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Total Results: 4,038 records

Showing results for "occurs".

361. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/865702/psn-pdf
     May 01, 2024 - Judgment errors in surgical care. May 1, 2024 Marsh KM, Turrentine FE, Jin R, et al. Judgment errors in surgical care. J Am Coll Surg. 2024;238(5):874- 879. doi:10.1097/xcs.0000000000001011. https://psnet.ahrq.gov/issue/judgment-errors-surgical-care Knowing when judgment errors are more likely to occur can increas…

362. Failure to Latch | PSNet
     psnet.ahrq.gov/web-mm/failure-latch
     November 27, 2012 - Jaundice occurs in 40%–60% of newborns and is typically benign. … starvation jaundice, aggravated by inadequate milk intake secondary to poor breastfeeding.( 7 ) It typically occurs

363. Radiology Missed an Intracranial Bleed in a Lethargic Infant. | PSNet
     psnet.ahrq.gov/web-mm/radiology-missed-intracranial-bleed-lethargic-infant
     August 21, 2016 - AHT occurs from direct impact to the head, shaking, or a combination of both, and can lead to serious … When this evaluation occurs overnight, it may not be feasible for many institutions to have an attending

364. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/49852/psn-pdf
     February 01, 2019 - Mueller, MD, MPH The transfer of patients between acute care hospitals, known as interhospital transfer, occurs … patients (1,13,14) and are therefore at even greater risk for poor outcomes when suboptimal communication occurs

365. Pseudo-obstruction But a Real Perforation | PSNet
     psnet.ahrq.gov/web-mm/pseudo-obstruction-real-perforation
     April 01, 2015 - ACPO typically occurs in hospitalized or institutionalized patients after surgery or in association with … ischemia is present.( 1 ) Even when pharmacologic or endoscopic therapy for ACPO is successful, relapse occurs

366. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/49699/psn-pdf
     February 01, 2014 - individuals to make mistakes and (ii) to permit the detection and correction of errors before harm occurs … • Prevent malfunctioning or unintentional operation by reverting back to a safe state if failure occurs

367. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/49425/psn-pdf
     November 01, 2003 - Misread Label November 1, 2003 Franklin BD. Misread Label. PSNet [internet]. 2003. https://psnet.ahrq.gov/web-mm/misread-label The Case An infant was born with sluggish respirations. During labor the infant’s mother had received meperidine [Demerol, a pain medication], a narcotic with a half-life of 2.5-4.0 hours…

368. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/851196/psn-pdf
     July 05, 2023 - Patient falls while under supervision: trends from incident reporting. July 5, 2023 Roberts M. Patient falls while under supervision: trends from incident reporting. Br J Nurs. 2023;32(11):508-513. doi:10.12968/bjon.2023.32.11.508. https://psnet.ahrq.gov/issue/patient-falls-while-under-supervision-trends-incident-…

369. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/867340/psn-pdf
     December 11, 2024 - Multiple points of system failure underpin continuous subcutaneous infusion safety incidents in palliative care: a mixed methods analysis. December 11, 2024 Brown AJ, Yardley S, Bowers B, et al. Multiple points of system failure underpin continuous subcutaneous infusion safety incidents in palliative care: a mixed…

370. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/866692/psn-pdf
     September 11, 2024 - Relationships between medications used in a mental health hospital and types of medication errors: a cross- sectional study over an 8-year period. September 11, 2024 Lebas R, Calvet B, Schadler L, et al. Relationships between medications used in a mental health hospital and types of medication errors: a cross-sect…

371. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/850913/psn-pdf
     June 21, 2023 - Understanding ultrarare adverse events - lessons learned from a twelve-year review of intraoperative deaths at an academic medical center. June 21, 2023 Cohen TN, Kanji FF, Wang AS, et al. Understanding ultrarare adverse events - lessons learned from a twelve-year review of intraoperative deaths at an academic med…

372. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/837671/psn-pdf
     July 13, 2022 - Long-term care healthcare-associated infections in 2021: an analysis of 17,971 reports. July 13, 2022 Kepner S, Adkins JA, Jones RM. Long-term care healthcare-associated infections in 2021: an analysis of 17,971 reports. Patient Saf. 2022;4(2):6-17. doi:10.33940/data/2022.6.1. https://psnet.ahrq.gov/issue/long-ter…

373. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/74256/psn-pdf
     January 19, 2022 - Potentially severe incidents during interhospital transport of critically ill patients, frequently occurring but rarely reported: a prospective study. January 19, 2022 Eiding H, Røise O, Kongsgaard UE. Potentially severe incidents during interhospital transport of critically ill patients, frequently occurring but …

374. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/50749/psn-pdf
     December 18, 2019 - Medication errors in the care transition of trauma patients December 18, 2019 Martín Mª ÁP, García MM, Silveira ED, et al. Medication errors in the care transition of trauma patients. Eur J Clin Pharmacol. 2019;75(12):1739-1746. doi:10.1007/s00228-019-02757-3. https://psnet.ahrq.gov/issue/medication-errors-care-tra…

375. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/33576/psn-pdf
     December 15, 2024 - Wrong-Site, Wrong-Procedure, and Wrong-Patient Surgery December 15, 2024 Wrong-Site, Wrong-Procedure, and Wrong-Patient Surgery. PSNet [internet]. 2019. https://psnet.ahrq.gov/primer/wrong-site-wrong-procedure-and-wrong-patient-surgery PSNet primers are regularly reviewed and updated by the UC Davis PSNet Editoria…

376. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/43405/psn-pdf
     August 14, 2014 - Characteristics associated with postdischarge medication errors. August 14, 2014 Mixon A, Myers AP, Leak CL, et al. Characteristics associated with postdischarge medication errors. Mayo Clin Proc. 2014;89(8):1042-51. doi:10.1016/j.mayocp.2014.04.023. https://psnet.ahrq.gov/issue/characteristics-associated-postdisc…

377. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/72479/psn-pdf
     November 18, 2020 - Lifetime prevalence and correlates of patient-perceived medical errors experienced in the U.S. ambulatory setting: a population-based study. November 18, 2020 Sundwall DN, Munger MA, Tak CR, et al. Lifetime prevalence and correlates of patient-perceived medical errors experienced in the U.S. ambulatory setting: a …

378. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/74074/psn-pdf
     November 17, 2021 - How safe is prehospital care? A systematic review. November 17, 2021 O’Connor P, O’malley R, Lambe KA, et al. How safe is prehospital care? A systematic review. Int J Qual Health Care. 2021;33(4):mzab138. doi:10.1093/intqhc/mzab138. https://psnet.ahrq.gov/issue/how-safe-prehospital-care-systematic-review Patient s…

379. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/73465/psn-pdf
     July 07, 2021 - Identifying health information technology usability issues contributing to medication errors across medication process stages. July 7, 2021 Adams KT, Pruitt Z, Kazi S, et al. Identifying health information technology usability issues contributing to medication errors across medication process stages. J Patient Saf…

380. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/48161/psn-pdf
     January 01, 2021 - Investigating the impact of intensive care unit interruptions on patient safety events and electronic health records use: an observational study. July 24, 2019 Khairat S, Whitt S, Craven CK, et al. Investigating the Impact of Intensive Care Unit Interruptions on Patient Safety Events and Electronic Health Records …