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Total Results: 4,231 records

Showing results for "occurred".

1. External Inquiry into the adverse incident that occurred at Queen's Medical Centre, Nottingham, 4th January 2001. | PSNet
   psnet.ahrq.gov/issue/external-inquiry-adverse-incident-occurred-queens-medical-centre-nottingham-4th-january-2001
   September 10, 2014 - Book/Report External Inquiry into the adverse incident that occurred at Queen's Medical … Citation Text: External Inquiry into the adverse incident that occurred at Queen's Medical Centre, … The fatality occurred as a result of a socio-technical systems failure at the hospital where he received … Cite Citation Citation Text: External Inquiry into the adverse incident that occurred

2. Psn-Pdf (pdf file)
   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 … https://psnet.ahrq.gov/issue/external-inquiry-adverse-incident-occurred-queens-medical-centre-nottingham … The fatality occurred as a result of a socio-technical systems failure at the hospital where he received … https://psnet.ahrq.gov/issue/external-inquiry-adverse-incident-occurred-queens-medical-centre-nottingham … -4th-january-2001 https://psnet.ahrq.gov/issue/external-inquiry-adverse-incident-occurred-queens-medical-centre-nottingham

3. Psn-Pdf (pdf file)
   psnet.ahrq.gov/node/851196/psn-pdf
   July 05, 2023 - Findings indicate that nearly one in five falls occurred while the patient was under enhanced supervision … and most commonly occurred in the patient’s bathroom or bedside.

4. Psn-Pdf (pdf file)
   psnet.ahrq.gov/node/867137/psn-pdf
   November 13, 2024 - reported events were classified as "care management events," eg, incorrect rate or dosage; 31% of errors occurred … during administration; and 28% occurred during monitoring.

5. Psn-Pdf (pdf file)
   psnet.ahrq.gov/node/50749/psn-pdf
   December 18, 2019 - observational, descriptive, prospective study comprises an analysis of the medication errors that occurred … Results indicate that most medication errors occurred in the trauma unit and 64.2% of these types of

6. Psn-Pdf (pdf file)
   psnet.ahrq.gov/node/866692/psn-pdf
   September 11, 2024 - This study used 8 years of medication records to identify when in the medication process the error occurred … Nearly one-third of errors were wrong dose and occurred in the prescribing stage.

7. Psn-Pdf (pdf file)
   psnet.ahrq.gov/node/73181/psn-pdf
   April 28, 2021 - This retrospective study analyzed critical incidents that occurred during MET responses over a five-year … They mainly occurred due to lack of compliance with protocols and lack of available supplies.

8. Psn-Pdf (pdf file)
   psnet.ahrq.gov/node/73465/psn-pdf
   July 07, 2021 - event reports to identify the type of medication error, the stage in the process in which the error occurred … Errors in dosing were the most frequent type, and occurred during ordering or reviewing.

9. Psn-Pdf (pdf file)
   psnet.ahrq.gov/node/73603/psn-pdf
   August 18, 2021 - In this study of oncology patients, more than one quarter perceived an adverse event had occurred. … While most were informed soon after the event occurred and given an explanation, fewer than half were

10. Adverse drug events in hospitalized cardiac patients. | PSNet
    psnet.ahrq.gov/issue/adverse-drug-events-hospitalized-cardiac-patients
    July 26, 2023 - Preventable ADEs most frequently occurred during medication administration , and cardiovascular agents … Interestingly, the most preventable ADEs occurred between 7:00 AM and 9:00 AM, during handoffs between

11. Psn-Pdf (pdf file)
    psnet.ahrq.gov/node/37309/psn-pdf
    January 05, 2012 - Preventable ADEs most frequently occurred during medication administration, and cardiovascular agents … Interestingly, the most preventable ADEs occurred between 7:00 AM and 9:00 AM, during handoffs between

12. Patient falls while under supervision: trends from incident reporting. | PSNet
    psnet.ahrq.gov/issue/patient-falls-while-under-supervision-trends-incident-reporting
    January 11, 2023 - Findings indicate that nearly one in five falls occurred while the patient was under enhanced supervision … and most commonly occurred in the patient’s bathroom or bedside.

13. Tenfold medication errors: 5 years' experience at a university-affiliated pediatric hospital. | PSNet
    psnet.ahrq.gov/issue/tenfold-medication-errors-5-years-experience-university-affiliated-pediatric-hospital
    August 07, 2024 - resulted in patient harm in the outpatient setting , and this study found that more than 250 such errors occurred … Although pharmacists intercepted nearly half the errors, more than one-third occurred at the time of

14. When errors occur. | PSNet
    psnet.ahrq.gov/issue/when-errors-occur
    March 12, 2011 - Newspaper/Magazine Article When errors occur. Citation Text: Wetzel TG. When errors occur, 'I'm sorry' is a big step, but just the first. Hospitals & health networks. 2010;84(10):41-2, 44, 2. Copy Citation Format: Google Scholar PubMed BibTeX EndNote X3 XML EndNote 7 XML En…

15. Psn-Pdf (pdf file)
    psnet.ahrq.gov/node/33592/psn-pdf
    December 15, 2024 - independently reviewed by two clinically experienced reviewers in order to determine whether an adverse event occurred … When an adverse event occurred, reviewers also may disagree about whether the event was preventable. … Important subcategories of adverse events include: Preventable adverse events: those that occurred … could have been less harmful if care had been different; Adverse events due to negligence: those that occurred

16. Psn-Pdf (pdf file)
    psnet.ahrq.gov/node/37446/psn-pdf
    January 06, 2017 - Investigators discovered that inpatient warfarin- related errors occurred most frequently during transcription … /documentation and administration, while outpatient errors occurred most frequently during prescribing

17. Psn-Pdf (pdf file)
    psnet.ahrq.gov/node/39402/psn-pdf
    August 08, 2010 - A fatal vincristine error that occurred in the United Kingdom was the subject of a detailed investigation … preventing-vincristine-administration-errors https://psnet.ahrq.gov/issue/external-inquiry-adverse-incident-occurred-queens-medical-centre-nottingham

18. Psn-Pdf (pdf file)
    psnet.ahrq.gov/node/36200/psn-pdf
    February 15, 2011 - Prior research revealed that patients wanted the physicians to apologize for the error, explain how it occurred … Approximately half of respondents declined to explain how the error occurred or discuss specific plans

19. Psn-Pdf (pdf file)
    psnet.ahrq.gov/node/41522/psn-pdf
    December 02, 2014 - resulted in patient harm in the outpatient setting, and this study found that more than 250 such errors occurred … Although pharmacists intercepted nearly half the errors, more than one-third occurred at the time of

20. Critical incidents involving the medical emergency team: a 5-year retrospective assessment for healthcare improvement. | PSNet
    psnet.ahrq.gov/issue/critical-incidents-involving-medical-emergency-team-5-year-retrospective-assessment
    November 11, 2020 - This retrospective study analyzed critical incidents that occurred during MET responses over a five-year … They mainly occurred due to lack of compliance with protocols and lack of available supplies.