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psnet.ahrq.gov/web-mm/coming-undone-failure-closure-device
April 01, 2006 - Reactions to the iodinated contrast agents commonly used occur in approximately 1% of patients.( 6 ) … Renal failure is one of the more common complications of catheterization.( 8 ) Renal dysfunction can occur … arterial puncture above the inguinal ligament or inadequate hemostasis after the procedure but may also occur … procedure with relatively low overall rates of major and minor complications, but complications do occur
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psnet.ahrq.gov/node/45425/psn-pdf
December 22, 2018 - an excessive number of safety warnings that prescribers must manually override, alert fatigue
may occur
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psnet.ahrq.gov/node/47058/psn-pdf
August 20, 2018 - for improving the safety and
quality of health care, consistent use of known best practices does not occur
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psnet.ahrq.gov/node/42900/psn-pdf
September 19, 2016 - The majority of inpatient suicides
occur in psychiatric units, but a prior Joint Commission sentinel
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psnet.ahrq.gov/node/39822/psn-pdf
February 17, 2011 - what
information to share and how to share it; of course, discussions about individual disclosure occur
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psnet.ahrq.gov/node/37462/psn-pdf
January 06, 2017 - medication-errors-associated-code-situations-us-hospitals-direct-and-
collateral-damage
This study describes medication error types that occur
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psnet.ahrq.gov/node/42693/psn-pdf
December 23, 2016 - Despite being
long recognized as a critical—and preventable—error, RFOs continue to occur, with nearly
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psnet.ahrq.gov/node/47711/psn-pdf
June 14, 2019 - Type 1 diabetes defined by severe insulin deficiency
occurs after 30 years of age and is commonly treated as
type 2 diabetes.
June 14, 2019
Thomas NJ, Lynam AL, Hill A, et al. Type 1 diabetes defined by severe insulin deficiency occurs after
30 years of age and is commonly treated as type 2 diabetes. Diabetologia.…
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psnet.ahrq.gov/node/74086/psn-pdf
November 17, 2021 - Review of reported adverse events occurring among the
homeless veteran population in the Veterans Health
Administration.
November 17, 2021
Soncrant C, Mills PD, Pendley Louis RP, et al. Review of reported adverse events occurring among the
homeless veteran population in the Veterans Health Administration. J Patien…
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psnet.ahrq.gov/node/838307/psn-pdf
October 12, 2022 - Misdiagnosis of thoracic aortic emergencies occurs
frequently among transfers to aortic referral centers: an
analysis of over 3700 patients.
October 12, 2022
Arnaoutakis GJ, Ogami T, Aranda?Michel E, et al. Misdiagnosis of thoracic aortic emergencies occurs
frequently among transfers to aortic referral centers: an…
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psnet.ahrq.gov/node/60159/psn-pdf
March 25, 2020 - Root cause analyses of reported adverse events
occurring during gastrointestinal scope and tube
placement procedures in the Veterans Health Association.
March 25, 2020
Soncrant C, Mills PD, Neily J, et al. Root cause analyses of reported adverse events occurring during
gastrointestinal scope and tube placement pro…
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psnet.ahrq.gov/node/38649/psn-pdf
May 20, 2009 - Managing the adverse event occurring during elective,
ambulatory pediatric surgery.
May 20, 2009
Skarsgard ED. Managing the adverse event occurring during elective, ambulatory pediatric surgery. Semin
Pediatr Surg. 2009;18(2):122-4. doi:10.1053/j.sempedsurg.2009.02.013.
https://psnet.ahrq.gov/issue/managing-advers…
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psnet.ahrq.gov/node/60980/psn-pdf
January 01, 2022 - Analysis of risk factors for patient safety events occurring
in the emergency department.
October 7, 2020
Alsabri M, Boudi Z, Zoubeidi T, et al. Analysis of risk factors for patient safety events occurring in the
emergency department. J Patient Saf. 2022;18(1):e124-e135. doi:10.1097/pts.0000000000000715.
https://p…
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psnet.ahrq.gov/node/37533/psn-pdf
April 22, 2011 - Systematic evaluation of errors occurring during the
preparation of intravenous medication.
April 22, 2011
Parshuram CS, To T, Seto W, et al. Systematic evaluation of errors occurring during the preparation of
intravenous medication. CMAJ. 2008;178(1):42-8. doi:10.1503/cmaj.061743.
https://psnet.ahrq.gov/issue/sys…
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psnet.ahrq.gov/node/35876/psn-pdf
June 18, 2013 - External Inquiry into the adverse incident that occurred at
Queen's Medical Centre, Nottingham, 4th January 2001.
June 18, 2013
Toft B. London, UK; Crown Copyright: 2001.
https://psnet.ahrq.gov/issue/external-inquiry-adverse-incident-occurred-queens-medical-centre-nottingham-
4th-january-2001
This UK Department o…
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psnet.ahrq.gov/node/42993/psn-pdf
March 19, 2014 - Baccalaureate nursing students' accounts of medical
mistakes occurring in the clinical setting: implications for
curricula.
March 19, 2014
Noland CM. Baccalaureate nursing students' accounts of medical mistakes occurring in the clinical setting:
implications for curricula. J Nurs Educ. 2014;53(3):S34-7. doi:10.392…
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psnet.ahrq.gov/node/37156/psn-pdf
October 06, 2011 - Preventable harm occurring to critically ill children.
October 6, 2011
Larsen G, Donaldson AE, Parker HB, et al. Preventable harm occurring to critically ill children. Pediatr Crit
Care Med. 2007;8(4):331-336.
https://psnet.ahrq.gov/issue/preventable-harm-occurring-critically-ill-children
This retrospective cohort…
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psnet.ahrq.gov/node/39743/psn-pdf
October 13, 2010 - Anatomy and pathophysiology of errors occurring in
clinical radiology practice.
October 13, 2010
Brook OR, O'Connell AM, Thornton E, et al. Quality initiatives: anatomy and pathophysiology of errors
occurring in clinical radiology practice. Radiographics. 2010;30(5):1401-10. doi:10.1148/rg.305105013.
https://psnet…
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psnet.ahrq.gov/node/37155/psn-pdf
October 06, 2011 - Classification of adverse events occurring in a surgical
intensive care unit.
October 6, 2011
Frankel H, Sperry J, Kaplan L, et al. Classification of adverse events occurring in a surgical intensive care
unit. Am J Surg. 2007;194(3):328-32.
https://psnet.ahrq.gov/issue/classification-adverse-events-occurring-surgi…
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psnet.ahrq.gov/node/38360/psn-pdf
March 18, 2010 - Medication errors occurring with the use of bar-code
administration technology.
March 18, 2010
PA-PSRS Patient Saf Advis. December 2008;5:122-126.
https://psnet.ahrq.gov/issue/medication-errors-occurring-use-bar-code-administration-technology
This article describes errors associated with bar coded medication admin…