Results

Total Results: over 10,000 records

Showing results for "occurred".

221. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/74098/psn-pdf
     January 01, 2023 - Over a nine-year period, 520 emergency events were identified; 25% were cardiac arrest events and 60% occurred

222. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/37941/psn-pdf
     July 30, 2008 - finding-blunders-thyroid-testing-experience-newborns Inconsistent and possibly erroneous results of thyroid tests for newborns occurred

223. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/38403/psn-pdf
     February 11, 2009 - psnet.ahrq.gov/issue/frequency-types-and-potential-clinical-significance-medication-dispensing- errors Errors occurred

224. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/40863/psn-pdf
     October 19, 2011 - family became involved with patient safety, serving on an advisory council at the hospital where it occurred

225. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/43405/psn-pdf
     August 14, 2014 - psnet.ahrq.gov/issue/characteristics-associated-postdischarge-medication-errors Postdischarge medication errors occurred

226. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/41136/psn-pdf
     February 15, 2012 - adverse-events-after-screening-and-follow-colonoscopy This study of more than 45,000 colonoscopies found that 4.7 serious adverse events occurred

227. AHRQ Mastectomy SB Infographic v15 (pdf file)
     hcup-us.ahrq.gov/reports/infographics/double-mastectomy.pdf
     February 01, 2016 - The rise in mastectomies occurred despite breast cancer rates remaining constant. 2005 2013 Sharp

228. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/49420/psn-pdf
     October 01, 2003 - Fortunately, no long-term sequelae occurred as a consequence of the errors in care suffered by this … Four distinct errors occurred in this case. … The errors in execution made by the original provider likely would not have occurred in less hectic … laboratory could have been more proactive about clarifying information, but had errors one and two not occurred

229. Appendix A. Recommendations for Ideal Consumer Reporting Systems | Agency for Healthcare Research and Quality
     www.ahrq.gov/patient-safety/reports/hotline/appa.html
     May 01, 2016 - The system should capture both objective information about what occurred and more-subjective information … Information collected from consumers should include where a patient safety event occurred; what contributed

230. Premortem Tool | Agency for Healthcare Research and Quality
     www.ahrq.gov/hai/tools/mvp/modules/cusp/premortem-tool.html
     January 01, 2017 - "Spend the next 10 minutes writing down all the reasons you believe this failure occurred. … Please spend the next 10 minutes writing down all the reasons you believe this failure occurred.

231. Tool: Premortem (doc file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/mvp/modules/cusp/premortem-tool.docx
     January 01, 2017 - · “Spend the next 10 minutes writing down all the reasons you believe this failure occurred. … Please spend the next 10 minutes writing down all the reasons you believe this failure occurred.

232. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/49512/psn-pdf
     May 01, 2006 - The first error (or series of errors) occurred 2 weeks prior to admission when the staff in the ED who … The next group of errors occurred when the patient was admitted. … The final set of errors occurred prior to the patient receiving spinal anesthesia. … such as cardiac arrest and neurological complications.(9) The institution at which this adverse event occurred … process of identifying and labeling radiographs should be reviewed to discover exactly how the errors occurred

233. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/36215/psn-pdf
     September 30, 2010 - oral-outpatient-chemotherapy-medication-errors-children-acute-lymphoblastic- leukemia This small cohort study demonstrated that dosing or administration errors occurred

234. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/39304/psn-pdf
     February 17, 2010 - pediatric-antidepressant-medication-errors-national-error-reporting-database This analysis of MEDMARX data found that harmful errors involving antidepressants most commonly occurred

235. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/47176/psn-pdf
     June 06, 2018 - This news article reports on serious medication errors that occurred at Children's Hospital in 2017,

236. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/35047/psn-pdf
     November 04, 2015 - Although no clinical errors occurred, some records were misplaced.

237. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/38016/psn-pdf
     August 27, 2008 - variability-concentrations-intravenous-drug-infusions-prepared-critical-care-unit This study found that errors frequently occurred

238. Board Checklist | Agency for Healthcare Research and Quality
     www.ahrq.gov/hai/cusp/toolkit/board-checklist.html
     December 01, 2012 - Discuss major patient safety events/errors that have occurred in the most recent timeframe to show that

239. Right? Left? Neither! | PSNet
     psnet.ahrq.gov/web-mm/right-left-neither
     November 16, 2022 - The first error (or series of errors) occurred 2 weeks prior to admission when the staff in the ED who … The next group of errors occurred when the patient was admitted. … The final set of errors occurred prior to the patient receiving spinal anesthesia. … as cardiac arrest and neurological complications.( 9 ) The institution at which this adverse event occurred … process of identifying and labeling radiographs should be reviewed to discover exactly how the errors occurred

240. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/851200/psn-pdf
     July 05, 2023 - In addition, post-event process gaps occurred, impacting learning and resolution such as a delay in