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Showing results for "mistakes".

3001. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/867850/psn-pdf
      February 26, 2025 - to do, but the word “reliability” carries less baggage than “safety” in terms of blame and making mistakes

3002. Importance of Following Safe Practices for Infant Feeding and Handling Expressed Breast Milk | PSNet
      psnet.ahrq.gov/web-mm/importance-following-safe-practices-infant-feeding-and-handling-expressed-breast-milk
      January 31, 2024 - and families impacted by the error. 21 This practice allows health team members to learn from their mistakes

3003. What Do We Know About Emergency Department Safety? | PSNet
      psnet.ahrq.gov/perspective/what-do-we-know-about-emergency-department-safety
      June 01, 2010 - I make mistakes just like the next guy, but hopefully I'm making fewer because I see them coming. … that works best is if you can get senior physician leaders to stand up and admit that they've made mistakes

3004. News Media and Health Care Providers at the Crossroads of Medical Adverse Events (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol1/Advances-Whitten_85.pdf
      June 05, 2008 - • Collecting and analyzing data on medical errors to determine whether there are areas where mistakes … Media mistakes in coverage of the Institute of Medicine’s error report.

3005. In Conversation with Carole Stockmeier about Zero Harm: Striving to Reduce Preventable Harms – Point, Counterpoint, and Areas of Agreement | PSNet
      psnet.ahrq.gov/perspective/conversation-carole-stockmeier-about-zero-harm-striving-reduce-preventable-harms-point
      September 24, 2024 - When errors and mistakes result in harm, we fail in our mission and fail those we serve. … The evidence-based approach is true when it comes to preventing errors and mistakes that can lead to

3006. In Conversation with…Peter J. Pronovost, MD, PhD | PSNet
      psnet.ahrq.gov/perspective/conversation-withpeter-j-pronovost-md-phd
      June 01, 2005 - Yet we also learned that despite all this, we often fail to learn from these defects; mistakes recur. … Internal Bleeding: The Truth Behind America's Terrifying Epidemic of Medical Mistakes.

3007. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/33796/psn-pdf
      January 01, 2016 - cases that should have been made in 3 or 4 months but stretched out over 9 or 12 or 15 months, or mistakes … Another factor is that we tend to rationalize away some of the mistakes that are made.

3008. Final Progress Report: Automated Medical Interviewing for Diagnostic Decision Support in the Emergency Department (pdf file)
      www.ahrq.gov/sites/default/files/2025-04/newman-toker2-report.pdf
      January 01, 2025 - and 2) “Did you make any mistakes when you were answering questions on the computer?” … When questioned through SACAI whether any mistakes were made in answering questions on the computer: … 92% (599/654) reported “No,” and 8% (55/654) answered “Yes; a few mistakes.” … No one answered “Yes; a lot of mistakes.” … Additionally, all age entry mistakes (n=11) were made using the digitizer pen technology and none with

3009. Presentation: Program Overview
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/mvp/modules/cusp/learn-from-defects-slides.pptx
      January 01, 2017 - Presentation: Program Overview Learn From Defects in Care of Mechanically Ventilated Patients AHRQ Safety Program for Mechanically Ventilated Patients AHRQ Pub. No. 16(17)-0018-34-EF January 2017 Learn From Defects ‹#› AHRQ Safety Program for Mechanically Ventilated Patients 1 Learning Objectives After this ses…

3010. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/33628/psn-pdf
      February 01, 2006 - In Conversation with…John Banja, PhD February 1, 2006 In Conversation with…John Banja, PhD. PSNet [internet]. 2006. https://psnet.ahrq.gov/perspective/conversation-withjohn-banja-phd Editor's Note: John Banja, PhD, is Assistant Director for Health Sciences and Clinical Ethics and Associate Professor of Clinical Et…

3011. Past Research on Patient Perceptions of Safety and Diagnostic Mishaps | Agency for Healthcare Research and Quality
      www.ahrq.gov/diagnostic-safety/resources/issue-briefs/dxsafety-patients-source-understanding-dx-error-vol1-3.html
      June 01, 2023 - Patient Experience as a Source for Understanding the Origins, Impact, and Remediation of Diagnostic Errors Past Research on Patient Perceptions of Safety and Diagnostic Mishaps Previous Page Next Page Table of Contents Patient Experience as a Source for Understanding the Origins, Impact, and Remedia…

3012. The Unfamiliar Catheter | PSNet
      psnet.ahrq.gov/web-mm/unfamiliar-catheter
      November 01, 2006 - device, the actual or potential risks associated with the device, and knowledge of how users may make mistakes … The doctor who makes mistakes needs help too. BMJ. 2000;320:726-727. [go to PubMed] 20.

3013. In Conversation with...Sorrel King | PSNet
      psnet.ahrq.gov/perspective/conversation-withsorrel-king
      March 01, 2007 - the hospital and the family can share the story together, and hopefully people can learn from their mistakes … Edwards Deming, said in his book, Out of the Crisis , "Customers would be eager to work...to reduce mistakes

3014. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/33771/psn-pdf
      August 22, 2014 - advances in ambulatory patient safety will come from our growing knowledge regarding how to best prevent mistakes … Ambulatory patient safety: the time is now: comment on "patient perceptions of mistakes in ambulatory

3015. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/33738/psn-pdf
      December 01, 2012 - It is important to try to understand cognitive functioning, why people make mistakes, and what are the … conditions in which they won't make as many mistakes.

3016. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/72811/psn-pdf
      September 01, 2022 - the program reduced overall medical errors, along with the incidence of several specific types of mistakes … medical errors had not been made, with the ED phase of care being responsible for the greatest number of mistakes

3017. Overview of the Comprehensive Unit-based Safety Program for Application to Mechanically Ventilated Patients: Facilitator Guide | Agency for Healthcare Research and Quality
      www.ahrq.gov/hai/tools/mvp/modules/cusp/overview-cusp-mvp-facguide.html
      February 01, 2017 - Say: CUSP is an adaptive intervention that helps teams identify and learn from mistakes, improve safety … CUSP is designed to improve safety culture and help teams learn from mistakes.

3018. Sensemaking and Learn from Defects for Perinatal Safety (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/perinatal-care/modules/teamwork/sensemaking/learn-from-defects-facilitator-guide.pdf
      May 01, 2017 - These conditions are the mistakes that occur without human error. … Sensemaking is a way for a L&D unit to learn from and prevent mistakes.

3019. Facilitator Guide: Build Your SSI Prevention Bundle (doc file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/mvp/modules/cusp/overview-cuspmvp-facguide.docx
      January 01, 2017 - SAY: CUSP is an adaptive intervention that helps teams identify and learn from mistakes, improve safety … CUSP is designed to improve safety culture and help teams learn from mistakes.

3020. Changing-System-Facilitator-Guide (doc file)
      www.ahrq.gov/sites/default/files/wysiwyg/antibiotic-use/long-term-care/changing-system-facilitator-guide.docx
      June 01, 2021 - Slide 5 Swiss Cheese Model SAY: Let’s return to our “Swiss cheese model” to help visualize where mistakes … Sharing and understanding our previous mistakes helps everyone improve!