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psnet.ahrq.gov/node/860050/psn-pdf
January 04, 2024 - In fact, patients often present with non-
specific symptoms such as vomiting, abnormal movements, changes … In fact, abused patients often have a delayed presentation. … Approach to Improving Safety
Get a Head CT First for Evaluation of Possible AHT
In this case, an ultrafast … The patient was discharged home to his caregivers once he showed mild clinical
improvement. … Radiologic head CT interpretation errors in pediatric abusive and
non-abusive head trauma patients.
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psnet.ahrq.gov/node/49585/psn-pdf
May 01, 2009 - Up to 25% of geriatric general ward patients and as many as 80% of
intensive care unit patients experience … Delirium poses several risks to the patient. … requests, too busy to see patient, etc.)? … Additionally, family may be willing to
participate in the care of the patient, which may reduce patient … Elements of the hospital environment can contribute to delirium and expose patients to safety risk.
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psnet.ahrq.gov/node/842919/psn-pdf
February 01, 2023 - The patient was placed in the ED hallway waiting for COVID-19 test results, as asymptomatic testing is … No nurse was assigned to the patient in the hallway, and the
patient was given a multitude of small … The patient was started on a continuous insulin infusion and transitioned to
subcutaneous insulin as … Case #2: A 49-year-old male patient with history of poorly controlled type 1 diabetes, homelessness, … obtaining-best-possible-medication-history-hospital-admission-description-pharmacy-technician
Approach to Improving Safety
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psnet.ahrq.gov/node/863308/psn-pdf
February 28, 2024 - Other factors
commonly found in patients presenting for ECRP with an increased aspiration risk include … recovery.5 MAC may also offer benefit if patients have cardiorespiratory risk
factors such as recent … MAC can include all levels of sedation and patients may
need airway intervention if deep sedation is … Safety and sedation-associated adverse event
reporting among patients undergoing endoscopic cholangiopancreatography … Procedural sedation for adult patients: an overview.
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psnet.ahrq.gov/node/49624/psn-pdf
May 01, 2011 - Furthermore,
disclosure of medical errors to patients has several benefits. … Disclosure allows patients to make informed
health care decisions. … Several ongoing projects, funded by the Agency for Healthcare Research and Quality (AHRQ)
Patient Safety … Disclosing harmful medical errors to
patients: tackling three tough cases. … • Tell the patient how the event will be treated or managed
• Tell the patient how the event may impact
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psnet.ahrq.gov/node/49744/psn-pdf
October 01, 2015 - At approximately 3 AM, the
patient was found unresponsive by his nurse. … In addition, reconciliation is challenging and requires multiple steps to ensure accuracy and safety. … is no national patient identifier in the US. … Hand delivered—on paper—by the patient. … Readers Write: National Patient Identifier: Why Patient-Matching Technology May Be a
Better Solution
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psnet.ahrq.gov/web-mm/when-patients-and-providers-speak-different-languages
December 08, 2021 - When Patients and Providers Speak Different Languages. PSNet [internet]. … clear communication necessary to care for these patients in a safe and patient-centered manner. … Address the patient directly Watch the patient during the interpretation so you don't miss valuable … Language barriers and patient-centered breast cancer care. Patient Educ Couns. 2011;84:223-228. … May 1, 2013
Family involvement, patient safety and suicide prevention in mental healthcare
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psnet.ahrq.gov/web-mm/stroke-error
February 01, 2016 - The safety and efficacy of rtPA in routine clinical use has been subsequently confirmed in a large cohort … rtPA, and admit patients to a stroke unit. … Gaze is testable in all aphasic patients. … If patient is blind from any cause, score 3. … Safety at Academic Medical Centers
August 1, 2010
Complexity and challenges
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psnet.ahrq.gov/web-mm/duty-disclose-someone-elses-error
June 01, 2004 - Furthermore, disclosure of medical errors to patients has several benefits. … Disclosure allows patients to make informed health care decisions. … Several ongoing projects, funded by the Agency for Healthcare Research and Quality (AHRQ) Patient Safety … Disclosing harmful medical errors to patients: tackling three tough cases. … • Tell the patient how the event will be treated or managed • Tell the patient how the event may
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psnet.ahrq.gov/node/49534/psn-pdf
May 01, 2007 - The patient was treated with antibiotics, and
his phenobarbital was held. … The therapeutic index (ratio between toxic dose and therapeutic dose, a measure of the relative
safety … Why did it take the patient 3 days to recover? … However, even in patients with no
apparent alteration in protein binding (i.e., patients who lack any … The common clinical dictum is "treat the patient, not the number."
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psnet.ahrq.gov/node/49717/psn-pdf
September 01, 2014 - Describe steps to improve prescribing and monitoring of patients on opioids in the hospital. … Embedded in this question are issues relating to efficacy and safety; specifically, finding
the right … Achieving adequate analgesia in patients on chronic opioid therapy is challenging. … analgesia in an alert patient. … Acute pain management in opioid-tolerant
patients: a growing challenge.
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psnet.ahrq.gov/node/865884/psn-pdf
May 29, 2024 - business is producing,
marketing, selling, reselling, or distributing healthcare products used by or on patients … Olson, MD, FACP, FAAP
Background
One of the hallmarks of many patients’ diagnostic odysseys in modern … psnet.ahrq.gov//#4
https://psnet.ahrq.gov//#5
https://psnet.ahrq.gov/issue/acog-committee-opinion-464-patient-safety-surgical-environment … settings are never
made by a single clinician alone; instead, it is always a partnership involving patients … Implicit clinician bias against obese patients must also be considered,16 because this bias
may interfere
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psnet.ahrq.gov/perspective/conversation-david-meltzer-md-phd
November 01, 2018 - When you did have a patient in the hospital, it was a big disruption to your schedule. … yet, what can you tell us about the key outcomes with a particular focus on anything you know about safety … We haven't measured patient safety outcomes in the way you might imagine—like errors and things like … Finally, growing pressures to improve quality and safety created a new paradigm which emphasized systems … Response to David Meltzer's paper "Hospitalists and the doctor-patient relationship."
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psnet.ahrq.gov/node/836794/psn-pdf
March 31, 2022 - In patients with schizophrenia, patients often have
poverty of speech and thought that prevent them … Patients with delusions may
believe a doctor is trying to harm the patient instead. … Psychosocial History: Getting to Know the Person Within the Patient
Meeting a patient gives us a quick … Approach to Improving Systemic Safety: Palliative Care and the Interdisciplinary Team Model
System barriers … Can the patient decide? Evaluating patient capacity in practice.
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psnet.ahrq.gov/node/49720/psn-pdf
December 01, 2014 - treated with rtPA compared to 20%–38% of patients in the placebo group. … The safety and efficacy of rtPA in routine clinical use has
been subsequently confirmed in a large cohort … rtPA, and admit patients to a stroke unit. … Gaze is
testable in all aphasic patients. … If patient
is blind from any cause, score 3.
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psnet.ahrq.gov/web-mm/diagnosing-hiv-it-doesnt-take-brain-surgeon
January 01, 2018 - The patient was single, with no children, and had emigrated from Mexico 8 years earlier. … Upon arrival to the referral facility, the patient remained neurologically stable and underwent left-sided … For the patient in this case, it is not clear that immediate HIV testing and timelier administration … AIDS Patient Care STDS. 2006;20:84-92. [go to PubMed] 26. US Preventive Services Task Force. … Safety
March 27, 2024
WebM&M Cases
A "Reflexive
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psnet.ahrq.gov/node/867206/psn-pdf
December 18, 2024 - Because sensory symptoms are frequently difficult for
patients to describe and because some patients … Thus, this patient likely had a spontaneous EVS. … looks right and beats to the left when the patient
looks left). … The patient is reported to have had “possible” seizures. … Safety
As the above background suggests, misdiagnosis of patients with acute dizziness is common6,21,39
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psnet.ahrq.gov/node/60744/psn-pdf
July 29, 2020 - The patient
was therefore diuresed and continued on antibiotics. … diagnostic errors remain
a prevalent ‘blind spot’ in patient safety and contribute to poor patient … Studies such as the
Harvard Medical Practice Study1 point out that in hospitalized patients, 17% of … preventable errors are
diagnostic errors, and autopsy studies reveal that 9% of patients experience … The nature of adverse
events in hospitalized patients.