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psnet.ahrq.gov/web-mm/bloody-bp-cuff
June 21, 2016 - To ensure proper cleansing or disposing of contaminated equipment, processes should be in place in all … Proper education and knowledge may help create a safer environment for both health care workers and patients
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psnet.ahrq.gov/web-mm/language-barrier
February 28, 2024 - The pharmacist attempted to demonstrate proper dosing and administration using the medication dropper … At the time of discharge from the hospital, the nurse counseled the parents on proper dosing through
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psnet.ahrq.gov/innovation/system-approaches-social-determinants-health-screening-and-intervention-innovation
July 23, 2024 - Shaheen says that proper EHR integration could allow smaller organizations to implement this innovation
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psnet.ahrq.gov/node/37417/psn-pdf
March 28, 2012 - Medication use leading to emergency department visits
for adverse drug events in older adults.
March 28, 2012
Budnitz DS, Shehab N, Kegler SR, et al. Medication use leading to emergency department visits for
adverse drug events in older adults. Ann Intern Med. 2007;147(11):755-765.
https://psnet.ahrq.gov/issue/med…
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psnet.ahrq.gov/web-mm/under-pressure-delayed-diagnosis-compartment-syndrome-after-lower-leg-fracture
November 25, 2020 - positives and false negatives, especially if measurements are not obtained at an ideal anatomic location or proper … 2022
WebM&M Cases
A Laceration that Needed a Proper … 2024
WebM&M Cases
A Laceration that Needed a Proper
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psnet.ahrq.gov/web-mm/navigating-complications-unintended-journey-guidewire-during-dialysis-catheter-placement
February 23, 2022 - rate and faster identification of complications are compelling benefits of using ultrasound guidance, proper … Access to ultrasound does not guarantee its proper use or the competence of a provider, but it can reduce
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psnet.ahrq.gov/web-mm/right-patient-wrong-sample
June 01, 2004 - To ensure proper patient identification, the hospital had implemented a policy requiring a registered … from weakest to strongest, are:
Weak : Retrain the phlebotomist and nurse regarding following the proper
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psnet.ahrq.gov/perspective/conversation-withbarbara-blakeney-ms-rn
August 01, 2005 - BB: Certainly, proper staffing is a huge issue. … But, in saying that we believe there is a better way to do it, we still believe ratios are proper.
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psnet.ahrq.gov/perspective/unfinished-patient-safety-agenda
August 01, 2005 - BB: Certainly, proper staffing is a huge issue. … But, in saying that we believe there is a better way to do it, we still believe ratios are proper.
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psnet.ahrq.gov/node/33592/psn-pdf
December 15, 2024 - The
physicians who reviewed his medical record judged that proper diagnostic management might have
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psnet.ahrq.gov/issue/medical-errors-and-medical-narcissism
August 03, 2005 - Book/Report
Medical Errors and Medical Narcissism.
Citation Text:
Medical Errors and Medical Narcissism. Banja JD. Sudbury MA: Jones and Bartlett, 2005. ISBN: 0763783617.
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psnet.ahrq.gov/node/33776/psn-pdf
January 01, 2015 - Even, "did you give them proper training to know how to use the
system?" … washing their hands often enough, there are usually systemic problems
getting in the way of practicing proper
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psnet.ahrq.gov/node/33574/psn-pdf
March 15, 2025 - likelihood of a medication error is linked to a
patient's understanding of the indication, dosage schedule, proper
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psnet.ahrq.gov/web-mm/home-medications-contribute-unique-opportunity-error-discharge-hospital
May 16, 2022 - Take-Home points Home medications brought into the hospital for use require vigilance to ensure proper
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psnet.ahrq.gov/issue/criminalization-human-error-and-guilty-verdict-travesty-justice-threatens-patient-safety
September 07, 2022 - Newspaper/Magazine Article
Criminalization of human error and a guilty verdict: a travesty of justice that threatens patient safety.
Citation Text:
Criminalization of human error and a guilty verdict: a travesty of justice that threatens patient safety. ISMP Medication Safety Alert! Acut…
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psnet.ahrq.gov/issue/partnering-families-and-patient-advocates-another-line-defense-adverse-event-surveillance
September 11, 2019 - Newspaper/Magazine Article
Partnering with families and patient advocates: another line of defense in adverse event surveillance.
Citation Text:
Partnering with families and patient advocates: another line of defense in adverse event surveillance. ISMP Medication Safety Alert! Acute Care…
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psnet.ahrq.gov/issue/safety-enhancements-every-hospital-must-consider-wake-another-tragic-neuromuscular-blocker
June 19, 2019 - Newspaper/Magazine Article
Safety enhancements every hospital must consider in wake of another tragic neuromuscular blocker event.
Citation Text:
Safety enhancements every hospital must consider in wake of another tragic neuromuscular blocker event. ISMP Medication Safety Alert! Acute Ca…
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psnet.ahrq.gov/web-mm/missing-ecg-and-missed-diagnosis-lead-dangerous-delay
March 01, 2015 - Had there been a proper handoff, the prehospital ECG would have been seen by ED providers at the time
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psnet.ahrq.gov/primer/ambulatory-care-safety
December 15, 2024 - of a medication error is linked to a patient's understanding of the indication, dosage schedule , proper
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psnet.ahrq.gov/issue/lessons-learned-implementation-computerized-provider-order-entry-5-community-hospitals
December 31, 2014 - Study
Lessons learned from implementation of computerized provider order entry in 5 community hospitals: a qualitative study.
Citation Text:
Simon SR, Keohane CA, Amato MG, et al. Lessons learned from implementation of computerized provider order entry in 5 community hospitals: a quali…