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Showing results for "represented".

  1. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49387/psn-pdf
    February 01, 2003 - observed.(2) In one study that used a variety of record review approaches, “wrong drug or patient” errors represented

  2. Prospective memory in the ICU: the effect of visual cues on task execution in a representative simulation. | PSNet

    psnet.ahrq.gov/issue/prospective-memory-icu-effect-visual-cues-task-execution-representative-simulation
    April 24, 2018 - Study Prospective memory in the ICU: the effect of visual cues on task execution in a representative simulation. Citation Text: Grundgeiger T, Sanderson PM, Orihuela B, et al. Prospective memory in the ICU: the effect of visual cues on task execution in a representative simulation. Ergo…

  3. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/41580/psn-pdf
    June 10, 2018 - Raising the index of suspicion: red flags that represent credible threats to patient safety. June 10, 2018 ISMP Medication Safety Alert! Acute Care Edition. July 26, 2012;17:1-3. https://psnet.ahrq.gov/issue/raising-index-suspicion-red-flags-represent-credible-threats-patient-safety This newsletter article highlig…

  4. Using a pediatric trigger tool to estimate total harm burden hospital-acquired conditions represent. | PSNet

    psnet.ahrq.gov/issue/using-pediatric-trigger-tool-estimate-total-harm-burden-hospital-acquired-conditions
    July 03, 2016 - Study Using a pediatric trigger tool to estimate total harm burden hospital-acquired conditions represent. Citation Text: Stockwell DC, Landrigan CP, Schuster MA, et al. Using a Pediatric Trigger Tool to Estimate Total Harm Burden Hospital-acquired Conditions Represent. Pediatr Qual Saf.…

  5. Error | PSNet

    psnet.ahrq.gov/taxonomy/term/3475
    June 09, 2025 - Error An act of commission (doing something wrong) or omission (failing to do the right thing) that leads to an undesirable outcome or significant potential for such an outcome. For instance, ordering a medication for a patient with a documented allergy to that medication would be an act of commission. Failing to pre…

  6. Patient Mix-Up | PSNet

    psnet.ahrq.gov/web-mm/patient-mix
    December 01, 2007 - .( 2 ) In one study that used a variety of record review approaches, “wrong drug or patient” errors represented

  7. A Picture Speaks 1000 Words | PSNet

    psnet.ahrq.gov/web-mm/picture-speaks-1000-words
    July 16, 2015 - due to a resident's failure to recognize certain pathology or the risk that the identified pathology represented

  8. Is It Safe to Be Direct? | PSNet

    psnet.ahrq.gov/web-mm/it-safe-be-direct
    September 30, 2015 - admitting office before a bed became available while also not receiving evaluation and treatment likely represented

  9. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49430/psn-pdf
    January 01, 2004 - The decision of the charge nurse may have represented a failure of communication between the two nurses

  10. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49526/psn-pdf
    December 01, 2006 - , it seems far more likely that the patient’s expectation of a positive home visit on her birthday represented

  11. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/33745/psn-pdf
    February 01, 2013 - representing the unrecognized needs of children completing cancer treatment, family caregivers, and under-represented

  12. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49805/psn-pdf
    September 01, 2017 - concluded that the delay in diagnosis of internal mesenteric artery dissection and bowel infarction represented

  13. Near Miss With Neonate | PSNet

    psnet.ahrq.gov/web-mm/near-miss-neonate
    August 15, 2018 - vaginal and rectal swab after a transition in care, despite a documented positive urine culture for GBS, represented

  14. Back to Basics | PSNet

    psnet.ahrq.gov/web-mm/back-basics
    July 13, 2010 - This decision making represented the wrong approach in this setting, an example of a rule-based error

  15. How Do Providers Recover From Errors? | PSNet

    psnet.ahrq.gov/web-mm/how-do-providers-recover-errors
    May 22, 2024 - This figure represented an underestimate of the true proportion, since it included residents completing

  16. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/866812/psn-pdf
    September 25, 2024 - Patient perspectives on adverse event investigations in health care. September 25, 2024 Dijkstra-Eijkemans RI, Knap LJ, Elbers NA, et al. Patient perspectives on adverse event investigations in health care. BMC Health Serv Res. 2024;24(1):1044. doi:10.1186/s12913-024-11522-x. https://psnet.ahrq.gov/issue/patient-p…

  17. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/74118/psn-pdf
    January 01, 2022 - From HRO to HERO: making health equity a core system capability. November 24, 2021 Moy E, Hausmann LRM, Clancy CM. From HRO to HERO: making health equity a core system capability. Am J Med Qual. 2022;37(1):81-83. doi:10.1097/jmq.0000000000000020. https://psnet.ahrq.gov/issue/hro-hero-making-health-equity-core-syst…

  18. Emergency Error | PSNet

    psnet.ahrq.gov/web-mm/emergency-error
    January 18, 2013 - The committee's judgment was that this represented a diagnostic error and that this was a preventable

  19. Oversight Hearing on Recent Patient Safety Issues. | PSNet

    psnet.ahrq.gov/issue/oversight-hearing-recent-patient-safety-issues
    November 06, 2019 - Congressional Testimony Oversight Hearing on Recent Patient Safety Issues. Citation Text: Oversight Hearing on Recent Patient Safety Issues. U.S. Department of Veterans Affairs. Hearing before the Committee on Veterans’ Affairs, House of Representatives, Subcommittee on Oversight and…

  20. Lessons Learned? Building a Culture of Patient Safety Within the Veterans Health Administration. | PSNet

    psnet.ahrq.gov/issue/lessons-learned-building-culture-patient-safety-within-veterans-health-administration
    November 06, 2019 - Congressional Testimony Lessons Learned? Building a Culture of Patient Safety Within the Veterans Health Administration. Citation Text: Lessons Learned? Building a Culture of Patient Safety Within the Veterans Health Administration. US House of Representatives Committee on Veterans' Affa…
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