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psnet.ahrq.gov/issue/learning-samples-one-or-fewer
December 21, 2017 - Review
Classic
Learning from samples of one or fewer. … Citation Text:
Learning from samples of one or fewer. March JG, Sproull LS, Tamuz M. … Copy URL
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Citation Text:
Learning from samples
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psnet.ahrq.gov/issue/do-medication-samples-jeopardize-patient-safety
November 16, 2022 - Study
Do medication samples jeopardize patient safety? … Do medication samples jeopardize patient safety? … Do medication samples jeopardize patient safety?
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psnet.ahrq.gov/node/38372/psn-pdf
April 09, 2009 - Do medication samples jeopardize patient safety? … Do medication samples jeopardize patient safety? … https://psnet.ahrq.gov/issue/do-medication-samples-jeopardize-patient-safety
Prior research has demonstrated … https://psnet.ahrq.gov/issue/do-medication-samples-jeopardize-patient-safety
https://psnet.ahrq.gov/issue
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psnet.ahrq.gov/node/34719/psn-pdf
December 23, 2008 - Learning from samples of one or fewer.
December 23, 2008
March JG, Sproull LS, Tamuz M. … https://psnet.ahrq.gov/issue/learning-samples-one-or-fewer
Organizations learn from experience. … https://psnet.ahrq.gov/issue/learning-samples-one-or-fewer
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psnet.ahrq.gov/node/49436/psn-pdf
February 26, 2004 - In
a 10-nation study of more than 690,000 blood samples from 62 hospitals, the median rate of sample … Mislabeled samples—samples with labels not meeting locally accepted standards—had an even higher but … A different study of tested samples rejected
because of mislabeling showed that these samples had a … 40-fold higher rate of blood type discrepancies
than correctly labeled samples.(3) These data indicate … Paradoxically, since inadequately labeled samples give the lab some degree of warning, they afford less
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psnet.ahrq.gov/node/47603/psn-pdf
March 20, 2019 - Investigators found that use of barcoding improved the accuracy of
labels on blood samples and samples … The authors conclude that the results support the use of barcoding and the
exclusion of blood samples
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psnet.ahrq.gov/web-mm/transfusion-slip
June 14, 2011 - Miscollected blood samples—the wrong blood in the tube—are a common problem in blood transfusion. … In a 10-nation study of more than 690,000 blood samples from 62 hospitals, the median rate of sample … Mislabeled samples—samples with labels not meeting locally accepted standards—had an even higher but … A different study of tested samples rejected because of mislabeling showed that these samples had a 40 … -fold higher rate of blood type discrepancies than correctly labeled samples.( 3 ) These data indicate
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psnet.ahrq.gov/issue/electronic-patient-identification-sample-labeling-reduces-wrong-blood-tube-errors
September 20, 2012 - Investigators found that use of barcoding improved the accuracy of labels on blood samples and samples … The authors conclude that the results support the use of barcoding and the exclusion of blood samples
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psnet.ahrq.gov/node/50949/psn-pdf
February 26, 2020 - The samples were dropped off at the central laboratory receiving window where the
time/date of receipt … Upon arrival at the satellite facility, samples are
logged and accessioned for testing at their respective … As per
routine procedure, the Clinical Laboratory immediately sequestered all samples related to the … The
frequency of lost samples reflects the challenges faced by hospital laboratories. … Blood bank safety practices: Mislabeled samples and
wrong blood in tube – a Q-Probes analysis of 122
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psnet.ahrq.gov/web-mm/urine-tough-position
January 01, 2009 - Both patients were asked to resubmit urine samples; in fact, the patient was pregnant. … The physician was placed in the awkward position of informing the patient that the samples had been switched … It was fortuitous that the laboratory technician realized that the samples had been swapped due to the … In addition, samples may not be labeled at all, or may be labeled only after the patient has left. … Barcode technology is another way of tracking samples and linking patients accurately to their samples
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psnet.ahrq.gov/web-mm/pre-analytical-pitfalls-missing-and-mislabeled-specimens
April 18, 2018 - The samples were dropped off at the central laboratory receiving window where the time/date of receipt … Upon arrival at the satellite facility, samples are logged and accessioned for testing at their respective … As per routine procedure, the Clinical Laboratory immediately sequestered all samples related to the … The frequency of lost samples reflects the challenges faced by hospital laboratories. … Blood bank safety practices: Mislabeled samples and wrong blood in tube – a Q-Probes analysis of 122
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psnet.ahrq.gov/sites/default/files/2024-08/spotlight_case_a_fatal_twist_in_pseudohyperkalemia_slides.pptx
January 01, 2024 - is common, contributing to approximately 40% of all laboratory errors and affecting up to 12% of all samples … , intravascular hemolysis) or non-biological conditions during the collection and handling of blood samples … one retrospective study, the mean difference in potassium concentration between in vitro hemolyzed samples … and non-hemolyzed samples was 1.9 mmol/L, with a minimum and maximum difference of 0.7 and 4.6 mmol/ … be unable to detect hemolysis.3
Increasing awareness of spurious results due to hemolysis:
If lab samples
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psnet.ahrq.gov/node/866618/psn-pdf
December 31, 2024 - common, contributing to approximately 40% of all laboratory errors and affecting up to
12% of all samples … during the collection and handling of blood
https://psnet.ahrq.gov//#1
https://psnet.ahrq.gov//#2
samples … one
retrospective study, the mean difference in potassium concentration between in vitro hemolyzed samples … and non-hemolyzed samples was 1.9 mmol/L, with a minimum and maximum difference of 0.7 and 4.6
mmol … be unable to detect hemolysis.3
Increasing awareness of spurious results due to hemolysis:
If lab samples
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psnet.ahrq.gov/web-mm/fatal-twist-pseudohyperkalemia
February 10, 2021 - is common, contributing to approximately 40% of all laboratory errors and affecting up to 12% of all samples … , intravascular hemolysis) or non-biological conditions during the collection and handling of blood samples … one retrospective study, the mean difference in potassium concentration between in vitro hemolyzed samples … and non-hemolyzed samples was 1.9 mmol/L, with a minimum and maximum difference of 0.7 and 4.6 mmol/ … be unable to detect hemolysis. 3 Increasing awareness of spurious results due to hemolysis: If lab samples
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psnet.ahrq.gov/node/43646/psn-pdf
January 01, 2021 - hospital-performance-trends-national-quality-measures-and-association-joint-commission
https://psnet.ahrq.gov/issue/learning-samples-one-or-fewer
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psnet.ahrq.gov/node/47515/psn-pdf
February 25, 2019 - A
WebM&M commentary explored problems associated with mislabeled blood samples.
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psnet.ahrq.gov/node/36075/psn-pdf
September 28, 2010 - present a protocol to measure and assess specimen-to-specimen contamination in large
sets of laboratory samples
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psnet.ahrq.gov/node/36027/psn-pdf
March 28, 2011 - screening
process may serve as an important method to survey patient safety in large population-based samples
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psnet.ahrq.gov/node/36469/psn-pdf
September 27, 2010 - follow the Institute for Safe Medication Practices'
recommendations for safe distribution of medication samples
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psnet.ahrq.gov/node/845348/psn-pdf
February 02, 2012 - Of the
27 rescreened samples, 16 were recategorized to positive.