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Showing results for "occurring".

  1. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/60878/psn-pdf
    January 01, 2021 - intervention-study-reduction-medication-errors-elderly-trauma-patients Researchers analyzed medication errors occurring

  2. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/50708/psn-pdf
    December 04, 2019 - This study compared the incidence of medication errors occurring in two NICUs over a three-month period

  3. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/50911/psn-pdf
    February 19, 2020 - medication errors due to the severity of their injuries and the multiple handoffs and transitions often occurring

  4. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/851656/psn-pdf
    July 26, 2023 - Using RCA data from the Veterans Health Administration (VHA), this study characterized adverse events occurring

  5. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/60575/psn-pdf
    June 10, 2020 - incident This case study describes the use of root cause analysis to investigate a critical incident occurring

  6. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/42204/psn-pdf
    June 10, 2013 - prospective study found that the rate of adverse events in outpatient dermatologic surgery was very low, occurring

  7. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/41286/psn-pdf
    April 11, 2012 - prevention-medical-accidents-caused-defective-surgical-instruments Near misses or adverse events due to defective surgical equipment were rare, occurring

  8. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/42385/psn-pdf
    June 26, 2013 - identifying-and-addressing-preventable-process-errors-trauma-care Most preventable errors in trauma care were errors of omission, often occurring

  9. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/866589/psn-pdf
    August 28, 2024 - the multidisciplinary panel identified actual harm in 89 cases, with three-quarters of actual harm occurring

  10. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/867340/psn-pdf
    December 11, 2024 - Approximately 72% described harms with breakdowns occurring in three processes: monitoring and supply

  11. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/60846/psn-pdf
    January 01, 2021 - safety-climate-associated-adverse-events-nursing-homes-national-va-study This cross-sectional study examined the impact of safety climate on adverse events occurring

  12. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/845350/psn-pdf
    March 01, 2023 - has the potential to mitigate failures by designing workspaces and processes to prevent errors from occurring

  13. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/849134/psn-pdf
    May 17, 2023 - Patient Safety data, this retrospective study characterized patient safety events related to COVID-19 occurring

  14. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/72479/psn-pdf
    November 18, 2020 - This study surveyed 9,206 adults across the United States about their perceptions of medical errors occurring

  15. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/837428/psn-pdf
    June 15, 2022 - This study reviewed serious surgical incidents occurring at large teaching hospitals in one National

  16. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/73323/psn-pdf
    May 26, 2021 - any difference in adverse events such as healthcare-acquired infections or unplanned reintubation occurring

  17. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/60353/psn-pdf
    May 20, 2020 - event during the transition from the intensive care unit (ICU)  to the hospital ward, with most (62%) occurring

  18. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/60619/psn-pdf
    June 24, 2020 - Systems from 2000 to 2017 in order to characterize errors attributed to healthcare professionals or occurring

  19. Sample Scenario for Uterine Tachysystole In Situ Simulation | Agency for Healthcare Research and Quality

    www.ahrq.gov/patient-safety/settings/labor-delivery/perinatal-care/modules/situ/simulation-ut-tachysystole.html
    July 01, 2023 - Contractions are now lasting 60 seconds and occurring every 90 seconds with very little return to baseline … Pulse 110 BP 140/85 Resp Rate 20 FHR: 130; late decelerations are occurring with each contraction … Contractions are now lasting 60 seconds and occurring every 90 seconds with very little return to baseline … assessment after trigger #2 Pulse 110 BP 140/85 Resp Rate 20 FHR: 130; late decelerations are occurring

  20. PowerPoint Presentation

    www.ahrq.gov/sites/default/files/wysiwyg/antibiotic-use/long-term-care/antibiotic-targets-slides.pptx
    June 01, 2021 - solving Solves one problem in one particular instance Generally does not help prevent future harm from occurring … adaptive interventions to change culture and beliefs Identifies system opportunities to prevent them from occurring
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