-
psnet.ahrq.gov/perspective/integrating-multiple-medication-decision-support-systems-how-will-we-make-it-all-work
May 01, 2008 - Implement the CDSS in a test unit, and immediately measure workflow changes and initial provider response … Even with this extensive preparation, we have needed to refine the intervention in response to user reactions … Insights such as these may be missed without adequate evaluation of provider response. … Physician response to computer reminders. JAMA. 1980;244:1579-1581. [go to PubMed] 2.
-
psnet.ahrq.gov/perspective/conversation-withallan-frankel-md
July 01, 2006 - Underneath that is the methodology for making changes, which includes reliable design, the rapid cycle … This committee should be able to authorize action in response to safety concerns or refer the actions … July 31, 2023
Patient Safety Innovations
Remote Response
-
psnet.ahrq.gov/perspective/accreditation-and-regulation-can-they-help-improve-patient-safety
April 01, 2009 - safety goals that exceed accreditation requirements, and many hospitals have voluntarily implemented rapid … response teams and other optional enhancements to care.( 6 )
In other words, accreditation and regulation … We have been pushing outside the routine accreditation and certification processes for the more rapid
-
psnet.ahrq.gov/node/73999/psn-pdf
October 27, 2021 - bypasses the multi-level safety checks otherwise implemented in the hospital
setting.3,4,5 In addition, rapid
-
psnet.ahrq.gov/node/49718/psn-pdf
January 01, 2015 - As this case illustrates, rapid administration of potassium can be
dangerous, even among patients with
-
psnet.ahrq.gov/web-mm/miscommunication-or-leads-anticoagulation-mishap
May 08, 2019 - Miscommunication in the OR Leads to Anticoagulation Mishap
Citation Text:
Solsky I, Haynes AB. Miscommunication in the OR Leads to Anticoagulation Mishap. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2017.
Copy Citation
Forma…
-
psnet.ahrq.gov/perspective/addressing-workplace-violence-and-creating-safer-workplace
October 31, 2023 - well as changes to work practices or administrative procedures, such as developing workplace violence response … Sarah Mossburg: What you just said makes me think that people are almost in a fight or flight response … I’ve seen in the news and heard from colleagues that health systems are increasing security in response … We can use strategies we know work in patient safety and quality—such as root-cause analysis, rapid response … August 30, 2023
Patient Safety Innovations
Remote Response
-
psnet.ahrq.gov/web-mm/ebola-are-we-ready
July 01, 2012 - which the above case was drawn, has used the technique of simulation to test and improve clinicians' response … The Ebola Response: Lessons and Changes. October 29, 2014. [Available at] 4. Emory Healthcare. … November 25, 2020
Enhancing departmental preparedness for COVID-19 using rapid-cycle
-
psnet.ahrq.gov/perspective/errors-and-near-misses-what-health-care-could-learn-aviation
September 01, 2006 - Errors and Near Misses: What Health Care Could Learn From Aviation
Carl Macrae, PhD | December 1, 2016
Also Read a Conversation
View more articles from the same authors.
Citation Text:
Macrae C. Errors and Near Misses: What Health Care Could Learn From Aviation…
-
psnet.ahrq.gov/node/33619/psn-pdf
September 01, 2005 - Also, the very enthusiastic response to the 100,000 Lives Campaign indicates that we're ready to act
-
psnet.ahrq.gov/node/60857/psn-pdf
August 26, 2020 - National Patient Safety Agency rapid response report: reducing the risk of tourniquets left on after
-
psnet.ahrq.gov/web-mm/renal-failure-due-benign-prostatic-hyperplasia
February 01, 2004 - Records
November 1, 2010
WebM&M Cases
A "Weak" Response
-
psnet.ahrq.gov/web-mm/central-line-clot
August 04, 2021 - reduction in cardiac arrests and duration of clinical instability after implementation of a paediatric rapid … response system.
-
psnet.ahrq.gov/perspective/implementing-fall-prevention-program
November 29, 2023 - Implementing a Fall Prevention Program
Frances Healey, RN, PhD | December 1, 2011
View more articles from the same authors.
Citation Text:
Healey F. Implementing a Fall Prevention Program. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Qualit…
-
psnet.ahrq.gov/web-mm/engaging-seriously-ill-older-patients-advance-care-planning
December 22, 2018 - December 22, 2018
Impact of nighttime rapid response team activation on outcomes of hospitalized
-
psnet.ahrq.gov/web-mm/failure-latch
November 27, 2012 - The former, breast milk jaundice, is an exaggerated physiologic response, occurring in approximately
-
psnet.ahrq.gov/web-mm/getting-root-matter
September 01, 2005 - with the patient (from physician to patient transport personnel), every order, every test, and every response … Related Resources From the Same Author(s)
Letter
In response
-
psnet.ahrq.gov/web-mm/diagnosing-missed-diagnosis
October 26, 2022 - Intuitive processing is a highly efficient, rapid method to cope with the enormous complexity of clinical
-
psnet.ahrq.gov/web-mm/wrong-catheter-right-patient
May 16, 2022 - Wrong Catheter in the Right Patient
Citation Text:
Chia C, Molla M. Wrong Catheter in the Right Patient. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2020.
Copy Citation
Format:
Google Scholar BibTeX EndNote X3 XML En…
-
psnet.ahrq.gov/node/74251/psn-pdf
January 26, 2022 - Delayed Diagnosis and Treatment of an Occult
Hemothorax Following Complicated Central Line Insertion
Leads to Cardiac Arrest
January 26, 2022
Raff G, Goudy B. Delayed Diagnosis and Treatment of an Occult Hemothorax Following Complicated
Central Line Insertion Leads to Cardiac Arrest. PSNet [internet]. 2022.
https…