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Total Results: 1,605 records

Showing results for "rather than".

421. Respectful Management of Serious Clinical Adverse Events. Second Edition. | PSNet
     psnet.ahrq.gov/issue/respectful-management-serious-clinical-adverse-events-second-edition
     January 27, 2016 - developing a culture of safety, and the need for organizations to have a comprehensive crisis plan in place rather … than reacting after events have occurred.

422. Autopsy Revelation | PSNet
     psnet.ahrq.gov/web-mm/autopsy-revelation
     December 01, 2007 - to below 6%, from rates of 40%-50% a generation earlier.( 6 ) A more recent survey found that more than … the clinical impression and a few basic laboratory tests, rather than a definitive biochemical, radiologic … diagnoses, even when they reflect atypical presentations or shortcomings of current diagnostic approaches rather … than quality problems. … It also illustrates the degree to which misdiagnoses continue to involve common conditions, rather than

423. Geisinger’s Outpatient Addiction Medicine Specialty Program Uses Data-Driven Decision Making and MAT to Reduce Mortality Rates | PSNet
     psnet.ahrq.gov/innovation/geisingers-outpatient-addiction-medicine-specialty-program-uses-data-driven-decision
     October 30, 2024 - prior to implementation, the treatment culture in PA focused on an inpatient abstinence-only model rather … than integrating the use of medication-assisted treatment across all care settings. 3 The team at … required to attend fewer clinic visits and counseling verification requirements are less stringent than … implementation of this intervention, substance use disorder has frequently been treated as a choice rather … than a disease.

424. Safety considerations in learning new procedures: a survey of surgeons. | PSNet
     psnet.ahrq.gov/issue/safety-considerations-learning-new-procedures-survey-surgeons
     January 23, 2017 - They also felt that requirements should be tailored to individual surgical experience rather than standardized

425. Patient safety incidents in home hospice care: the experiences of hospice interdisciplinary team members. | PSNet
     psnet.ahrq.gov/issue/patient-safety-incidents-home-hospice-care-experiences-hospice-interdisciplinary-team-members
     February 15, 2011 - error of omission) were the most common concerns, often related to patient or family caregiver actions rather … than the home hospice team.

426. Medication safety and the administration of intravenous vincristine: international survey of oncology pharmacists. | PSNet
     psnet.ahrq.gov/issue/medication-safety-and-administration-intravenous-vincristine-international-survey-oncology
     March 26, 2015 - always causes fatal toxicity if it is incorrectly administered intrathecally (via spinal injection) rather … than intravenously.

427. Interruptions and multi-tasking: moving the research agenda in new directions. | PSNet
     psnet.ahrq.gov/issue/interruptions-and-multi-tasking-moving-research-agenda-new-directions
     March 23, 2011 - interruptions in health care, this commentary reveals that most studies focus on the rate of interruptions rather … than the relationship between interruptions and errors.

428. Conditions that influence the impact of malpractice litigation risk on physicians' behavior regarding patient safety. | PSNet
     psnet.ahrq.gov/issue/conditions-influence-impact-malpractice-litigation-risk-physicians-behavior-regarding-patient
     January 07, 2015 - behavior and litigation risk: complexity of care, discussion of mistakes among colleagues, personalized rather … than team responsibility, and how hospitals respond to incidents.

429. Safety-I, Safety-II and burnout: how complexity science can help clinician wellness. | PSNet
     psnet.ahrq.gov/issue/safety-i-safety-ii-and-burnout-how-complexity-science-can-help-clinician-wellness
     December 20, 2017 - Building on success rather than reacting to failure is an emerging focus of improvement efforts.

430. Failures in communication through documents and documentation across the perioperative pathway. | PSNet
     psnet.ahrq.gov/issue/failures-communication-through-documents-and-documentation-across-perioperative-pathway
     August 07, 2013 - a reliance on written documentation, which was often difficult to find or missing key information, rather … than verbal signout .

431. Hospital system barriers to rapid response team activation: a cognitive work analysis. | PSNet
     psnet.ahrq.gov/issue/hospital-system-barriers-rapid-response-team-activation-cognitive-work-analysis
     September 09, 2015 - study suggested that calling a rapid response is felt to only be justifiable in extreme situations rather … than beforehand, which severely limits the potential effectiveness of this intervention.

432. Chasing the 6-sigma: drawing lessons from the cockpit culture. | PSNet
     psnet.ahrq.gov/issue/chasing-6-sigma-drawing-lessons-cockpit-culture
     April 22, 2015 - Aviation safety relies on systems improvement rather than individual blame to understand and mitigate

433. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/33671/psn-pdf
     July 01, 2008 - Rather, the "soil" must be well prepared and fertile for discovery to take root. … involvement in the investigation process.(3) Administrative and medical staff leaders must do more than … Rather than pronounce the root cause to be "lack of training" and stop at that point, the team is encouraged

434. Say It Again | PSNet
     psnet.ahrq.gov/web-mm/say-it-again
     January 31, 2020 - Rather than unnecessarily impose separate protocols on facilities to achieve the two NPSGs, the Table … Rather than relying blindly on the read-back, providers still need to exercise heightened sensitivity … Acceptance of new protocols occurs when there is involvement and ownership at the local-unit level rather … than solely imposed externally.

435. In Conversation With… Kathleen Sutcliffe, MN, PhD | PSNet
     psnet.ahrq.gov/perspective/conversation-kathleen-sutcliffe-mn-phd
     April 26, 2023 - Rather than going to a school of public health, I chose to go to a business school, in part because I … We started discussing how this idea of high reliability was probably more generalizable than had been … literature even in non–health care was fairly sparse and more around crisis management, Tylenol, etc. rather … In fact, knowing that we've been on this good run sometimes contributes to less vigilance rather than

436. Spotlight Case [MONTH] 2003 (ppt file)
     psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.143_slideshow.ppt
     January 01, 2015 - linear, focused questions based on a succinct chief complaint Providers quickly focus in on the problem rather … than identifying the broader agenda In practice, only one-third of clinical encounters begin with open-ended … I know my kid better than anyone.” Worried: “Will it heal correctly now?” … Current System: Provider-Centered Care Many current systems seem designed to meet needs of providers rather … than patients, supported by varying adoption of patient-centered practices in a recent survey Audet

437. Multiple Levels Involved in Prescribing the Wrong Medication | PSNet
     psnet.ahrq.gov/web-mm/multiple-levels-involved-prescribing-wrong-medication
     December 23, 2020 - psychologist James Reason, suggests that safety failures are rarely caused by a single human error; rather … There was not a single cause of this adverse drug event, but rather multiple failures in the system.  … than the provider entering every order themselves. … , or its brand name, Topamax™, than does trimethobenzamide alone.   … The provider approving topiramate rather than trimethobenzamide is an individual level error, which occurred

438. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/49584/psn-pdf
     April 01, 2009 - Rather, the errors were in (i) weak linkages among computer systems, (ii) insufficient safeguards against … than a gain in clinical insights. … than the kilograms the software expects. … Implementations are more wrenching than they need to be. … EMRs are undoubtedly better than paper records.

439. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/73998/psn-pdf
     October 27, 2021 - and intravenous fluids were infused under pressure into the external jugular intravenous catheter rather … than the femoral central venous catheter.  … Shorter catheters provide less resistance to flow than longer ones and thus are preferred when rapid … anesthesiologist in this case chose to place an intravenous catheter in the external jugular vein rather … than in another large-bore vein such as the saphenous or antecubital vein. 

440. Vial Mistakes Involving Heparin | PSNet
     psnet.ahrq.gov/web-mm/vial-mistakes-involving-heparin
     May 11, 2014 - When the ACT returned normal rather than prolonged (as it should have been after the heparin), the anesthesiologist … He quickly realized that the heparin vial from the garbage was a 10 units/mL concentration rather than … and three were injured when nurses administered heparin flushes prepared from 10,000 units/mL vials rather … than from similar-looking vials containing the 10 units/mL concentration used to flush intravenous catheters … heparin selections had a four-fold higher incidence of averted programming errors identified by the DERS than