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Total Results: 1,785 records

Showing results for "problem".

261. Overview of Methicillin-Resistant Staphylococcus aureus (MRSA)-Related Adult Inpatient Stays, 2016–2021. HCUP Statistical Brief #315. | PSNet
     psnet.ahrq.gov/issue/overview-methicillin-resistant-staphylococcus-aureus-mrsa-related-adult-inpatient-stays-2016
     December 11, 2024 - April 13, 2011 Development of "SWARM" as a model for high reliability, rapid problem

262. Reduction in warfarin adverse events requiring patient hospitalization after implementation of a pharmacist-managed anticoagulation service. | PSNet
     psnet.ahrq.gov/issue/reduction-warfarin-adverse-events-requiring-patient-hospitalization-after-implementation
     October 23, 2024 - April 24, 2018 Retained surgical items: a problem yet to be solved.

263. Perioperative team-based morbidity and mortality conferences: a systematic review of the literature. | PSNet
     psnet.ahrq.gov/issue/perioperative-team-based-morbidity-and-mortality-conferences-systematic-review-literature
     November 29, 2023 - March 8, 2023 Crisis recovery in surgery: error management and problem solving in safety-critical

264. Governing the safety of artificial intelligence in healthcare. | PSNet
     psnet.ahrq.gov/issue/governing-safety-artificial-intelligence-healthcare
     February 28, 2024 - July 21, 2017 The problem with incident reporting.

265. Prevalence and Burden of Healthcare-Associated Infections (HAIs), 2016–2021. HCUP Statistical Brief #313. | PSNet
     psnet.ahrq.gov/issue/prevalence-and-burden-healthcare-associated-infections-hais-2016-2021-hcup-statistical-brief
     December 18, 2024 - April 13, 2011 Development of "SWARM" as a model for high reliability, rapid problem

266. How unprofessional behaviours between healthcare staff threaten patient care and safety. | PSNet
     psnet.ahrq.gov/issue/how-unprofessional-behaviours-between-healthcare-staff-threaten-patient-care-and-safety
     July 24, 2024 - May 15, 2024 Speaking up and taking action: psychological safety and joint problem-solving

267. Medication Mix-Up Leads to Patient Death | PSNet
     psnet.ahrq.gov/web-mm/medication-mix-leads-patient-death
     July 08, 2022 - trusted each other, and they blamed the barcode medication administration (BCMA) process for causing a problem … been frustrated by the unexpected inability to scan the medication label, and the need to resolve the problem … the Pennsylvania Patient Safety Authority from 2005 through 2016, 25.7% involved an equipment-related problem

268. Patient safety is not elective: a debate at the NPSF Patient Safety Congress. | PSNet
     psnet.ahrq.gov/issue/patient-safety-not-elective-debate-npsf-patient-safety-congress
     March 18, 2019 - April 16, 2019 'Bad apples': time to redefine as a type of systems problem?

269. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/33602/psn-pdf
     March 15, 2025 - physicians who repeatedly provided substandard—and even dangerous—care have also served to highlight the problem … A https://www.propublica.org/article/when-caregivers-harm-california-problem-nurses-stay-on-job-710

270. Using incident reports to assess communication failures and patient outcomes. | PSNet
     psnet.ahrq.gov/issue/using-incident-reports-assess-communication-failures-and-patient-outcomes
     February 06, 2019 - February 6, 2019 Evaluation of a problem-specific SBAR tool to improve after-hours nurse-physician

271. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/45945/psn-pdf
     April 24, 2018 - nature-adverse-events-hospitalized-patients-results-harvard-medical-practice-study-ii https://psnet.ahrq.gov/issue/incident-reporting-system-does-not-detect-adverse-drug-events-problem-quality-improvement

272. Medication Reconciliation Pitfalls | PSNet
     psnet.ahrq.gov/web-mm/medication-reconciliation-pitfalls
     May 01, 2006 - To further aggravate the problem, the errant metoprolol dose was increased in response to this elderly … Problem Description Errors in the drug name, dosage, frequency, and route of administration for home … These cases may be justified to avoid any delay or problem with therapy—provided that all of the safeguards

273. After-Visit Confusion | PSNet
     psnet.ahrq.gov/web-mm/after-visit-confusion
     August 21, 2007 - These summaries often include the patient's problem list, diagnostic test results, and updated medication … Reserve templates for documentation Separate some data entry from the encounter; review problem … 2005 Perspective The Soil, Not the Seed: The Real Problem

274. Unintended Consequences of CPOE | PSNet
     psnet.ahrq.gov/web-mm/unintended-consequences-cpoe
     September 01, 2004 - ) Subsequently, usability experts traced 12 of the 18 problems to usability design flaws.( 10 ) The problem … These poor interfaces transform old problems into new ones; they eliminate the problem of illegible or … played a role in this case, focusing only on interface issues misses a much more serious and fundamental problem … The discussions of the unintended consequences of health IT ( 4,24-27 ) illustrate this problem.

275. Do not let "Depo-" medications be a depot for mistakes. | PSNet
     psnet.ahrq.gov/issue/do-not-let-depo-medications-be-depot-mistakes
     March 15, 2022 - May 7, 2018 Reporting and second-order problem solving can turn short-term fixes into

276. Preventable errors in the operating room: retained foreign bodies after surgery--part I. | PSNet
     psnet.ahrq.gov/issue/preventable-errors-operating-room-retained-foreign-bodies-after-surgery-part-i
     April 28, 2021 - September 24, 2014 Retained surgical items: a problem yet to be solved.

277. Checklists, safety, my culture and me. | PSNet
     psnet.ahrq.gov/issue/checklists-safety-my-culture-and-me
     June 19, 2019 - May 18, 2016 The problem with checklists.

278. Fatality involving vinblastine overdose as a result of a complex medical error. | PSNet
     psnet.ahrq.gov/issue/fatality-involving-vinblastine-overdose-result-complex-medical-error
     January 25, 2023 - November 2, 2016 How not to waste a crisis: a qualitative study of problem definition

279. A culture of civility: positively impacting practice and patient safety. | PSNet
     psnet.ahrq.gov/issue/culture-civility-positively-impacting-practice-and-patient-safety
     July 13, 2022 - April 20, 2016 Drug-related-problem outcomes and program satisfaction from a comprehensive

280. To eliminate bias, some seek out doctors of their own race or ethnicity. | PSNet
     psnet.ahrq.gov/issue/eliminate-bias-some-seek-out-doctors-their-own-race-or-ethnicity
     December 11, 2019 - December 14, 2016 The other big drug problem: older people taking too many pills.