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9881. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/60328/psn-pdf
      May 27, 2020 - opioid-induced respiratory depression, deaths most frequently occur overnight between 00:00-06:00 am when nurse … RN Postdoctoral Research Fellow, Division of Pulmonary, Critical Care and Sleep Medicine Clinical Nurse … Avoiding Adverse Events Secondary to Opioid-Induced Respiratory Depression: Implications for Nurse Executives

9882. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/33602/psn-pdf
      September 07, 2019 - other health professions, some reports have raised the concern that similar problems may exist among nurses … A https://www.propublica.org/article/when-caregivers-harm-california-problem-nurses-stay-on-job-710 … psnet.ahrq.gov/issue/responding-clinicians-who-fail-follow-patient-safety-practices-perceptions-physicians-nurses

9883. Periodic Issue | PSNet
      psnet.ahrq.gov/periodic-issue/periodic-issue-304
      August 25, 2021 - develop a classification system to organize, prioritize, and discriminate alarm sounds in order to reduce nurse … develop a classification system to organize, prioritize, and discriminate alarm sounds in order to reduce nurse

9884. Organizational learning and patient safety: hospital pharmacy settings. | PSNet
      psnet.ahrq.gov/issue/organizational-learning-and-patient-safety-hospital-pharmacy-settings
      September 23, 2020 - March 5, 2014 Evaluation of a problem-specific SBAR tool to improve after-hours nurse-physician … July 31, 2023 The impact of safety culture, quality of care, missed care and nurse

9885. Too Tight Control | PSNet
      psnet.ahrq.gov/web-mm/too-tight-control
      March 20, 2013 - In one study, the wound infection rate was reduced from 3% to 1% using a nurse-managed IV insulin protocol … At 2 am, when the nurse came to measure the hourly fingerstick, she found the patient somnolent, tremulous

9886. Add-on Case and the Missing Checklist | PSNet
      psnet.ahrq.gov/web-mm/add-case-and-missing-checklist
      September 01, 2012 - When the endoscopy suite called for the patient, the bedside nurse said that the patient had just had … While performing the preanesthesia checklist, the certified nurse anesthetist documented that enoxaparin

9887. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49660/psn-pdf
      August 01, 2012 - The Case A 10-year-old girl with a history of asthma was brought by her mother (a nurse) to see a pediatrician … customizing alerts to prevent alert fatigue • A population-based view that allows clinicians and/or nurse

9888. Discharge Instructions in the PACU: Who Remembers? | PSNet
      psnet.ahrq.gov/web-mm/discharge-instructions-pacu-who-remembers
      August 05, 2009 - highly-structured approaches to the discharge process that involve numerous supporting elements, including nurse … Nurse–patient/visitor communication in the emergency department. J Emerg Nurs. 2009;35:406-411.

9889. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49455/psn-pdf
      July 01, 2004 - She had presented to clinic later that day, where a nurse practitioner assessed her symptoms as consistent … We are not told how the nurse practitioner "assessed her symptoms as consistent with her prior migraines

9890. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49470/psn-pdf
      December 01, 2004 - family doctor to let her know the likely problems that will develop, and arranging home visits by a nurse … In-hospital case management with intensive nurse follow-up has been demonstrated to reduce hospital

9891. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/846768/psn-pdf
      March 29, 2023 - However, while the team was moving him from the OR table to the gurney, a nurse inadvertently pulled … breathing circuit before transferring an intubated patient This patient’s ETT was dislodged because the nurse

9892. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49462/psn-pdf
      October 01, 2004 - example, I recently asked for an E-cylinder of oxygen to transport a critically ill patient, and the nurse … The nurse had inadvertently brought a CO2 cylinder (gray in color) instead of an oxygen cylinder.

9893. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/836942/psn-pdf
      April 27, 2022 - Nanji et al noted no difference in error rates between residents, physician staff, and nurse anesthetists … medication safeguards that make institutional sense; for example, checking by multiple physicians or nurses

9894. Spotlight (pdf file)
      psnet.ahrq.gov/sites/default/files/2020-04/final_april-spotlight-implicit_biases_04.02.2020.pdf
      January 01, 2020 - • The Respiratory Therapist and Nurses on the team determine that the patient does not require ICU … team rounds • Accountable Care Units (ACUs): A hospital care model designed to organize physicians, nurses … Nurse Educ Pract. 2016;19:36-40. … Nurse Educ Pract. 2016;19:36-40. doi:10.1016/j.nepr.2016.04.005 • 30.

9895. Spotlight (pdf file)
      psnet.ahrq.gov/sites/default/files/2020-05/final_may-spotlight-fatal_pca_slides_05.01.2020_cme_review-revised.pdf
      January 01, 2020 - desaturation compared with intermittent nursing spot-checks – Deaths most frequently occur overnight when nurse … Avoiding Adverse Events Secondary to Opioid-Induced Respiratory Depression: Implications for Nurse Executives

9896. Are incorrectly used drugs more frequently involved in adverse drug reactions? A prospective study. | PSNet
      psnet.ahrq.gov/issue/are-incorrectly-used-drugs-more-frequently-involved-adverse-drug-reactions-prospective-study
      March 08, 2017 - December 6, 2006 Physician and nurse well-being and preferred interventions to address … prevent medication errors in drugs administered to children by mouth or gastric tube: a programme for nurses

9897. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/40412/psn-pdf
      March 23, 2012 - methicillin-resistant-staphylococcus-aureus-central-line-associated-bloodstream-infections-us https://psnet.ahrq.gov/perspective/connies-story-nurses-personal-experience-mrsa

9898. AHRQ PSNet Webinar (pdf file)
      psnet.ahrq.gov/sites/default/files/2025-03/PSNet%20Webinar%20Feb%202025_0.pdf
      January 01, 2025 - Primary Removed hospitalist physician, added critical care nurse Hospital Standardized Mortality … Primary Changed from nurse led team to physician led Incidence of cardiorespiratory arrest 2.2 … • 4 non-randomized studies • Combination of opioid education to prescribers, academic detailing, nurse

9899. Part 2 of the 9th Annual Communication, Apology, and Resolution (CARe) Forum. | PSNet
      psnet.ahrq.gov/issue/part-2-9th-annual-communication-apology-and-resolution-care-forum
      June 19, 2019 - Meeting/Conference Proceedings Part 2 of the 9th Annual Communication, Apology, and Resolution (CARe) Forum. Citation Text: Betsy Lehman Center for Patient Safety. June 2, 2022. Copy Citation Save Save to your library Print Share Facebook Tw…

9900. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/38585/psn-pdf
      April 30, 2014 - primer/culture-safety https://psnet.ahrq.gov/issue/does-error-and-adverse-event-reporting-physicians-and-nurses-differ