issue/infection-prevention-compendium-long-term-care-facilities Healthcare-associated infections (HAIs) challenge safety in long-te…

6080. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/41514/psn-pdf
      July 02, 2014 - Perspective: beyond counting hours: the importance of supervision, professionalism, transitions of care, and workload in residency training. July 2, 2014 Schumacher D, Slovin SR, Riebschleger MP, et al. Perspective. Academic Medicine. 2012;87(7). doi:10.1097/acm.0b013e318257d57d. https://psnet.ahrq.gov/issue/pers…