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Showing results for "patient safety indicators".
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3321. Pre-analytical pitfalls: Missing and mislabeled specimens | PSNet
      psnet.ahrq.gov/web-mm/pre-analytical-pitfalls-missing-and-mislabeled-specimens
      April 18, 2018 - encountered during the analytic phase typically resides with improper instrument operation, faulty reagents … April 18, 2018 Wake Up Safe in the USA & international patient safety. … August 7, 2024 Status of patient safety culture in community pharmacy settings: a systematic … August 23, 2023 Interventions to engage patients and families in patient safety: a systematic … implications of missed test results for hospitalised patients: a systematic review.

3322. Ambulatory Safety Nets to Reduce Missed and Delayed Diagnoses of Cancer | PSNet
      psnet.ahrq.gov/innovation/ambulatory-safety-nets-reduce-missed-and-delayed-diagnoses-cancer
      February 26, 2025 - The Brigham and Women’s Hospital’s (BWH) Patient Safety Collaborative, which included Ambulatory Patient … a colonoscopy following safety net team outreach to the patient and (2) the proportion of patients for … 56.9% when accounting for the proportion of patients who were effectively caught by the safety net by … outreach via a clinic-determined method (hard copy letters, phone calls to client, or outreach to patient … Identify drivers of change to ensure patient safety and to minimize patient harm.

3323. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/33753/psn-pdf
      August 22, 2013 - Recent evidence shows that roughly one in three hospitalized patients experiences an adverse event, and … culture deliver better care because they are able to do the basics every time, like turning patients … The Essential Guide for Patient Safety Officers, 2nd edition. … Committee on Patient Safety and Health Information Technology, Board on Health Care Services, Institute … Health IT and Patient Safety: Building Safer Systems for Better Care.

3324. In Conversation With… Neel Shah, MD, MPP | PSNet
      psnet.ahrq.gov/perspective/conversation-neel-shah-md-mpp
      October 30, 2019 - We spoke with him about his insights regarding patient safety in obstetrics, maternal mortality, the … Neel Shah: I was in medical school during an era where patient safety was very much on everyone's mind … But if that somehow got better, what would remain as a key patient safety issue in OB? … Conceptual Model of Value-based Patient Safety in the NICU. … A flat hierarchy interdisciplinary team conducts safety-centered huddles and patient-centered rounds.

3325. Incident Reporting: More Attention to the Safety Action Feedback Loop, Please | PSNet
      psnet.ahrq.gov/perspective/incident-reporting-more-attention-safety-action-feedback-loop-please
      September 01, 2011 - reviewing medical records or applying patient safety indicators to discharge data.( 5,9 ) Second, increasing … New patient safety organizations can help health providers learn from and reduce patient safety events … J Patient Saf. 2009;5:1-2. [go to PubMed] 4. Patient Safety Organizations. … of the University of Toronto Centre for Patient Safety. … January 6, 2010 Building a Culture of Patient Safety: Report of the Commission on Patient

3326. Do physicians clean their hands? Insights from a covert observational study. | PSNet
      psnet.ahrq.gov/issue/do-physicians-clean-their-hands-insights-covert-observational-study
      July 02, 2019 - June 21, 2017 Computerized prescriber order entry–related patient safety reports: analysis … August 31, 2016 Staying silent about safety issues: conceptualizing and measuring safety

3327. Long-term Care and Patient Safety | PSNet
      psnet.ahrq.gov/primer/long-term-care-and-patient-safety
      February 24, 2022 - Long-term Care and Patient Safety. PSNet [internet]. … Long-term Care and Patient Safety. PSNet [internet]. … faced by patients, education, patient safety training for health care providers in long-term care settings … Long-term Care and Patient Safety. PSNet [internet]. … Safety Leads to Patient Falls in Nursing Homes.

3328. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49469/psn-pdf
      December 01, 2004 - In doing so, the phlebotomist overrode the computerized alert that prompted him to be sure the patient … Once patients are adequately informed, how can we document that patient consent has or has not been … Nonetheless, protection of patient autonomy for many forms of genetic testing, or any procedure in which … reasonable people may have doubts about its safety or effectiveness, should receive priority. … reproductive and family issues arise and when the safety and effectiveness of the interventions that

3329. In Conversation With… Susan E. Skochelak, MD, PhD | PSNet
      psnet.ahrq.gov/perspective/conversation-susan-e-skochelak-md-phd
      February 01, 2019 - safety, interprofessional education) and GME (e.g., quality improvement, patient safety) curricula. … safety issues across the continuum for individual patients and populations of patients are critical … Boston, MA: National Patient Safety Foundation; 2015. [Available at] 5. … Create centralized and coordinated oversight of patient safety 3. … Increase funding for research in patient safety and implementation science 5.

3330. Standard Deviations | PSNet
      psnet.ahrq.gov/web-mm/standard-deviations
      January 01, 2006 - Case Objectives Understand the safety risks associated with patients being discharged against medical … From the perspective of patient safety, this case emphasizes how important it is to focus on our competencies … Outreach workers spend months trying to develop trusting relationships with homeless clients and even … Patients whom staff find difficult to like, or care for, are vulnerable to safety risks created by reduced … November 5, 2014 Nurse judgements of hospitalized patients' safety concerns are affected

3331. Sepsis Resulting from Delays in Treatment and Miscommunication among Specialists | PSNet
      psnet.ahrq.gov/web-mm/sepsis-resulting-delays-treatment-and-miscommunication-among-specialists
      February 26, 2025 - Safety February 26, 2025 Perspective Learning … Health Systems for Patient Safety February 26, 2025 Estimating breast cancer … September 2, 2020 Why is safety in intrapartum electronic fetal monitoring so hard? … February 7, 2024 Patient safety and the COVID-19 pandemic: a qualitative study of perspectives … May 15, 2024 View More Related Resources Patient Safety

3332. Rehearsing Team Care for Relatively Rare Obstetric Emergencies Leads to Improved Outcomes | PSNet
      psnet.ahrq.gov/innovation/rehearsing-team-care-relatively-rare-obstetric-emergencies-leads-improved-outcomes
      July 23, 2024 - Innovation Patient Safety Focus This innovation uses core patient safety communication and teamwork … births. 10   Improved task completion, medication administration, and response times for eclampsia patients … : A randomized controlled trial (RCT) focused on the care of patients with eclampsia found that PROMPT … Patient Safety Innovations Risk Mitigation Using the … August 16, 2023 Psychological intervention to improve communication and patient safety

3333. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/851389/psn-pdf
      July 31, 2023 - The Brigham and Women’s Hospital’s (BWH) Patient Safety Collaborative, which included Ambulatory Patient … a colonoscopy following safety net team outreach to the patient and (2) the proportion of patients … 56.9% when accounting for the proportion of patients who were effectively caught by the safety net by … outreach via a clinic-determined method (hard copy letters, phone calls to client, or outreach to patient … Identify drivers of change to ensure patient safety and to minimize patient harm.

3334. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/33561/psn-pdf
      September 15, 2024 - safety field. … However, when Never Events occur, they are devastating to patients and may indicate a fundamental safety … Sentinel events are defined as "a patient safety event (not primarily related to the natural course … These variations prevent comparisons and learning from the international patient safety community. … /primer/reporting-patient-safety-events https://psnet.ahrq.gov/issue/adverse-health-events-minnesota-

3335. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/60269/psn-pdf
      April 29, 2020 - Identifying Risks to Patient Safety In the presented case, there were undoubtedly multiple failures … Burnout affects not only the physician experience, but also patient safety and outcomes. … Physician burnout demands attention both as an underlying cause of decreased patient safety as well … Patient Safety Network. https://psnet.ahrq.gov/primer/burnout. Updated September, 2019. … Understanding Patient Safety. Third Edition: McGraw-Hill Education, China; 2018.

3336. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/33606/psn-pdf
      December 15, 2024 - This Primer will describe the nature of the opioid epidemic as a patient safety problem, discuss the … epidemiology of opioid prescribing and its resultant effects on patient safety and mortality, and review … research-topics/trends-statistics/overdose-death-rates#Fig3 https://psnet.ahrq.gov/perspective/opioid-overdose-patient-safety-problem … The patient safety field was slow to recognize the burgeoning epidemic. … national-surveillance-emergency-department-visits-outpatient-adverse-drug-events https://psnet.ahrq.gov/primer/measurement-patient-safety

3337. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49699/psn-pdf
      February 01, 2014 - opioids on sedation and respiratory depression, differences between opioid-naïve and opioid-tolerant patients … To help them prevent errors, patients and families should be empowered to detect medication errors by … ISMP Medication Safety Alert! Community/Ambulatory Care Edition. … Pa Patient Saf Advis. 2013;10:27-33. [Available at] 8. ISMP Medication Safety Alert! … of patient input n quality improvement and safety initiatives Quality processes and risk management

3338. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/33592/psn-pdf
      December 15, 2024 - safety field. … As the science of patient safety advances, these judgments can change over time, such that more adverse … assessment-adverse-events-medical-care-lack-consistency-between-experienced-teams-using https://psnet.ahrq.gov/issue/measurement-patient-safety-systematic-review-reliability-and-validity-adverse-event-detection … Two other terms define hazards to patients that do not result in harm: Near miss: an unsafe situation … act of commission (doing something wrong) or omission (failing to do the right thing) that exposes patients

3339. In Conversation With…Kaveh G. Shojania, MD | PSNet
      psnet.ahrq.gov/perspective/conversation-withkaveh-g-shojania-md
      September 01, 2011 - of the University of Toronto Centre for Patient Safety. … reviewing medical records or applying patient safety indicators to discharge data.( 5,9 ) Second, increasing … New patient safety organizations can help health providers learn from and reduce patient safety events … J Patient Saf. 2009;5:1-2. [go to PubMed] 4. Patient Safety Organizations. … Legal concerns in patient safety: the need for regulatory action.

3340. Discharge Against Medical Advice | PSNet
      psnet.ahrq.gov/web-mm/discharge-against-medical-advice
      July 01, 2017 - ( 5 ) and 13% of patients with HIV/AIDS leave AMA.( 6 ) It is not clear why the patient in this case … Patient Outcomes in Discharges AMA It seems likely that discharge AMA puts patients at increased … autonomy and patient safety, physicians should ensure that a patient with a severe life-threatening … Why patients sign out against medical advice (AMA): factors motivating patients to sign out AMA. … August 24, 2015 The business case for patient safety.