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  1. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49576/psn-pdf
    January 01, 2009 - Accordingly, policies may be very https://psnet.ahrq.gov//#references https://psnet.ahrq.gov//#references … https://psnet.ahrq.gov//#references https://psnet.ahrq.gov//#references https://psnet.ahrq.gov//#references … Changing EMS Policy https://psnet.ahrq.gov//#references https://psnet.ahrq.gov//#references This is … References 1. Pham JC, Patel R, Millin MG, Kirsch TD, Chanmugam A. … [go to PubMed] https://psnet.ahrq.gov//#references http://www.ncbi.nlm.nih.gov/pubmed/16946281 http:
  2. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49574/psn-pdf
    November 01, 2008 - https://psnet.ahrq.gov/web-mm/mid-summer-fog https://psnet.ahrq.gov//#references This case clearly … https://psnet.ahrq.gov/issue/national-surgical-quality-improvement-program https://psnet.ahrq.gov//#references … https://psnet.ahrq.gov//#references Basic principles of adult learning suggest that content-heavy … https://psnet.ahrq.gov//#references https://psnet.ahrq.gov//#references https://psnet.ahrq.gov//#references … https://psnet.ahrq.gov//#references Finally, the variety of approaches that hospitals take to improve
  3. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49456/psn-pdf
    July 12, 2004 - https://psnet.ahrq.gov//#references https://psnet.ahrq.gov//#references https://psnet.ahrq.gov//#references … https://psnet.ahrq.gov//#references https://psnet.ahrq.gov//#references https://psnet.ahrq.gov//#references … https://psnet.ahrq.gov//#references https://psnet.ahrq.gov//#figure Errors during cross-coverage are … Clinical Professor Assistant Chief of the Medical Service University of California, San Francisco References
  4. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49616/psn-pdf
    December 01, 2010 - colleagues reported that the most common errors in the medication use process in https://psnet.ahrq.gov//#references … https://psnet.ahrq.gov//#references https://psnet.ahrq.gov//#references https://psnet.ahrq.gov//#references … https://psnet.ahrq.gov//#references children occurred during physician prescribing (74%) and nurse … https://psnet.ahrq.gov//#references https://psnet.ahrq.gov//#table https://psnet.ahrq.gov//#references … Francisco Tessa Dixon, PharmD Pharmacy Resident, Lucile Packard Children's Hospital at Stanford   References
  5. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49790/psn-pdf
    April 01, 2017 - https://psnet.ahrq.gov/web-mm/patient-allergies-and-electronic-health-records https://psnet.ahrq.gov//#references … If an https://psnet.ahrq.gov//#references https://psnet.ahrq.gov//#references https://psnet.ahrq.gov … //#references https://psnet.ahrq.gov//#references electronic health record allows coded entries differentiating … Doyle, MBBS GP Principal Indigo Medical Jersey, Channel Islands References 1.
  6. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49506/psn-pdf
    March 01, 2006 - https://psnet.ahrq.gov//#box https://psnet.ahrq.gov//#references https://psnet.ahrq.gov//#references … https://psnet.ahrq.gov//#references https://psnet.ahrq.gov//#references https://psnet.ahrq.gov//#references … If the resident finds an https://psnet.ahrq.gov//#references https://psnet.ahrq.gov//#references https … ://psnet.ahrq.gov//#references https://psnet.ahrq.gov//#figure https://psnet.ahrq.gov//#figure https: … References 1. Hunter TB, Krupinski EA, Hunt KR, Erly WK.
  7. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49565/psn-pdf
    July 01, 2008 - tendency to cast blame and https://psnet.ahrq.gov/web-mm/wrong-route-nutrients https://psnet.ahrq.gov//#references … it can be argued that the LPN was not attempting to be reckless with her https://psnet.ahrq.gov//#references … https://psnet.ahrq.gov//#references https://psnet.ahrq.gov//#references https://psnet.ahrq.gov//#references … Scott-Cawiezell, RN, PhD Associate Professor University of Missouri-Columbia, Sinclair School of Nursing References … [go to PubMed] https://psnet.ahrq.gov//#references http://www.ncbi.nlm.nih.gov/pubmed/15636418 http:
  8. psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.266_slideshow.ppt
    May 01, 2012 - float services when residents care for patients for whom they lack primary knowledge See Notes for references … of attending physicians and residents currently responsible for each patient’s care See Notes for references … that these techniques improve clinical practice; unclear impact on patient outcomes See Notes for references … feedback from trained ‘receiver’ Practice-based audit tools to improve written sign-out See Notes for references … synopsis, relevant action items, anticipatory guidance with corresponding rationale See Notes for references
  9. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49514/psn-pdf
    July 01, 2006 - information from the patient, any https://psnet.ahrq.gov/web-mm/one-ace-too-many https://psnet.ahrq.gov//#references … (RALES), only 1.7% of heart failure patients treated with spironolactone https://psnet.ahrq.gov//#references … https://psnet.ahrq.gov//#references https://psnet.ahrq.gov//#table https://psnet.ahrq.gov//#references … Departments of Medicine, Pediatrics, and Health Policy, Management, and Evaluation University of Toronto References … [go to PubMed] https://psnet.ahrq.gov//#references https://psnet.ahrq.gov//#references http://www.ncbi.nlm.nih.gov
  10. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49667/psn-pdf
    October 01, 2012 - Unfortunately, there are limits to medication-safety https://psnet.ahrq.gov//#references https://psnet.ahrq.gov … //#references https://psnet.ahrq.gov//#references https://psnet.ahrq.gov//#references https://psnet.ahrq.gov … //#references engineering. … Manias, PhD, RN, MPharm Professor Melbourne School of Health Sciences The University of Melbourne References … name=anchoringerror https://psnet.ahrq.gov//#references http://www.ncbi.nlm.nih.gov/pubmed/18238771
  11. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49520/psn-pdf
    September 01, 2006 - these differences in https://psnet.ahrq.gov/web-mm/dnr-or-and-afterwards https://psnet.ahrq.gov//#references … https://psnet.ahrq.gov//#references both approach to and outcomes of life-sustaining interventions … these issues with patients or surrogates and be guided by their informed https://psnet.ahrq.gov//#references … https://psnet.ahrq.gov//#references https://psnet.ahrq.gov//#references preferences and choices.(6 … [go to PubMed] https://psnet.ahrq.gov//#references https://psnet.ahrq.gov//#table http://www.ncbi.nlm.nih.gov
  12. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49692/psn-pdf
    September 01, 2013 - workarounds might be considered comparable to a "near miss," that is, an https://psnet.ahrq.gov//#references … https://psnet.ahrq.gov//#references https://psnet.ahrq.gov//#references https://psnet.ahrq.gov//#references … https://psnet.ahrq.gov//#references opportunity to recognize a dysfunction in the existing system. … Awareness Officer, Veterans Health Administration Director, VA National Center for Patient Safety References … [go to PubMed] https://psnet.ahrq.gov//#references http://www.ncbi.nlm.nih.gov/pubmed/12091660 http:
  13. Spotlight Case (ppt file)

    psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.275_slideshow.ppt
    August 01, 2012 - Up to 25% of these lawsuits are from avoidable failures in the test follow-up system See Notes for references … few times a year, they have seen a patient worsen due to delays in lab test follow-up See Notes for references … lists Forwarding capability and allowing the use of surrogates during planned absences See Notes for references … handoff procedures to manage results during times of provider absence (i.e., weekends) See Notes for references … due to "fatigue" on the part of the clinicians (too many alerts become overwhelming) 18 See Notes for references
  14. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49584/psn-pdf
    April 01, 2009 - implementation and usability difficulties, which I will review below.(2,3) https://psnet.ahrq.gov//#references … https://psnet.ahrq.gov//#references https://psnet.ahrq.gov//#references Potential Challenges with … While these https://psnet.ahrq.gov//#references https://psnet.ahrq.gov//#references https://psnet.ahrq.gov … //#references https://psnet.ahrq.gov//#table https://psnet.ahrq.gov//#references house officers uniformly … https://psnet.ahrq.gov//#references https://psnet.ahrq.gov//#references Although the present case was
  15. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49550/psn-pdf
    December 01, 2007 - web-mm/deaths-not-foretold-are-unexpected-deaths-useful-patient-safety-signals https://psnet.ahrq.gov//#references … "(8) In absolute terms, however, the https://psnet.ahrq.gov//#references https://psnet.ahrq.gov//#references … https://psnet.ahrq.gov//#table https://psnet.ahrq.gov//#references https://psnet.ahrq.gov//#references … https://psnet.ahrq.gov//#references https://psnet.ahrq.gov//#table https://psnet.ahrq.gov//#references … https://psnet.ahrq.gov//#references https://psnet.ahrq.gov//#references rate of quality problems was
  16. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49567/psn-pdf
    September 01, 2008 - point to https://psnet.ahrq.gov/web-mm/empiric-steroids-good-bad-and-ugly https://psnet.ahrq.gov//#references … https://psnet.ahrq.gov//#references https://psnet.ahrq.gov//#references support a search is that there … https://psnet.ahrq.gov//#references https://psnet.ahrq.gov//#references compare targeted treatment … https://psnet.ahrq.gov//#references https://psnet.ahrq.gov//#references While awaiting other tests, … References 1. Mikami K, Suzuki M, Kitagawa H, et al.
  17. psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.227_slideshow.ppt
    November 01, 2010 - days of discharge from the hospital 9%-48% of hospital re-admissions are preventable See Notes for references … follow-up visit Post-discharge, patients often have heightened needs for timely care See Notes for references … treatment Account for 25% of diagnosis-related malpractice law suits from one insurer * See Notes for references … with high patient safety awareness in general Presence of electronic medical record * See Notes for references … telephone calls, scheduling appointments for patients within 1 week of discharge) * See Notes for references
  18. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49685/psn-pdf
    May 01, 2013 - https://psnet.ahrq.gov//#references https://psnet.ahrq.gov//#references https://psnet.ahrq.gov//#references … https://psnet.ahrq.gov//#references Using multiple pharmacies (unless it involves a chain with an … Dean, School of Pharmacy Professor of Clinical Pharmacy University of California, San Francisco References
  19. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49495/psn-pdf
    December 01, 2005 - received an invasive cardiac procedure intended for another patient.(5) https://psnet.ahrq.gov//#references … https://psnet.ahrq.gov//#figure https://psnet.ahrq.gov//#references https://psnet.ahrq.gov//#references … https://psnet.ahrq.gov//#references https://psnet.ahrq.gov//#references https://psnet.ahrq.gov//#referencesReferences https://psnet.ahrq.gov//#references 1. Sexton J, Helmreich R, Thomas E. … cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12679507 https://psnet.ahrq.gov//#references https://www.ahrq.gov
  20. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49824/psn-pdf
    March 01, 2018 - means that personnel must respond, set up the laboratory, receive and prepare https://psnet.ahrq.gov//#references … https://psnet.ahrq.gov//#references https://psnet.ahrq.gov//#references https://psnet.ahrq.gov//#references … https://psnet.ahrq.gov//#references https://psnet.ahrq.gov//#references Emergency department personnel … Chair Department of Emergency Medicine University of Virginia School of Medicine Charlottesville, VA References

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