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Showing results for "mistakes".

  1. A Double “Never Event”: Wrong Patient and Wrong Side. | PSNet

    psnet.ahrq.gov/web-mm/double-never-event-wrong-patient-and-wrong-side
    August 20, 2018 - Potential solutions are to provide counseling, to create a “safe place” to learn from mistakes without

  2. When the Lytes Go Out: A Case of Inpatient Cardiac Arrest | PSNet

    psnet.ahrq.gov/web-mm/when-lytes-go-out-case-inpatient-cardiac-arrest
    February 01, 2023 - Early in the career of the freshly graduated physician, there are many things to learn and many mistakes

  3. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49527/psn-pdf
    December 01, 2006 - Mistakes in a stat laboratory: types and frequency. Clin Chem. 1997;43:1348–1351.

  4. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49388/psn-pdf
    February 01, 2003 - A preliminary classification of mistakes. In: Rasumussen J, Duncan K, Lelpat J, eds.

  5. Recurrent Hypoglycemia: A Care Transition Failure? | PSNet

    psnet.ahrq.gov/web-mm/recurrent-hypoglycemia-care-transition-failure
    December 23, 2020 - features in the emergence of diagnostic errors and the mechanisms through which reflection counteracts mistakes

  6. ABCDEF Bundle Data Literacy Training, Performance Measurement Tracking, and Performance Feedback | PSNet

    psnet.ahrq.gov/innovation/abcdef-bundle-data-literacy-training-performance-measurement-tracking-and-performance
    September 23, 2024 - requires additional treatment decisions. 2 The complex care provided in the ICU increases the risk of mistakes

  7. Don't Use That Port: Insert a PICC | PSNet

    psnet.ahrq.gov/web-mm/dont-use-port-insert-picc
    December 22, 2018 - Don't Use That Port: Insert a PICC Citation Text: Ilan R. Don't Use That Port: Insert a PICC. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2013. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNote 7 XML…

  8. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49403/psn-pdf
    June 01, 2003 - Missed Appendicitis June 1, 2003 Adams JG. Missed Appendicitis. PSNet [internet]. 2003. https://psnet.ahrq.gov/web-mm/missed-appendicitis Case Objectives Appreciate the variable presentations of appendicitis List complications of missed appendicitis Understand the advantages and disadvantages of CT in diagnosing…

  9. New Patient Mistakenly Checked in as Another | PSNet

    psnet.ahrq.gov/web-mm/new-patient-mistakenly-checked-another
    October 01, 2013 - New Patient Mistakenly Checked in as Another Citation Text: Green RA, Adelman JS. New Patient Mistakenly Checked in as Another. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2016. Copy Citation Format: Google Scholar B…

  10. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49512/psn-pdf
    May 01, 2006 - Right? Left? Neither! May 1, 2006 Chassin MR, Howell EA. Right? Left? Neither!. PSNet [internet]. 2006. https://psnet.ahrq.gov/web-mm/right-left-neither Case Objectives Appreciate the role of Reason's Swiss Cheese Model in medical errors Understand the process of analyzing a single error Provide suggestions for …

  11. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/33626/psn-pdf
    January 01, 2006 - In Conversation with…Jack Barker, PhD January 1, 2006 In Conversation with…Jack Barker, PhD. PSNet [internet]. 2006. https://psnet.ahrq.gov/perspective/conversation-withjack-barker-phd Editor's Note: Jack Barker, PhD, is Vice President of Research and Development for Mach One Leadership and a commercial pilot for …

  12. Mistaken Identity | PSNet

    psnet.ahrq.gov/web-mm/mistaken-identity
    December 18, 2014 - Mistaken Identity Citation Text: Hall LW. Mistaken Identity. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2008. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged PubMedId RIS …

  13. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49535/psn-pdf
    May 01, 2007 - Production Pressures May 1, 2007 Carayon P. Production Pressures. PSNet [internet]. 2007. https://psnet.ahrq.gov/web-mm/production-pressures The Case A 65-year-old man with bipolar disorder was scheduled for maintenance electroconvulsive therapy (ECT), a procedure he had received dozens of times before. These pro…

  14. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/836978/psn-pdf
    May 16, 2022 - Check Twice, Transport Once May 16, 2022 DePew A, Rice J, Chou J. Check Twice, Transport Once. PSNet [internet]. 2022. https://psnet.ahrq.gov/web-mm/check-twice-transport-once The Case Case #1: A 26-year-old woman (Patient A) presented to the Emergency Department (ED) with abdominal pain and was diagnosed with “s…

  15. Lesson from the VA's Team Training Program | PSNet

    psnet.ahrq.gov/perspective/lesson-vas-team-training-program
    November 01, 2011 - Lesson from the VA's Team Training Program Julia Neily, RN, MS, MPH; Peter D. Mills, PhD, MS; Lisa M. Mazzia, MD; and Douglas E. Paull,MD | November 1, 2011  Also Read a Conversation View more articles from the same authors. Citation Text: Neily J, Mills PD, Pa…

  16. In Conversation With… Eduardo Salas, PhD | PSNet

    psnet.ahrq.gov/perspective/conversation-eduardo-salas-phd
    November 01, 2011 - In Conversation With… Eduardo Salas, PhD November 1, 2011  Also Read an Essay Citation Text: In Conversation With… Eduardo Salas, PhD . PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2011.…

  17. Late Anemia Following Rh Disease in a Newborn | PSNet

    psnet.ahrq.gov/web-mm/late-anemia-following-rh-disease-newborn
    June 17, 2010 - Late Anemia Following Rh Disease in a Newborn Citation Text: Newman TB, Maisels JM. Late Anemia Following Rh Disease in a Newborn. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2014. Copy Citation Format: Google Schola…

  18. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49609/psn-pdf
    October 01, 2010 - Dangerous Dialysis October 1, 2010 Holley JL. Dangerous Dialysis . PSNet [internet]. 2010. https://psnet.ahrq.gov/web-mm/dangerous-dialysis Case Objectives List common errors that occur in dialysis units. Describe steps that can be taken by dialysis units to prevent these common errors. Describe the role of the …

  19. The Dropped "No" | PSNet

    psnet.ahrq.gov/web-mm/dropped-no
    October 30, 2019 - The Dropped "No" Citation Text: Johnson AJ. The Dropped "No". PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2011. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged PubMedId RIS …

  20. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49419/psn-pdf
    October 01, 2003 - The Other Side October 1, 2003 Vincent CA. The Other Side. PSNet [internet]. 2003. https://psnet.ahrq.gov/web-mm/other-side Case Objectives List the factors contributing to wrong site surgery. Understand the key components of the Universal Protocol for eliminating wrong site, wrong procedure, wrong person surger…
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