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Total Results: 4,038 records

Showing results for "occurs".

221. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/837963/psn-pdf
     August 31, 2022 - Anamaria Robles, MD, and Garth Utter, MD, MSc Background: Mesenteric Ischemia Mesenteric ischemia occurs … Acute mesenteric, or intestinal, ischemia occurs when perfusion abruptly decreases, with or without … https://psnet.ahrq.gov//#1 Obstruction of the venous mesenteric outflow occurs as a result of venous

222. Spotlight (pdf file)
     psnet.ahrq.gov/sites/default/files/2022-08/final_spotlight_case_mesenteric_ischemia_08.05.2022.pdf
     January 01, 2022 - Robles, MD, and Garth Utter, MD, MSc 9 BACKGROUND 10 Background (1) • Mesenteric ischemia occurs … Background (2) • Major causes of mesenteric ischemia – Acute mesenteric, or intestinal, ischemia occurs … Obstruction of the venous mesenteric outflow occurs as a result of venous thrombosis of the superior

223. Procedural Mishap: Learning Curve? | PSNet
     psnet.ahrq.gov/web-mm/procedural-mishap-learning-curve
     April 28, 2021 - Prospective studies have reported that injury to the bowel or major vessels during laparoscopic procedures occurs … major vessels are the distal aorta and the right common iliac artery (RCIA).( 7 ) This injury pattern occurs

224. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/72693/psn-pdf
     January 29, 2021 - Commentary By Christian Bohringer MD This incident describes a common type of adverse drug event that occurs … resuspended in different concentrations when they are drawn up from the ampule.1,2  This type of event occurs

225. Near Miss with Bedside Medications | PSNet
     psnet.ahrq.gov/web-mm/near-miss-bedside-medications
     February 01, 2006 - Importantly for institutions, it is not necessary to capture every incident or every near miss that occurs … undesirable, as in the case of repeated reporting of the same incident.( 7 ) Active clinical monitoring occurs … If a near miss incident occurs commonly and has a high probability to cause great harm, it may take priority

226. Advancing Patient Safety Through State Reporting Systems | PSNet
     psnet.ahrq.gov/perspective/advancing-patient-safety-through-state-reporting-systems
     June 01, 2007 - than as intended Patient death or serious disability associated with intravascular air embolism that occurs … care facility Patient death or serious disability associated with hypoglycemia, the onset of which occurs … significant injury of a patient or staff member resulting from a physical assault (i.e., battery) that occurs

227. Crossing the Line | PSNet
     psnet.ahrq.gov/web-mm/crossing-line
     December 01, 2012 - subclavian vein placement.( 6 ) However, it is more difficult to control excessive bleeding when it occurs … Arterial puncture occurs in approximately 5% to 10% of internal jugular catheterization attempts.( 3,9 … ) Although pulsatile bright red blood is typically encountered when arterial puncture occurs (hitting

228. Lost in Transition | PSNet
     psnet.ahrq.gov/web-mm/lost-transition
     November 17, 2010 - Shift changeover occurs when two or more workers exchange mission-specific information, responsibility … Second, message failure occurs when there is poor or non-existent transfer of information. … Third, reception failure occurs with misinterpretation or late arrival of proper information.

229. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/33714/psn-pdf
     July 01, 2011 - and unsafe conditions, and it will be standardized throughout the hospital regardless of where it occurs … Hence the information will be clinically comparable no matter where in the institution an event occurs—or … even in what institution it occurs.

230. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/49388/psn-pdf
     February 01, 2003 - Prolonged apnea occurs more often in hyperventilated patients; neonates; elderly patients; patients … Poor system design also makes errors difficult to intercept before injury occurs. … This problem also occurs with different doses of the same drug--the vials for at least three concentrations

231. Anatomy and pathophysiology of errors occurring in clinical radiology practice. | PSNet
     psnet.ahrq.gov/issue/anatomy-and-pathophysiology-errors-occurring-clinical-radiology-practice
     February 01, 2011 - Commentary Anatomy and pathophysiology of errors occurring in clinical radiology practice. Citation Text: Brook OR, O'Connell AM, Thornton E, et al. Quality initiatives: anatomy and pathophysiology of errors occurring in clinical radiology practice. Radiographics. 2010;30(5):1401-10. d…

232. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/49389/psn-pdf
     February 01, 2003 - Prospective studies have reported that injury to the bowel or major vessels during laparoscopic procedures occurs … major vessels are the distal aorta and the right common iliac artery (RCIA).(7) This injury pattern occurs

233. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/49701/psn-pdf
     February 01, 2014 - FMS is unsuitable for spinal cord injury patients due to the high risk of autonomic dysreflexia that occurs … psnet.ahrq.gov//#references bleeding, and abdominal distention.(8) If any suspected adverse event occurs

234. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/33812/psn-pdf
     August 01, 2016 - problem is that, unlike hospitals, dental offices are not supervised until a serious adverse event occurs … RW: You've noted that most care occurs in small offices.

235. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/49414/psn-pdf
     September 01, 2003 - When this sort of improvisation occurs, the surgeon must ensure that the system provides the same level … Even though infection is possible, sepsis rarely occurs after operative hysteroscopy.

236. Delayed Diagnosis of Mesenteric Ischemia | PSNet
     psnet.ahrq.gov/web-mm/delayed-diagnosis-mesenteric-ischemia
     March 31, 2021 - Anamaria Robles, MD, and Garth Utter, MD, MSc Background: Mesenteric Ischemia Mesenteric ischemia occurs … Acute mesenteric, or intestinal, ischemia occurs when perfusion abruptly decreases, with or without vascular … Obstruction of the venous mesenteric outflow occurs as a result of venous thrombosis of the superior

237. Risk Mitigation Using the Anesthesia Risk Alert Program: Applying a Proactive Approach With Data Review & Collaborating With a Second Practitioner | PSNet
     psnet.ahrq.gov/innovation/risk-mitigation-using-anesthesia-risk-alert-program-applying-proactive-approach-data
     February 26, 2025 - When a positive screen occurs, documentation of whether or not the mitigation strategy was applied. … When a positive screen occurs, documentation of whether or not the mitigation strategy was applied.

238. PSNet Curated Library (pdf file)
     psnet.ahrq.gov/print/pdf/node/865864
     January 01, 2024 - article provides an overview of the literature on diagnosis-related uncertainty, where uncertainty occurs … article provides an overview of the literature on diagnosis-related uncertainty, where uncertainty occurs

239. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/867359/psn-pdf
     December 18, 2024 - Processes for Infant Feeding Expressed breast milk being given to the wrong baby is a mistake that occurs … After an error occurs, healthcare teams should have an open discussion with the patient and family as … Healthcare team members should also be provided support after an error occurs.

240. Unexplained Apnea Under Anesthesia | PSNet
     psnet.ahrq.gov/web-mm/unexplained-apnea-under-anesthesia
     December 01, 2005 - Prolonged apnea occurs more often in hyperventilated patients; neonates; elderly patients; patients with … Poor system design also makes errors difficult to intercept before injury occurs. … This problem also occurs with different doses of the same drug--the vials for at least three concentrations