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Total Results: 4,038 records

Showing results for "occurring".

  1. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/42577/psn-pdf
    December 31, 2014 - Estimating the information gap between emergency department records of community medication compared to on-line access to the community-based pharmacy records. December 31, 2014 Tamblyn R, Poissant L, Huang A, et al. Estimating the information gap between emergency department records of community medication compa…

  2. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/39822/psn-pdf
    February 17, 2011 - The disclosure dilemma—large-scale adverse events. February 17, 2011 Dudzinski DM, Hébert PC, Foglia MB, et al. The disclosure dilemma--large-scale adverse events. New Engl J Med. 2010;363(10):978-986. doi:10.1056/NEJMhle1003134. https://psnet.ahrq.gov/issue/disclosure-dilemma-large-scale-adverse-events Error disc…

  3. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/39404/psn-pdf
    March 31, 2010 - Incidence and root cause analysis of wrong-site pain management procedures: a multicenter study. March 31, 2010 Cohen SP, Hayek SM, Datta S, et al. Incidence and root cause analysis of wrong-site pain management procedures: a multicenter study. Anesthesiology. 2010;112(3):711-8. doi:10.1097/ALN.0b013e3181cf892d. h…

  4. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/45814/psn-pdf
    March 22, 2017 - Emergency medical services responders' perceptions of the effect of stress and anxiety on patient safety in the out-of-hospital emergency care of children: a qualitative study. March 22, 2017 Guise J-M, Hansen M, O'Brien K, et al. Emergency medical services responders' perceptions of the effect of stress and anxi…

  5. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/37462/psn-pdf
    January 06, 2017 - Medication errors associated with code situations in U.S. hospitals: direct and collateral damage. January 6, 2017 Lipshutz AKM, Morlock LL, Shore AD, et al. Medication Errors Associated with Code Situations in U.S. Hospitals: Direct and Collateral Damage. Jt Comm J Qual Patient Saf. 2016;34(1):46-56. doi:10.1016/…

  6. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/42693/psn-pdf
    December 23, 2016 - Preventing unintended retained foreign objects. December 23, 2016 Preventing unintended retained foreign objects. Sentinel event alert. 2013;(51):1-5. https://psnet.ahrq.gov/issue/preventing-unintended-retained-foreign-objects Sentinel event alerts are issued periodically by The Joint Commission to identify common …

  7. Multimodal system designed to reduce errors in recording and administration of drugs in anaesthesia: prospective randomised clinical evaluation. | PSNet

    psnet.ahrq.gov/issue/multimodal-system-designed-reduce-errors-recording-and-administration-drugs-anaesthesia
    September 26, 2012 - March 23, 2011 Medication errors occurring with the use of bar-code administration technology

  8. Spotlight Case [MONTH] 2003 (ppt file)

    psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.84_slideshow.ppt
    December 01, 2004 - Adverse drug events occurring following hospital discharge [abstract]. … Adverse drug events occurring following hospital discharge [abstract].

  9. Can asking emergency physicians whether or not they would have done something differently (WYHDSD) be a useful screening tool to identify emergency department error? | PSNet

    psnet.ahrq.gov/issue/can-asking-emergency-physicians-whether-or-not-they-would-have-done-something-differently
    July 01, 2016 - January 26, 2022 Analysis of risk factors for patient safety events occurring in the

  10. Supratherapeutic dosing of acetaminophen among hospitalized patients. | PSNet

    psnet.ahrq.gov/issue/supratherapeutic-dosing-acetaminophen-among-hospitalized-patients
    February 14, 2017 - October 30, 2010 Medication errors occurring with the use of bar-code administration

  11. Inadequacies of physical examination as a cause of medical errors and adverse events: a collection of vignettes. | PSNet

    psnet.ahrq.gov/issue/inadequacies-physical-examination-cause-medical-errors-and-adverse-events-collection
    June 01, 1989 - April 22, 2015 Baccalaureate nursing students' accounts of medical mistakes occurring

  12. Improving health care quality and patient safety through peer-to-peer assessment: demonstration project in two academic medical centers. | PSNet

    psnet.ahrq.gov/issue/improving-health-care-quality-and-patient-safety-through-peer-peer-assessment-demonstration
    March 14, 2018 - September 29, 2021 Systematic evaluation of errors occurring during the preparation of

  13. Root cause analysis of serious adverse events among older patients in the Veterans Health Administration. | PSNet

    psnet.ahrq.gov/issue/root-cause-analysis-serious-adverse-events-among-older-patients-veterans-health
    August 02, 2015 - April 12, 2019 Root cause analyses of reported adverse events occurring during gastrointestinal

  14. Missed serious neurologic conditions in emergency department patients discharged with nonspecific diagnoses of headache or back pain. | PSNet

    psnet.ahrq.gov/issue/missed-serious-neurologic-conditions-emergency-department-patients-discharged-nonspecific
    April 08, 2018 - March 19, 2019 Analysis of risk factors for patient safety events occurring in the emergency

  15. Root cause analysis reports help identify common factors in delayed diagnosis and treatment of outpatients. | PSNet

    psnet.ahrq.gov/issue/root-cause-analysis-reports-help-identify-common-factors-delayed-diagnosis-and-treatment
    October 24, 2018 - April 12, 2019 Root cause analyses of reported adverse events occurring during gastrointestinal

  16. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49527/psn-pdf
    December 01, 2006 - The Commentary Background Errors in laboratory services encompass a number of problems occurring outside … physicians often attribute to errors inside the laboratory, are actually the result of preanalytic problems occurring … Specific Errors in This Case The particular error in this case is a mislabeling error occurring outside

  17. The Safety and Quality of Long Term Care | PSNet

    psnet.ahrq.gov/web-mm/safety-and-quality-long-term-care
    January 01, 2016 - warrants close assessment and aggressive management by nursing staff to prevent serious breakdown from occurring … constitute nearly 10% of Medicare admissions to acute care, with nearly 40% of these hospitalizations occurring … taking high risk medications such as anticoagulants are monitored daily to assure no adverse events are occurring

  18. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49830/psn-pdf
    May 01, 2018 - In a recent study of adverse events occurring on mental health units in the Veterans Health Administration … Adverse events occurring on VHA mental health units. Gen Hosp Psychiatry. 2018;50:63-68.

  19. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/33687/psn-pdf
    August 01, 2009 - downside of first-order problem solving is lack of communication, which hinders real improvement from occurring … Even this meager form of second-order problem solving was rare, occurring in only 7% of the situations

  20. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49650/psn-pdf
    March 01, 2012 - The most recent analysis described 46 deaths and 263 procedure-related complications occurring from … references https://psnet.ahrq.gov//#references Quality improvement strategies to prevent these events from occurring
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