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Total Results: 4,038 records

Showing results for "occurs".

421. In Conversation with…Gerald B. Hickson, MD | PSNet
     psnet.ahrq.gov/perspective/conversation-withgerald-b-hickson-md
     December 01, 2009 - The problem is that when an event occurs, does it represent an anomaly or just one more event that identifies … If the event occurs, addressing it in real time is essential to prevent a negative downstream effect.

422. The “Great Pretender” (Syphilis) is Still Stumping Healthcare Providers | PSNet
     psnet.ahrq.gov/web-mm/great-pretender-syphilis-still-stumping-healthcare-providers
     January 07, 2022 - spontaneously without treatment in 3-6 weeks, but if treated it resolves more quickly. 10 Secondary syphilis occurs … copper-colored lesions on the palms or soles, but its appearance is highly variable, and if the rash occurs

423. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/841306/psn-pdf
     December 14, 2022 - Safety occurs when as many things as possible go right.

424. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/74022/psn-pdf
     March 01, 2021 - visited a community-based pharmacy 35 times per year, as compared to a primary care physician, which occurs

425. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/36784/psn-pdf
     February 24, 2011 - The many faces of error disclosure: a common set of elements and a definition. February 24, 2011 Fein SP, Hilborne LH, Spiritus EM, et al. The many faces of error disclosure: a common set of elements and a definition. J Gen Intern Med. 2007;22(6):755-761. https://psnet.ahrq.gov/issue/many-faces-error-disclosure-co…

426. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/47919/psn-pdf
     April 03, 2019 - How to Talk About Patient Safety. April 3, 2019 Hendricks R, O'Neil M, Volmert A. Boston, MA: Betsy Lehman Center for Patient Safety; March 2019. https://psnet.ahrq.gov/issue/how-talk-about-patient-safety This report suggests that the field of patient safety needs to be reframed for the public. The report recommen…

427. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/43799/psn-pdf
     January 07, 2015 - Omission of high-alert medications: a hidden danger. January 7, 2015 Grissinger M, Alghamdi D. PA-PSRS Patient Saf Advis. December 2014;11:149-155. https://psnet.ahrq.gov/issue/omission-high-alert-medications-hidden-danger Analyzing incidents reported over a 4-month period, this article reveals that 21% of 2700 med…

428. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/34656/psn-pdf
     May 27, 2011 - A look into the nature and causes of human errors in the intensive care unit. May 27, 2011 Donchin Y, Gopher D, Olin M, et al. A look into the nature and causes of human errors in the intensive care unit. Crit Care Med. 1995;23(2):294-300. https://psnet.ahrq.gov/issue/look-nature-and-causes-human-errors-intensive-…

429. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/44599/psn-pdf
     December 09, 2015 - Association between day of delivery and obstetric outcomes: observational study. December 9, 2015 Palmer WL, Bottle A, Aylin P. Association between day of delivery and obstetric outcomes: observational study. BMJ. 2015;351:h5774. doi:10.1136/bmj.h5774. https://psnet.ahrq.gov/issue/association-between-day-delivery-…

430. Failure Mode and Effect Analysis (FMEA) | PSNet
     psnet.ahrq.gov/glossary/failure-mode-and-effect-analysis-fmea
     September 13, 2021 - Failure Mode and Effect Analysis (FMEA) September 13, 2021 Anonymous (not verified) A common process used to prospectively identify error risk within a particular process. FMEA begins with a complete process mapping that identifies all the steps that must occur for a given process to occur (e.g., programming an…

431. Neurological Red Flags: A Missed Stroke after Intermittent Episodes of Dizziness and Headache | PSNet
     psnet.ahrq.gov/web-mm/neurological-red-flags-missed-stroke-after-intermittent-episodes-dizziness-and-headache
     February 08, 2023 - aortic dissection; however, a patient with intermittent episodes of “sharp tearing” chest pain that only occurs … primary care practice.A fourth category not covered in this table, the chronic vestibular syndrome, also occurs

432. Wrong-side/wrong-site, wrong-procedure, and wrong-patient adverse events: are they preventable? | PSNet
     psnet.ahrq.gov/issue/wrong-sidewrong-site-wrong-procedure-and-wrong-patient-adverse-events-are-they-preventable
     February 24, 2011 - Study Wrong-side/wrong-site, wrong-procedure, and wrong-patient adverse events: are they preventable? Citation Text: Seiden SC, Barach P. Wrong-side/wrong-site, wrong-procedure, and wrong-patient adverse events: Are they preventable? Arch Surg. 2006;141(9):931-9. Copy Citation Fo…

433. Responding to Patient Safety Events | PSNet
     psnet.ahrq.gov/primer/responding-patient-safety-events
     October 18, 2023 - Responding to Patient Safety Events Citation Text: Shaikh U. Responding to Patient Safety Events. PSNet [internet]. Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2025. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endnote tag…

434. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/47291/psn-pdf
     October 31, 2018 - Incidence and method of suicide in hospitals in the United States. October 31, 2018 Williams SC, Schmaltz SP, Castro GM, et al. Incidence and Method of Suicide in Hospitals in the United States. Jt Comm J Qual Patient Saf. 2018;44(11):643-650. doi:10.1016/j.jcjq.2018.08.002. https://psnet.ahrq.gov/issue/incidence-…

435. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/40921/psn-pdf
     November 16, 2011 - Adverse Events in Hospitals: Medicare's Responses to Alleged Serious Events. November 16, 2011 Levinson DR. Washington, DC: US Department of Health and Human Services, Office of the Inspector General; October 2011. Report No. OEI-01-08-00590. https://psnet.ahrq.gov/issue/adverse-events-hospitals-medicares-response…

436. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/38758/psn-pdf
     July 08, 2009 - An international review of patient safety measures in radiotherapy practice. July 8, 2009 Shafiq J, Barton M, Noble DJ, et al. An international review of patient safety measures in radiotherapy practice. Radiother Oncol. 2009;92(1):15-21. doi:10.1016/j.radonc.2009.03.007. https://psnet.ahrq.gov/issue/international…

437. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/44767/psn-pdf
     January 20, 2016 - "What's psychology got to do with it?" Applying psychological theory to understanding failures in modern healthcare settings. January 20, 2016 Rydon-Grange M. 'What's Psychology got to do with it?' Applying psychological theory to understanding failures in modern healthcare settings. J Med Ethics. 2015;41(11):880-…

438. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/37648/psn-pdf
     January 12, 2012 - Office surgery incidents: what seven years of Florida data show us. January 12, 2012 Coldiron BM, Healy C, Bene NI. Office surgery incidents: what seven years of Florida data show us. Dermatol Surg. 2008;34(3):285-91; discussion 291-2. doi:10.1111/j.1524-4725.2007.34060.x. https://psnet.ahrq.gov/issue/office-surge…

439. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/49750/psn-pdf
     January 01, 2016 - Kalish and colleagues (5) found missed nursing care occurs frequently among staff nurses.

440. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/49781/psn-pdf
     January 01, 2017 - therapeutic range, small changes in dose can lead to exponential increases in concentration.(4) This occurs