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psnet.ahrq.gov/node/74194/psn-pdf
December 15, 2021 - ;
https://psnet.ahrq.gov/issue/age-related-covid-19-vaccine-mix-ups
Vaccine missteps are known to occur
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psnet.ahrq.gov/node/49393/psn-pdf
April 01, 2003 - consisted of failure to identify the appropriate limb of colon to bring up for
colostomy, which can occur … This error is not confined to laparoscopy; it can occur during open
surgery, especially when multiple … psnet.ahrq.gov//#references
Any time error prevention relies solely on vigilance, errors will eventually occur—due … It is important to note
that mechanical obstruction can occur for reasons other than the error described
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psnet.ahrq.gov/node/838029/psn-pdf
September 07, 2022 - emergency-preparedness-be-ready-unanticipated-electronic-health-record-ehr-
downtime
Unanticipated health information system downtime can occur
-
psnet.ahrq.gov/node/60949/psn-pdf
September 23, 2020 - can assign accountability appropriately while encouraging disclosure and improvement when
mistakes occur
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psnet.ahrq.gov/node/852803/psn-pdf
August 23, 2023 - potential for data breaches and reduce their impact on care delivery and processes should cyberattacks
occur
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psnet.ahrq.gov/node/838312/psn-pdf
October 12, 2022 - causes-adverse-events-home-mechanical-ventilation-nursing-perspective
Hospital-level care at home can reduce cost and hospital readmissions, but adverse events still occur
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psnet.ahrq.gov/node/73295/psn-pdf
May 19, 2021 - bupivacaine-
hydrochloride-injection-usp
Anesthesia medications can be high risk should dosing errors occur
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psnet.ahrq.gov/node/837974/psn-pdf
August 31, 2022 - healthcare balances organizational and individual responsibility and accountability when
medical errors occur
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psnet.ahrq.gov/node/837300/psn-pdf
June 01, 2022 - https://psnet.ahrq.gov/issue/surgery-itself-risk-factor-patient
Preventable adverse events (AE) can occur
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psnet.ahrq.gov/node/846153/psn-pdf
March 15, 2023 - Fires were most likely to occur
during upper aerodigestive tract and head and neck surgeries; these
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psnet.ahrq.gov/node/846756/psn-pdf
March 29, 2023 - the majority of studies as administration greater than 60 minutes before or after the scheduled time) occur
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psnet.ahrq.gov/node/73181/psn-pdf
April 28, 2021 - effectiveness of medical emergency teams (MET) has been widely researched, critical incidents
that occur
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psnet.ahrq.gov/node/865877/psn-pdf
May 15, 2024 - The revised
framework identifies critical points where communication breakdowns are likely to occur
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psnet.ahrq.gov/node/36604/psn-pdf
June 04, 2024 - 15th-annual-public-report
The National Quality Forum has defined 29 never events—patient safety problems that should never occur
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psnet.ahrq.gov/node/867142/psn-pdf
November 13, 2024 - AEs were more
likely to occur among patients with longer ED stays.
-
psnet.ahrq.gov/node/867192/psn-pdf
November 20, 2024 - reported medication and other substance events, outlining data such as when in the
process errors occur
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psnet.ahrq.gov/node/866905/psn-pdf
October 09, 2024 - Errors
typically occur due to lack of access to the appropriate knowledge, and neither system is essential
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psnet.ahrq.gov/node/867234/psn-pdf
December 04, 2024 - This two-part series examines
characteristics of misconnections, how often they occur, and what can
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psnet.ahrq.gov/node/44290/psn-pdf
April 10, 2023 - prevention-and
Retained surgical items are rare and potentially catastrophic incidents that continue to occur
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psnet.ahrq.gov/node/47860/psn-pdf
June 30, 2019 - new-mother-number-14
Rigid adherence to protocols may detract from safety when unexpected critical events occur