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Showing results for "patient safety indicators".
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3721. The Risks of a Malpositioned Gastrostomy Tube and Poor Communication | PSNet
      psnet.ahrq.gov/web-mm/risks-malpositioned-gastrostomy-tube-and-poor-communication
      August 01, 2012 - Safety Patients who require anticoagulant and/or antiplatelet therapy to minimize thrombotic risk are … Safety of percutaneous endoscopic gastrostomy in high-risk patients. … AHRQ Patient Safety Network. Accessed November 6, 2023. [ Free full text ] Pinto A, Brunese L. … Patient safety at handoff in rehabilitation medicine. … on patient safety of enabling the digital transfer of patients' prescription information in the English

3722. Playing Well with Others: "Translocational Research" in Patient Safety | PSNet
      psnet.ahrq.gov/perspective/playing-well-others-translocational-research-patient-safety
      September 01, 2005 - Playing Well with Others: "Translocational Research" in Patient Safety Robert M. … Playing Well with Others: "Translocational Research" in Patient Safety. PSNet [internet]. … Playing Well with Others: "Translocational Research" in Patient Safety. PSNet [internet]. … In: Making Health Care Safer: A Critical Analysis of Patient Safety Practices. … An American View of the UK's Patient Safety Enterprise: Top Down vs.

3723. Debriefing for Clinical Learning | PSNet
      psnet.ahrq.gov/primer/debriefing-clinical-learning
      September 15, 2024 - safety and patient care based on a recent event or a hypothetical situation. 1 Debriefing is an important … situation may provide cause for a debrief, highly emotional resuscitations, those involving pediatric patients … They decide to focus on the patient and staff safety concerns and identify gaps in systems, teamwork, … Safety January 31, 2024 Nature of blame in patient safety incident reports: … Patient Safety Primers Improving Patient Safety and Team Communication

3724. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/50949/psn-pdf
      February 26, 2020 - encountered during the analytic phase typically resides with improper instrument operation, faulty reagents … tracked For mislabeled specimens, studies show the failure points occur at the time of collection where patients … wrong diagnoses due to lost or mislabeled specimens can be devastating or catastrophic to individual patients … caused patients to receive inappropriate treatment.17 In the end, the price for testing errors have … Blood bank safety practices: Mislabeled samples and wrong blood in tube – a Q-Probes analysis of 122

3725. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/865454/psn-pdf
      March 27, 2024 - In addition to specific health outcomes, patients report having better experiences with their care when … the culture of patient safety is strong. … , it can improve behaviors related to patient safety. … National Steering Committee for Patient Safety. Declaration to advance patient safety. … https://www.ihi.org/initiatives/national-steering-committee-patient-safety/declaration-advance-patient-safety

3726. The Dropped "No" | PSNet
      psnet.ahrq.gov/web-mm/dropped-no
      October 30, 2019 - Fortunately, the patient tolerated the procedures well. … and aviation models to improve safety and quality. … June 9, 2010 Perspective Patient and Family Roles in Safety … September 23, 2020 Optimizing Pediatric Patient Safety in the Emergency Care Setting. … Safety Innovations Ambulatory Safety Nets to Reduce Missed and Delayed Diagnoses of

3727. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49840/psn-pdf
      September 01, 2018 - in their own safety, including programs to facilitate patient-reported medication adverse events and … Lucier, MD, MBA, MPH Director of Quality Improvement and Patient Safety Hospital Medicine Unit Department … Patient Safety Primer: Patient Engagement and Safety. … www.ncbi.nlm.nih.gov/pubmed/22733210 https://www.ncbi.nlm.nih.gov/pubmed/22007045 https://psnet.ahrq.gov/primer/patient-engagement-and-safety … https://psnet.ahrq.gov/primer/patient-engagement-and-safety https://www.ahrq.gov/policy/electronic/disclaimers

3728. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/865412/psn-pdf
      March 27, 2024 - The psychiatric prodromal concept also may lack predictive value, in that many patients (eventually) … Approaches to Improving Patient Safety The tragedy in this case is that there was clinical suspicion … James Bourgeois, OD, MD Consulting Editor, AHRQ, Patient Safety Network (PSNet) Professor of Psychiatry … https://psnet.ahrq.gov/issue/failure-follow-test-results-ambulatory-patients-systematic-review https … Neuropsychiatric lupus in late- and early-onset systemic lupus erythematosus patients: a systematic

3729. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49790/psn-pdf
      April 01, 2017 - When challenge testing has been performed, only around 10% of these patients demonstrate allergy to … Diagnosis of true drug allergy is challenging and patients have often had adverse drug reactions recorded … Patients should expect and anticipate that both adverse drug reactions and allergies to drugs are appropriately … Other safety mechanisms should include the addition of drug allergy status to all correspondence between … Penicillin allergy: a study of incidence as reported by patients. Br J Clin Pract. 1994;48:5-7.

3730. When the Lytes Go Out: A Case of Inpatient Cardiac Arrest | PSNet
      psnet.ahrq.gov/web-mm/when-lytes-go-out-case-inpatient-cardiac-arrest
      February 01, 2023 - Approach to Improving Safety & Patient Safety Target  Protocol-based management of medical problems … are key points of potential intervention for ensuring patient safety.  … Shift-to-shift handoff effects on patient safety and outcomes.  … Management of Sepsis May 31, 2023 Patient Safety Innovations … and Quality April 26, 2023 Patient Safety Innovations

3731. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/866578/psn-pdf
      August 28, 2024 - safety.11 Approaches to Improving Safety  Optimize Human Factors Engineering Clinicians in both the … Reported medication events in a paediatric emergency research network: sharing to improve patient safety … Racial/ethnic disparities and patient safety. Pediatr Clin North Am. 2006;53(6):1197-1215. … Human factors engineering and patient safety. … Minimizing medication errors in pediatric patients. US Pharm. 2018;44(4):20-23.

3732. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/857061/psn-pdf
      November 27, 2023 - Joan Stanley about The Role of Undergraduate Nursing Education in Patient Safety November 27, 2023 … Joan Stanley about The Role of Undergraduate Nursing Education in Patient Safety . … safety into classroom and clinical instruction, and how this affects patient safety as a whole. … harm to patients and providers through system and individual performance.” … https://www.ihi.org/Engage/Initiatives/National-Steering-Committee-Patient-Safety/Pages/National-Action-Plan-to-Advance-Patient-Safety.aspx

3733. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49668/psn-pdf
      October 01, 2012 - This too can be difficult for patients, and communication between programs can be challenging. … Patients unwilling to participate in recommended psychosocial therapies may not be good candidates for … Patients who drop out of psychosocial treatments need to be reevaluated for continued opioid therapy. … treatment for opioid dependence should be based on the assessment of the patient's clinical needs and safety … The risk is increased in patients with pre-existing respiratory compromise and with some abused drugs

3734. In Conversation With... Charles A Crecelius, MD, PhD, CMD and Lori L Popejoy, PhD, RN, FAAN | PSNet
      psnet.ahrq.gov/perspective/conversation-charles-crecelius-md-phd-cmd-and-lori-l-popejoy-phd-rn-faan
      October 28, 2020 - KH : What about impact on other safety concerns? … You put in a system of delivery of fluids for patients. … care and ensuring the safety of both the patient and the healthcare workforce. … risks associated with usual care needs for this patient population, such as falls and pressure ulcers … Colton Hood about Remote Patient Monitoring March 15, 2023 The Lancet Commission

3735. Medication Reconciliation: Whose Job Is It? | PSNet
      psnet.ahrq.gov/web-mm/medication-reconciliation-whose-job-it
      May 01, 2018 - against the physician's admission, transfer, and/or discharge orders.( 14 ) Given the patient safety … risk posed by medication discrepancies during transitions of care, leading patient safety organizations … Patient-physician communication at hospital discharge and patients' understanding of the postdischarge … Joint Commission. 2006 Critical access hospital and hospital national patient safety goals. … OSF healthcare's journey in patient safety. Qual Manag Health Care. 2004;13:53-59.

3736. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/60542/psn-pdf
      May 27, 2020 - Examples of tools in the toolkit include: the daily Safety Huddles Tool,22 weekly Patient Safety Leadership … increase patient safety awareness, improve the identification of patient safety issues, and reduce … of patient safety events.   … Patient Safety Essentials Toolkit. Boston, MA: Institute for Healthcare Improvement. … The Joint Commission Journal on Quality and Patient Safety. 2016;42(12):545-AP3.

3737. An Obstructed View | PSNet
      psnet.ahrq.gov/web-mm/obstructed-view
      August 07, 2019 - The nasogastric tube is really just for patient comfort and may be omitted if the patient is not retching … March 13, 2024 National survey of patient safety experiences in hospital medicine during … January 10, 2024 Patients' perspectives on quality and patient safety failures: lessons … May 8, 2024 View More Related Resources Patient Safety … Innovations The e-Autopsy/e-Biopsy: A Systematic Chart Review to Increase Safety and

3738. Continuing Education | PSNet
      psnet.ahrq.gov/continuing-education
      February 26, 2025 - commentary describes the appropriate evaluation for acute abdominal pain, the importance of imaging in patients … The commentary highlights the importance of thorough neurological investigation of patients presenting … adult, and the limitations of non-contrast brain CT for identifying TIA or early ischemic strokes in patients … safety during spine surgery. … can enable care team members to voice concerns about patient safety. 

3739. The Consequences of Miscommunication Regarding a Possible Artifact | PSNet
      psnet.ahrq.gov/web-mm/consequences-miscommunication-regarding-possible-artifact
      May 11, 2019 - Approach to Improving Safety & Patient Safety Target Given the importance of communication between … safety. … should be incorporated into a systems-level model for improving patient safety. … the patient and the referring clinician, and between the patient and the radiologist. 12 Take-Home … Available at: https://www.jointcommission.org/resources/patient-safety-topics/sentinel-event/ .

3740. Spotlight (pdf file)
      psnet.ahrq.gov/sites/default/files/2020-05/final_may-spotlight-fatal_pca_slides_05.01.2020_cme_review-revised.pdf
      January 01, 2020 - but recommendations differ: – The Anesthesia Patient Safety Foundation (APSF) recommends continuous … Safety Issues with Patient Controlled Analgesia Part II - How To Prevent Errors ISMP Medication Safety … Safety and patient-controlled analgesia: part 2: how to prevent errors. P T. 2008;33(1):8-9. 17. … San Diego Patient Safety Council. … Capnography monitoring enhances safety of postoperative patient-controlled analgesia.