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Showing results for "reporting".

9921. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/844791/psn-pdf
      September 18, 2019 - Review of alternatives to root cause analysis: developing a robust system for incident report analysis. September 18, 2019 Hagley G, Mills PD, Watts B, et al. Review of alternatives to root cause analysis: developing a robust system for incident report analysis. BMJ Open Qual. 2019;8(3):e000646. doi:10.1136/bmjoq-2…

9922. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/44585/psn-pdf
      November 04, 2015 - Evaluation of near-miss wrong-patient events in radiology reports. November 4, 2015 Sadigh G, Loehfelm T, Applegate KE, et al. JOURNAL CLUB: Evaluation of Near-Miss Wrong-Patient Events in Radiology Reports. AJR Am J Roentgenol. 2015;205(2):337-43. doi:10.2214/AJR.14.13339. https://psnet.ahrq.gov/issue/evaluation-…

9923. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/43149/psn-pdf
      July 23, 2014 - FDASIA Health IT Report: Proposed Strategy and Recommendations for a Risk-Based Framework. July 23, 2014 Washington, DC: Office of the National Coordinator for Health Information Technology, Federal Communications Commission. Silver Spring, MD: Food and Drug Administration. April 2014. https://psnet.ahrq.gov/issue…

9924. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/840167/psn-pdf
      November 16, 2022 - 'Reading the Signals' : Maternity and Neonatal Services in East Kent – the Report of the Independent Investigation. November 16, 2022 Kirkup B. Department of Health and Social Care. London, England: Crown Copyright; 2022.  ISBN: 9781528636759. https://psnet.ahrq.gov/issue/reading-signals-maternity-and-neonata…

9925. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/867020/psn-pdf
      October 23, 2024 - What can we learn from coroners’ reports on preventable deaths? October 23, 2024 Jeraj S. What can we learn from coroners’ reports on preventable deaths? BMJ. 2024;386:q1943. https://psnet.ahrq.gov/issue/what-can-we-learn-coroners-reports-preventable-deaths Analysis of system failure is only the beginning of the i…

9926. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/47156/psn-pdf
      November 28, 2018 - Antidepressant and antipsychotic medication errors reported to United States poison control centers. November 28, 2018 Kamboj A, Spiller HA, Casavant MJ, et al. Antidepressant and antipsychotic medication errors reported to United States poison control centers. Pharmacoepidemiol Drug Saf. 2018;27(8):902-911. doi:1…

9927. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/45553/psn-pdf
      October 13, 2018 - Computerized prescriber order entry–related patient safety reports: analysis of 2522 medication errors. October 13, 2018 Amato MG, Salazar A, Hickman T-TT, et al. Computerized prescriber order entry-related patient safety reports: analysis of 2522 medication errors. J Am Med Inform Assoc. 2017;24(2):316-322. doi:1…

9928. Emergency department visits for outpatient adverse drug events: demonstration for a national surveillance system. | PSNet
      psnet.ahrq.gov/issue/emergency-department-visits-outpatient-adverse-drug-events-demonstration-national
      February 14, 2017 - Study Emergency department visits for outpatient adverse drug events: demonstration for a national surveillance system. Citation Text: Budnitz DS, Pollock DA, Mendelsohn AB, et al. Emergency department visits for outpatient adverse drug events: demonstration for a national surveillance …

9929. Action Planning Tool for the AHRQ Surveys on Patient Safety Culture. | PSNet
      psnet.ahrq.gov/issue/action-planning-tool-ahrq-surveys-patient-safety-culture
      February 12, 2019 - Toolkit Action Planning Tool for the AHRQ Surveys on Patient Safety Culture. Citation Text: Action Planning Tool for the AHRQ Surveys on Patient Safety Culture. Yount N, Edelman S, Sorra J, et al. Rockville, MD: Agency for Healthcare Research and Quality; November 2022. AHRQ Publication …

9930. It is time to define antimicrobial never events. | PSNet
      psnet.ahrq.gov/issue/it-time-define-antimicrobial-never-events
      November 16, 2022 - Commentary It is time to define antimicrobial never events. Citation Text: Liu J, Kaye KS, Mercuro NJ, et al. It is time to define antimicrobial never events. Infect Control Hosp Epidemiol. 2019;40(2):206-207. doi:10.1017/ice.2018.313. Copy Citation Format: DOI Google Schol…

9931. Recommendations and low-technology safety solutions following neuromuscular blocking agent incidents. | PSNet
      psnet.ahrq.gov/issue/recommendations-and-low-technology-safety-solutions-following-neuromuscular-blocking-agent
      October 02, 2024 - Commentary Recommendations and low-technology safety solutions following neuromuscular blocking agent incidents. Citation Text: Graudins L, Downey G, Bui T, et al. Recommendations and Low-Technology Safety Solutions Following Neuromuscular Blocking Agent Incidents. Jt Comm J Qual Patient…

9932. Infusion medication error reduction by two-person verification: a quality improvement initiative. | PSNet
      psnet.ahrq.gov/issue/infusion-medication-error-reduction-two-person-verification-quality-improvement-initiative
      June 19, 2019 - Commentary Infusion medication error reduction by two-person verification: a quality improvement initiative. Citation Text: Subramanyam R, Mahmoud M, Buck D, et al. Infusion Medication Error Reduction by Two-Person Verification: A Quality Improvement Initiative. Pediatrics. 2016;138(6). …

9933. Deprescribing: a simple method for reducing polypharmacy. | PSNet
      psnet.ahrq.gov/issue/deprescribing-simple-method-reducing-polypharmacy
      September 09, 2015 - Commentary Deprescribing: a simple method for reducing polypharmacy. Citation Text: McGrath K, Hajjar ER, Kumar C, et al. Deprescribing: A simple method for reducing polypharmacy. J Fam Pract. 2017;66(7):436-445. https://www.mdedge.com/familymedicine/article/141753/practice-management/de…

9934. Development of a standardized, citywide process for managing smart-pump drug libraries. | PSNet
      psnet.ahrq.gov/issue/development-standardized-citywide-process-managing-smart-pump-drug-libraries
      June 07, 2017 - Commentary Development of a standardized, citywide process for managing smart-pump drug libraries. Citation Text: Walroth TA, Smallwood S, Arthur KJ, et al. Development of a standardized, citywide process for managing smart-pump drug libraries. Am J Health Syst Pharm. 2018;75(12):893-900…

9935. Public comment period extended for strategies to improve patient safety: Draft Report to Congress for Public Comment and Review by the National Academy of Medicine. | PSNet
      psnet.ahrq.gov/issue/public-comment-period-extended-strategies-improve-patient-safety-draft-report-congress-public
      June 16, 2021 - Press Release/Announcement Public comment period extended for strategies to improve patient safety: Draft Report to Congress for Public Comment and Review by the National Academy of Medicine. Citation Text: Public comment period extended for strategies to improve patient safety: Draft Re…

9936. A call to action for anticoagulation stewardship. | PSNet
      psnet.ahrq.gov/issue/call-action-anticoagulation-stewardship
      March 04, 2020 - Commentary A call to action for anticoagulation stewardship. Citation Text: Burnett AE, Barnes GD. A call to action for anticoagulation stewardship. Res Pract Thromb Haemost. 2022;6(5):e12757. doi:10.1002/rth2.12757. Copy Citation Format: DOI Google Scholar BibTeX EndNote X…

9937. Applying Lean Sigma solutions to mistake-proof the chemotherapy preparation process. | PSNet
      psnet.ahrq.gov/issue/applying-lean-sigma-solutions-mistake-proof-chemotherapy-preparation-process
      September 02, 2015 - Commentary Applying Lean Sigma solutions to mistake-proof the chemotherapy preparation process. Citation Text: Aboumatar HJ, Winner L, Davis RO, et al. Applying Lean Sigma solutions to mistake-proof the chemotherapy preparation process. Jt Comm J Qual Patient Saf. 2010;36(2):79-86. Cop…

9938. Hospital Survey on Patient Safety Culture 2.0. | PSNet
      psnet.ahrq.gov/issue/hospital-survey-patient-safety-culture-20
      October 23, 2019 - Database/Directory Hospital Survey on Patient Safety Culture 2.0. Citation Text: Hospital Survey on Patient Safety Culture 2.0. Rockville, MD: Agency for Healthcare Research and Quality; 2019. Copy Citation Save Save to your library Print Download PDF …

9939. A Conversation with Patient Safety Officers. | PSNet
      psnet.ahrq.gov/issue/conversation-patient-safety-officers
      April 30, 2024 - Book/Report A Conversation with Patient Safety Officers. Citation Text: A Conversation with Patient Safety Officers. Harrisburg, PA: Patient Safety Authority; 2007. Copy Citation Save Save to your library Print Download PDF Share Facebook…

9940. Exploring the Costs of Unsafe Care in the NHS: A Report Prepared for the Department of Health. | PSNet
      psnet.ahrq.gov/issue/exploring-costs-unsafe-care-nhs-report-prepared-department-health
      July 10, 2019 - Book/Report Exploring the Costs of Unsafe Care in the NHS: A Report Prepared for the Department of Health. Citation Text: Exploring the Costs of Unsafe Care in the NHS: A Report Prepared for the Department of Health. London, UK: Frontier Economics Ltd; October 2014. Copy Citation …