Results

Total Results: 4,231 records

Showing results for "occurred".

41. Missed and delayed diagnoses in the ambulatory setting: a study of closed malpractice claims. | PSNet
    psnet.ahrq.gov/issue/missed-and-delayed-diagnoses-ambulatory-setting-study-closed-malpractice-claims
    October 26, 2010 - Diagnostic errors resulting in patient harm occurred in 181 cases, chiefly consisting of missed or delayed … As with prior studies  using chart review, reviewer's agreement on whether an error occurred was only

42. Psn-Pdf (pdf file)
    psnet.ahrq.gov/node/72713/psn-pdf
    February 03, 2021 - information to individuals that contact the organization for  help when they feel an error may have occurred

43. Psn-Pdf (pdf file)
    psnet.ahrq.gov/node/865598/psn-pdf
    April 17, 2024 - on an analysis of 520 transplant medication-related errors to summarize the types of mistakes that occurred

44. Psn-Pdf (pdf file)
    psnet.ahrq.gov/node/838632/psn-pdf
    October 19, 2022 - This systematic review including 13 studies found that nursing workarounds most often occurred due to

45. Psn-Pdf (pdf file)
    psnet.ahrq.gov/node/851195/psn-pdf
    July 05, 2023 - This study of 7,452 pediatric patients with appendicitis found that delayed diagnosis occurred in 1.4%

46. Psn-Pdf (pdf file)
    psnet.ahrq.gov/node/865346/psn-pdf
    March 27, 2024 - summarizes a presentation by a nurse charged criminally after a medication mistake, her memory of what occurred

47. Psn-Pdf (pdf file)
    psnet.ahrq.gov/node/34936/psn-pdf
    March 12, 2009 - https://psnet.ahrq.gov/issue/another-fatal-failure-kingdrew This article reports on a death that occurred

48. Psn-Pdf (pdf file)
    psnet.ahrq.gov/node/866324/psn-pdf
    July 17, 2024 - This article summarizes a case where problems were not responded to, and harm occurred.

49. Psn-Pdf (pdf file)
    psnet.ahrq.gov/node/72522/psn-pdf
    December 02, 2020 - Conducted at a single emergency department (ED) in Italy, this study found that nurse-led triage errors occurred

50. Medication Overdose | PSNet
    psnet.ahrq.gov/web-mm/medication-overdose
    September 01, 2011 - ADE), and an additional 5% experience a potential ADE (ie, the error reached the patient, but no harm occurred … reported similar rates of ADEs, though rates of potential ADEs were even higher.( 5 ) Most potential ADEs occurred … illegible, can have life-threatening consequences.( Figure 1 , Figure 2 ) The error in this case occurred … confusion between ‘dose’ and ‘day,’ due to ambiguous use of the abbreviation “d” in “mg/kg/d,” could have occurred … and ensures that orders are complete and in a standard format, eliminating ambiguous dosing orders as occurred

51. Psn-Pdf (pdf file)
    psnet.ahrq.gov/node/41218/psn-pdf
    March 14, 2012 - medication-errors-when-pharmacy-closed This newsletter article discusses data on medication errors that occurred

52. Psn-Pdf (pdf file)
    psnet.ahrq.gov/node/867020/psn-pdf
    October 23, 2024 - discusses an effort in the United Kingdom to learn from preventable deaths reported to coroners that occurred

53. Psn-Pdf (pdf file)
    psnet.ahrq.gov/node/866732/psn-pdf
    September 18, 2024 - Adverse events occurred across the medication process including prescribing, dispensing, and administration

54. Psn-Pdf (pdf file)
    psnet.ahrq.gov/node/865702/psn-pdf
    May 01, 2024 - Most errors occurred post- operatively (including after discharge) and in colorectal and hepatobiliary

55. Misread Label | PSNet
    psnet.ahrq.gov/web-mm/misread-label
    August 28, 2024 - On face value, it is almost impossible to imagine how this could have occurred. … In addition to exploring why the error occurred at the level of individuals at the "sharp end," such … effectively, but involves interviewing staff involved to identify care management problems and why each occurred … Although physicians disclosed the adverse event, they often avoided stating that an error had occurred

56. Psn-Pdf (pdf file)
    psnet.ahrq.gov/node/36702/psn-pdf
    June 30, 2011 - researchers studied adverse events in stroke patients at one academic medical center and found that errors occurred

57. Psn-Pdf (pdf file)
    psnet.ahrq.gov/node/37088/psn-pdf
    August 08, 2007 - art-apology-when-and-how-seek-forgiveness This article offers practical advice on how to determine when an error has occurred

58. Psn-Pdf (pdf file)
    psnet.ahrq.gov/node/73535/psn-pdf
    July 28, 2021 - inpatients at one New York hospital between 2016 and 2018 and found that wrong- patient order errors occurred

59. Psn-Pdf (pdf file)
    psnet.ahrq.gov/node/851653/psn-pdf
    July 26, 2023 - this study, nurses at one Australian hospital provided a reflection as to why they believed an MAE occurred

60. Psn-Pdf (pdf file)
    psnet.ahrq.gov/node/41988/psn-pdf
    January 23, 2013 - article reveals lessons a medical student learned about patient safety while dealing with errors that occurred