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psnet.ahrq.gov/web-mm/departure-central-line-ritual
October 13, 2018 - Let's use the Haddon structure to examine these specific interventions for CVC—a common procedure (more … Or, had the proceduralist team used a systematic counting procedure—as is routinely done in the OR—both … during and after the procedure, they likely would have recognized that they were one wire short of a … these simple cases, there is an efficiency cost, as well as a potential morbidity, inherent in any procedure … May 20, 2019
Clinical reasoning assessment methods: a scoping review and practical guidance
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psnet.ahrq.gov/periodic-issue/periodic-issue-389
April 26, 2023 - researchers identified healthcare delays involving laboratory results, treatment and interventional procedures … Overlapping surgery – when surgeons schedule distinct procedures on different patients concurrently – … In this article, the authors used health economics methods to understand the health economic impacts … system-wide safety protocols and practices to prevent medication administration errors during high-risk procedures
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psnet.ahrq.gov/node/49865/psn-pdf
June 01, 2019 - include alerts, order sets, or web-based
tools.(13) Alternative approaches to skin testing and test dose methods … https://www.ncbi.nlm.nih.gov/pubmed/31009700
https://psnet.ahrq.gov//#references
Test dose procedures … Unlike desensitization procedures, which typically require intensive care
unit monitoring, test dose … procedures can be performed on the medical floors.
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psnet.ahrq.gov/perspective/conversation-withpeter-j-pronovost-md-phd
June 01, 2005 - Much, perhaps most, of the efforts in that area were weaker on research methods in terms of rigorously … a different kind of research, studying the delivery of care, but it ought to be just as rigorous as methods … RW: In terms of big buckets—informatics, culture change, hiring more nurses, standard procedures—how
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psnet.ahrq.gov/print/pdf/node/865308
January 01, 2023 - National Health Service (NHS) system, examine how the NHS
might learn from those failures, and recommend methods … National Health Service (NHS) system, examine how the NHS
might learn from those failures, and recommend methods
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psnet.ahrq.gov/web-mm/e-prescribing-e-error
February 03, 2021 - A mixed methods study. … November 9, 2022
Medication adverse events in the ambulatory setting: a mixed-methods
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psnet.ahrq.gov/sites/default/files/2022-08/final_spotlight_latex_allergies-slides.pdf
January 01, 2022 - • No antibiotics were administered during the procedure and repair of
the diverticulum was uneventful … • One medical center in the early 1990’s reported that 1 out of every 8 anesthetic
procedures among … – Consider carrying out the procedure in a “latex safe” environment where no latex
products are used … Hourihane JO, Allard MN, Wade AM, McEwan AI, Strobel S: Impact of repeated surgical procedures on the … Clinical and laboratory based methods in the diagnosis of natural rubber latex allergy.
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psnet.ahrq.gov/node/846564/psn-pdf
March 29, 2023 - One in-depth pre-post, mixed-methods study showed that a fully implemented CPOE system significantly … https://psnet.ahrq.gov/issue/electronic-prescribing-systems-hospitals-improve-medication-safety-multi-methods-research
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psnet.ahrq.gov/perspective/conversation-christopher-p-landrigan-md-mph
April 01, 2013 - when you look at workforce trends in the United States, with the exception of a couple of the more procedure-intensive … North Carolina to try to understand whether the tool could be used as a reliable systemic surveillance method
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psnet.ahrq.gov/perspective/are-residency-duty-hour-rules-improving-patient-safety
April 01, 2013 - when you look at workforce trends in the United States, with the exception of a couple of the more procedure-intensive … North Carolina to try to understand whether the tool could be used as a reliable systemic surveillance method
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psnet.ahrq.gov/web-mm/point-care-mixup-1-shot-turns-3
February 14, 2024 - in reducing immunization pain in infancy ( 1,9 ) and later in childhood.( 10 ) Among the effective methods … a systematic review and meta-analysis of pain memory-reframing interventions for children's needle procedures
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psnet.ahrq.gov/node/33782/psn-pdf
March 01, 2015 - Even within a hospital whose R-AHMR seems
reasonable, individual diagnoses and procedures may demonstrate … every in-hospital death and using
continuously monitored risk-adjusted statistical process control methods
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psnet.ahrq.gov/periodic-issue/periodic-issue-326
January 07, 2022 - Procedure-related complications contributed to the majority of adverse event deaths. … Procedure-related complications contributed to the majority of adverse event deaths. … 2022;4(s1):1-45
Pharmacists play a unique role in patient safety that educational methods … nurse, resident physician, attending physician, and anethesiology team) to help prepare her for the procedure … This commentary addresses the importance of mitigating risk during procedures, balancing education of
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psnet.ahrq.gov/perspective/care-transitions
December 01, 2007 - diagnoses, pertinent history and physical findings, dates of hospitalization, hospital course, results of procedures … medications), details of follow-up arrangements made, specific follow-up needs (including appointments or procedures … 2020
Implementation and sustainability of a medication reconciliation toolkit: a mixed methods … January 11, 2017
Understanding patient-centred readmission factors: a multi-site, mixed-methods
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psnet.ahrq.gov/periodic-issue/periodic-issue-347
May 16, 2022 - Study
Toward safer opioid prescribing in HIV care (TOWER): a mixed-methods, cluster-randomized … patient being transported from the Emergency Department (ED) to other parts of the hospital for tests or procedures … In one case, the wrong patient was identified before undergoing an unnecessary procedure; in the second
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psnet.ahrq.gov/periodic-issue/periodic-issue-415
November 29, 2023 - A mixed methods study.
Grailey K, Hussain R, Wylleman E, et al. … of the AHRQ toolkit Improving Your Office Testing Process to implement new testing and communication procedures … rocuronium for endotracheal intubation, and she was given intravenous sugammadex (200 mg) at the end of the procedure
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psnet.ahrq.gov/node/843234/psn-pdf
January 01, 2013 - activity which has been mitigated through UC Davis Health, Office of Continuing Medical
Education procedures … but significant time and effort
were required for development and maintenance.24
Other potential methods … specific pain medication
order sets to guide clinicians through appropriate medications and doses.These methods
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psnet.ahrq.gov/perspective/conversation-withalison-stuebe-md-msc-and-kristin-tully-phd
October 06, 2021 - resultant consequences, and I'm wondering if there's an opportunity to integrate some of those safety methods … These include concordance of patient-clinician race and ethnicity; the timing, methods, and pace of information … of birthing parents, their infants, and their dyadic relationships. 7
Through their PSLL’s mixed-methods
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psnet.ahrq.gov/perspective/health-equity-and-maternal-health
October 06, 2021 - These include concordance of patient-clinician race and ethnicity; the timing, methods, and pace of information … of birthing parents, their infants, and their dyadic relationships. 7
Through their PSLL’s mixed-methods … resultant consequences, and I'm wondering if there's an opportunity to integrate some of those safety methods
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psnet.ahrq.gov/web-mm/failure-report
July 01, 2008 - answer, although the mistake would most likely be attributed to an unexplainable lapse in following procedures … To prevent unintentional unsafe acts—slips, lapses, mistakes, or procedure violations—the contributory … Make it easy to report and provide several different reporting methods. … October 27, 2010
Procedures should promote patient safety.