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psnet.ahrq.gov/node/864865/psn-pdf
March 20, 2024 - demands during the crisis to affect falls, medication
safety, healthcare associated infections, and pressure … injuries.
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psnet.ahrq.gov/issue/impact-dedicated-medication-nurses-medication-administration-error-rate-randomized-controlled
September 24, 2010 - July 17, 2024
Early identification and evaluation of severe pressure injuries. … March 19, 2019
Detection of missed injuries in a pediatric trauma center with the addition
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psnet.ahrq.gov/issue/patient-characteristics-and-occurrence-never-events
February 15, 2011 - October 30, 2024
Learning during crisis: the impact of COVID-19 on hospital-acquired pressure … injury incidence. … From research to practice: factors affecting implementation of prospective targeted injury-detection
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psnet.ahrq.gov/node/33823/psn-pdf
January 01, 2017 - The burning platform: the current injury rate and why it must be reduced
2. … A goal for injury reduction as measured by days away from work due to injury on the job; a
reasonable … Were there time pressures in the OR to proceed with no help? … Workplace injuries cost healthcare industry billions. Fierce Healthcare. November 12, 2013. … ; MSI: musculoskeletal injury
Figures
Figure 1.
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psnet.ahrq.gov/web-mm/sudden-collapse-during-upper-gastrointestinal-endoscopy-expect-unexpected
September 25, 2024 - The required insufflation leads to an increase in peak inspiratory pressures, and this increase is more … pronounced during dilation as the balloon pressure increases tracheal stress. … Patient death or serious injury associated with intravascular air embolism that occurs while being cared … If endoscopy is utilized, decreased insufflation and lower dilation pressures may be necessary to avoid … Technical steps like using appropriate monitoring, minimizing insufflation and dilation pressures to
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psnet.ahrq.gov/issue/preeminent-hospitals-penalized-over-rates-patients-injuries
January 17, 2018 - Newspaper/Magazine Article
Preeminent hospitals penalized over rates of patients’ injuries … Citation Text:
Preeminent hospitals penalized over rates of patients’ injuries. Rau J. … Citation
Citation Text:
Preeminent hospitals penalized over rates of patients’ injuries … February 16, 2022
More than 750 hospitals face Medicare crackdown on patient injuries
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psnet.ahrq.gov/node/49559/psn-pdf
April 01, 2008 - Multiple therapies were initiated to reduce the intracranial pressure and swelling, including intubation … The "Lund protocol," derived in patients with elevated ICP in the setting of head trauma, assumes
that … Continuous recording and control of ventricular fluid pressure in neurosurgical practice. … Introduction to cerebral perfusion pressure management. Neurosurg Clin N Am. 1995;6:761-
773. … Hyperventilation in head injury: a review. Chest.
2005;127:1812-1827. [go to PubMed]
5.
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psnet.ahrq.gov/node/60268/psn-pdf
April 29, 2020 - The most common complications of ECMO are bleeding from cannulation sites
(15-20%) or surgical wounds … Device operating at proper settings (example: ventilator pressures, pump rpm)
iii. … Brain injury during
venovenous extracorporeal membrane oxygenation. … Pressures – does the pump produce a pressure adequate for flow? What are the pressure trends? … Pressures are monitored before (pre-pump pressure), between pump and oxygenator (pre-oxygenator),
and
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psnet.ahrq.gov/issue/decade-preventing-harm
July 10, 2008 - The health system sought to prevent pressure ulcers , adverse drug events , falls with injury , health … January 3, 2017
The cost of serious fall-related injuries at three midwestern hospitals
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psnet.ahrq.gov/issue/patient-safety-curriculum-2nd-edition
July 12, 2017 - October 24, 2018
Pressure Injury Prevention in Hospitals Training Program.
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psnet.ahrq.gov/issue/fall-prevention-hospitals-training-program
May 01, 2017 - July 23, 2019
Pressure Injury Prevention in Hospitals Training Program.
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psnet.ahrq.gov/innovation/algorithm-based-decision-support-system-guides-trauma-staff-during-initial-treatment
May 31, 2023 - High risk of errors, preventable death : Multidisciplinary trauma teams face tremendous time pressures … , and specialty situations (neurotrauma, burns, spinal cord injury, and orthopedic trauma). … For example, prompts might remind staff working with a patient with abnormally low blood pressure to … The program had a particularly large impact on the use of pressure dressings to control hemorrhage (p … Missed injuries in a level I trauma center. J Trauma. 2002 Apr;52(4):715-9.
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psnet.ahrq.gov/issue/copying-and-pasting-examinations-within-electronic-medical-record
June 12, 2013 - September 9, 2010
A randomized trial of a multifactorial strategy to prevent serious fall injuries … October 12, 2016
Towards international consensus on patient harm: perspectives on pressure … injury policy.
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psnet.ahrq.gov/node/866344/psn-pdf
January 01, 2025 - Rates of three
nurse sensitive indicators - falls, healthcare associated pressure injuries, and healthcare
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psnet.ahrq.gov/issue/adverse-effects-medicare-psi-90-hospital-penalty-system-revenue-neutral-hospital-acquired
October 30, 2024 - Overall, HAC rates declined over the 2 years following implementation of the program, with only rates of pressure … Are evidence-based practices associated with effective prevention of hospital-acquired pressure … December 21, 2017
Complexity bias in the prevention of iatrogenic injury: why specific
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psnet.ahrq.gov/web-mm/distraction-anesthesiologist-and-lack-resuscitation-drugs-resulting-delayed-treatment
January 29, 2021 - chest wall muscles can create much higher negative intrathoracic pressures than those of elderly patients … Succinylcholine is contraindicated in patients with stroke, spinal cord injury, burns, or myotonic dystrophy … inadequate resources such as the broken drug refrigerator otherwise could have led to irreversible injury … Risk of respiratory complications and wound infection in patients undergoing ambulatory surgery: smokers … Negative-pressure pulmonary edema.
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psnet.ahrq.gov/node/72811/psn-pdf
September 01, 2022 - High risk of errors, preventable death: Multidisciplinary trauma teams face tremendous time
pressures … , and specialty situations
(neurotrauma, burns, spinal cord injury, and orthopedic trauma). … For example, prompts might remind staff
working with a patient with abnormally low blood pressure to … The program had a particularly
large impact on the use of pressure dressings to control hemorrhage ( … Missed injuries in a level I trauma center. J Trauma. 2002
Apr;52(4):715-9.
2.
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psnet.ahrq.gov/node/852449/psn-pdf
August 16, 2023 - include overcrowding and patients with complex care
needs, which may result in medication errors, pressure … injuries, or patient deterioration.
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psnet.ahrq.gov/perspective/workplace-safety-health-care
January 01, 2017 - Were there time pressures in the OR to proceed with no help? … their workforce, I announced we should be an injury-free workplace. … And over the 13 years I was there we got close to achieving zero injuries. … safety, namely to identify as quickly as possible anything gone wrong—including medication errors, pressure … are probably no better than average at all the other things they do, like central line infections and pressure
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psnet.ahrq.gov/issue/drill-down-root-cause-analysis
June 15, 2016 - Related Resources From the Same Author(s)
A case of transfusion error in a trauma … May 25, 2022
Root cause analysis for hospital-acquired pressure injury.