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psnet.ahrq.gov/issue/problems-health-information-technology-and-their-effects-care-delivery-and-patient-outcomes
February 14, 2024 - Review
Problems with health information technology and their effects on care delivery … Problems with health information technology and their effects on care delivery and patient outcomes: … This systematic review of studies describing safety problems associated with health information technology … Problems with health information technology and their effects on care delivery and patient outcomes: … February 14, 2024
Using automated methods to detect safety problems with health information
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psnet.ahrq.gov/issue/insulin-pumps-have-most-reported-problems-fda-database
October 03, 2018 - Newspaper/Magazine Article
Insulin pumps have most reported problems in FDA database … Citation Text:
Insulin pumps have most reported problems in FDA database. Mohr H, Weiss M. … This news article reports on problems associated with ambulatory use of insulin pumps submitted to … Cite
Citation
Citation Text:
Insulin pumps have most reported problems
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psnet.ahrq.gov/issue/non-dispensing-pharmacists-actions-and-solutions-drug-therapy-problems-among-elderly
February 03, 2021 - Study
Non-dispensing pharmacists' actions and solutions of drug therapy problems … Non-dispensing pharmacists' actions and solutions of drug therapy problems among elderly polypharmacy … The reviews identified 1,292 drug therapy problems, citing overtreatment most frequently (24%) followed … Non-dispensing pharmacists' actions and solutions of drug therapy problems among elderly polypharmacy … April 14, 2021
Drug related problems and pharmacist interventions in a geriatric unit
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psnet.ahrq.gov/issue/drug-related-problems-among-older-people-dementia-systematic-review
January 12, 2022 - Review
Drug-related problems among older people with dementia: a systematic review … Drug-related problems among older people with dementia: a systematic review. … Medication-related problems (including adverse drug events, medication errors, and potentially inappropriate … This systematic review of 15 studies found that the prevalence of medication-related problems among patients … Drug-related problems among older people with dementia: a systematic review.
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psnet.ahrq.gov/issue/updated-guidance-needed-longstanding-large-volume-parenteral-lvp-labeling-and-packaging
March 10, 2021 - Updated guidance needed for longstanding large volume parenteral (LVP) labeling and packaging problems … Text:
Updated guidance needed for longstanding large volume parenteral (LVP) labeling and packaging problems … Packaging and labeling problems hinder safe medication use. … Text:
Updated guidance needed for longstanding large volume parenteral (LVP) labeling and packaging problems
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psnet.ahrq.gov/issue/preventable-deaths-due-problems-care-english-acute-hospitals-retrospective-case-record-review
July 20, 2022 - Study
Classic
Preventable deaths due to problems in care … Preventable deaths due to problems in care in English acute hospitals: a retrospective case record review … The reviewers did find evidence of significant quality problems among both preventable and non-preventable … Preventable deaths due to problems in care in English acute hospitals: a retrospective case record review … December 16, 2020
Problems in care and avoidability of death after discharge from intensive
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psnet.ahrq.gov/issue/clinician-identified-problems-and-solutions-delayed-diagnosis-primary-care-prioritize-study
December 14, 2016 - Study
Clinician-identified problems and solutions for delayed diagnosis in primary … Clinician-identified problems and solutions for delayed diagnosis in primary care: a PRIORITIZE study … Participants identified 33 discrete problems associated with delays in diagnosis and suggested 27 solutions … Clinician-identified problems and solutions for delayed diagnosis in primary care: a PRIORITIZE study … Prioritizing medication safety in care of people with cancer: clinicians' views on main problems
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psnet.ahrq.gov/issue/frequency-and-nature-potentially-harmful-preventable-problems-primary-care-patients
June 30, 2021 - Study
Frequency and nature of potentially harmful preventable problems in primary … Frequency and nature of potentially harmful preventable problems in primary care from the patient's perspective … About 8% of patients reported an adverse event, which were frequently problems with medications, accessing … Frequency and nature of potentially harmful preventable problems in primary care from the patient's perspective
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psnet.ahrq.gov/issue/problems-after-discharge-and-understanding-communication-their-primary-care-physicians-pcps
March 28, 2018 - Study
Problems after discharge and understanding of communication with their primary … Problems after discharge and understanding of communication with their primary care physicians among … geriatric patients, conducted 2 weeks after hospital discharge, identified a large proportion who suffered problems … Problems after discharge and understanding of communication with their primary care physicians among
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psnet.ahrq.gov/issue/problem-checklists
March 29, 2023 - Commentary
The problem with checklists.
Citation Text:
Catchpole K, Russ S. The problem with checklists. BMJ Qual Saf. 2015;24(9):545-9. doi:10.1136/bmjqs-2015-004431.
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psnet.ahrq.gov/issue/problem-incident-reporting
February 28, 2024 - Commentary
The problem with incident reporting.
Citation Text:
Macrae C. The problem with incident reporting. BMJ Qual Saf. 2016;25(2):71-75. doi:10.1136/bmjqs-2015-004732.
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psnet.ahrq.gov/innovation/care-managers-use-software-aided-medication-review-protocol-frail-community-dwelling
September 13, 2023 - The HomeMeds Medication Safety Program identified and addressed targeted medication problems, leading … Program implementation identified and addressed several common medication problems found among older … In the waiver study, 62 percent of pharmacist-confirmed therapeutic duplication problems were resolved … In the waiver program, 61 percent of pharmacist-confirmed problems had changes. … Over time, the nurses and the pharmacist began to identify common medication-related problems and felt
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psnet.ahrq.gov/issue/problem-using-patient-complaints-improvement
February 20, 2019 - Patient complaints can provide insights into care problems . … Identifying patient and practice characteristics associated with patient-reported experiences of safety problems
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psnet.ahrq.gov/issue/problem-never-events
July 12, 2023 - Commentary
The problem with 'never events'.
Citation Text:
Zaslow J, Fortier J, Garber G. The problem with ‘never events’. BMJ Qual Saf. 2024;33(9):613-616. doi:10.1136/bmjqs-2023-016981.
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psnet.ahrq.gov/issue/encouraging-patients-speak-about-problems-cancer-care
March 11, 2013 - Study
Encouraging patients to speak up about problems in cancer care. … Encouraging patients to speak up about problems in cancer care. … Encouraging patients to speak up about problems in cancer care.
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psnet.ahrq.gov/issue/measurement-and-monitoring-safety
October 01, 2024 - Despite great effort, health care organizations are still learning how to identify safety problems , … Prior studies have shown that no single method can unearth all safety problems within an organization … adherence to appropriate processes of care), sensitivity to operations (prospectively identifying safety problems
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psnet.ahrq.gov/issue/using-incident-reports-assess-communication-failures-and-patient-outcomes
February 06, 2019 - failures and safety has been best studied in the operating room , this issue likely contributes to safety problems … Investigators examined incident reports at an academic medical center to characterize how communication problems … implying that situational awareness was not achieved—were among the most common types of communication problems … Communication problems most often led to delays in care without physical harm, highlighting the difficulty
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psnet.ahrq.gov/taxonomy/term/3440
April 10, 2025 - Failure to maintain situational awareness can result in various problems that compound the crisis. … situational awareness to the point that steps are not taken to address immediately life-threatening problems
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psnet.ahrq.gov/issue/how-experiencing-preventable-medical-problems-changed-patients-interactions-primary-health
December 13, 2023 - Study
How experiencing preventable medical problems changed patients' interactions … How experiencing preventable medical problems changed patients' interactions with primary health care … How experiencing preventable medical problems changed patients' interactions with primary health care
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psnet.ahrq.gov/issue/incidence-nature-and-causes-avoidable-significant-harm-primary-care-england-retrospective
November 13, 2019 - Their analysis identified three primary types of avoidable harm in primary care – problems with diagnoses … , medication-related problems, and delayed referrals. … January 11, 2023
The frequency and nature of prescribing problems by general practitioners