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Showing results for "situation".

2601. High Reliability Organization (HRO) Principles and Patient Safety | PSNet
      psnet.ahrq.gov/perspective/high-reliability-organization-hro-principles-and-patient-safety
      February 26, 2025 - Commitment to resilience: Awareness of the unpredictability of the system and its inherent risks, leading to situation

2602. The new medical errors: how to protect yourself. | PSNet
      psnet.ahrq.gov/issue/new-medical-errors-how-protect-yourself
      June 09, 2021 - Newspaper/Magazine Article The new medical errors: how to protect yourself. Citation Text: Lunzer Kritz F. Copy Citation Save Save to your library Print Share Facebook Twitter Linkedin Copy URL November 23, 2005 …

2603. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/33845/psn-pdf
      November 01, 2017 - In Conversation With… Wanda Pratt, PhD November 1, 2017 In Conversation With… Wanda Pratt, PhD. PSNet [internet]. 2017. https://psnet.ahrq.gov/perspective/conversation-wanda-pratt-phd Editor's note: Wanda Pratt is a Professor in the Information School with an adjunct appointment in the Division of Biomedical and …

2604. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49423/psn-pdf
      November 01, 2003 - The Missing Suction Tip November 1, 2003 Thomas EJ, Moore FA. The Missing Suction Tip. PSNet [internet]. 2003. https://psnet.ahrq.gov/web-mm/missing-suction-tip Case Objectives Identify the risk factors for retained foreign bodies. Understand methods used to prevent and identify retained foreign bodies. Apprecia…

2605. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/74253/psn-pdf
      January 12, 2022 - Patient Safety Events and the Role of Patient Safety Organizations During the COVID-19 Pandemic January 12, 2022 Dickman R, Sharma P, Higgins D, et al. Patient Safety Events and the Role of Patient Safety Organizations During the COVID-19 Pandemic. PSNet [internet]. 2022. https://psnet.ahrq.gov/perspective/patient…

2606. Double Dosing, by the Rules | PSNet
      psnet.ahrq.gov/web-mm/double-dosing-rules
      February 03, 2010 - Double Dosing, by the Rules Citation Text: Cohen H. Double Dosing, by the Rules. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2009. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endnote tagg…

2607. Medication Reconciliation Pitfalls | PSNet
      psnet.ahrq.gov/web-mm/medication-reconciliation-pitfalls
      May 01, 2006 - Medication Reconciliation Pitfalls Citation Text: Weber RJ. Medication Reconciliation Pitfalls. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2010. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNote 7 X…

2608. Bowel Prep | PSNet
      psnet.ahrq.gov/web-mm/bowel-prep
      March 01, 2017 - Bowel Prep Citation Text: Nelson D. Bowel Prep. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2004. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged PubMedId RIS Downloa…

2609. Is the Admission Drug Dose Too Low? | PSNet
      psnet.ahrq.gov/web-mm/admission-drug-dose-too-low
      September 01, 2011 - Is the Admission Drug Dose Too Low? Citation Text: Kaushal R, Abramson EL. Is the Admission Drug Dose Too Low?. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2009. Copy Citation Format: Google Scholar BibTeX EndNote X3…

2610. The Wrong Blade: A Lack of Familiarity With Pediatric Emergency Equipment | PSNet
      psnet.ahrq.gov/web-mm/wrong-blade-lack-familiarity-pediatric-emergency-equipment
      June 01, 2018 - The Wrong Blade: A Lack of Familiarity With Pediatric Emergency Equipment Citation Text: Katznelson J. The Wrong Blade: A Lack of Familiarity With Pediatric Emergency Equipment. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2018. …

2611. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49688/psn-pdf
      August 21, 2013 - Discharge Instructions in the PACU: Who Remembers? August 21, 2013 Engel KG. Discharge Instructions in the PACU: Who Remembers? PSNet [internet]. 2013. https://psnet.ahrq.gov/web-mm/discharge-instructions-pacu-who-remembers The Case A 42-year-old woman was diagnosed with a torn anterior cruciate ligament (ACL) in …

2612. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49739/psn-pdf
      August 21, 2015 - Breathe Easy: Safe Tracheostomy Management August 21, 2015 Russell MS, Russell MD. Breathe Easy: Safe Tracheostomy Management. PSNet [internet]. 2015. https://psnet.ahrq.gov/web-mm/breathe-easy-safe-tracheostomy-management The Case A 75-year-old man was admitted to the hospital with sepsis due to multilobar pneumo…

2613. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49407/psn-pdf
      July 01, 2003 - Bleeding Risk July 1, 2003 Crowther MA. Bleeding Risk. PSNet [internet]. 2003. https://psnet.ahrq.gov/web-mm/bleeding-risk The Case A frail 78-year-old woman fell at home and fractured her left hip. Her past medical history included atrial fibrillation, hypertension, coronary artery disease, and stroke. The surgi…

2614. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/33650/psn-pdf
      May 01, 2007 - Patient Safety in the United Kingdom: Evolution and Progress May 1, 2007 Burnett S, Vincent CA. Patient Safety in the United Kingdom: Evolution and Progress. PSNet [internet]. 2007. https://psnet.ahrq.gov/perspective/patient-safety-united-kingdom-evolution-and-progress Perspective The dangers of health care in B…

2615. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/50701/psn-pdf
      November 26, 2019 - In Conversation With... Heidi Wald, MD November 26, 2019 In Conversation With.. Heidi Wald, MD. PSNet [internet]. 2019. https://psnet.ahrq.gov/perspective/conversation-heidi-wald-md Editor’s note: Dr. Wald, MD, MSPH, is the Chief Quality and Safety Officer at SCL Health in Denver, CO. She has previously served as …

2616. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49517/psn-pdf
      August 01, 2006 - Miscalculated Risk August 1, 2006 Strassels SA. Miscalculated Risk. PSNet [internet]. 2006. https://psnet.ahrq.gov/web-mm/miscalculated-risk The Case A healthy 36-year-old man was admitted to a teaching hospital for acute low back strain after lifting his 2- week-old infant. He received Vicodin (hydrocodone and a…

2617. Paradoxical Pulse | PSNet
      psnet.ahrq.gov/web-mm/paradoxical-pulse
      May 01, 2013 - Paradoxical Pulse Citation Text: Roy CL. Paradoxical Pulse. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2011. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged PubMedId RIS …

2618. An Easily Forgotten Tube | PSNet
      psnet.ahrq.gov/web-mm/easily-forgotten-tube
      June 01, 2016 - An Easily Forgotten Tube Citation Text: Ousey K. An Easily Forgotten Tube. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2014. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged Pub…

2619. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49715/psn-pdf
      August 21, 2014 - Liver Biopsy: Proceed With Caution August 21, 2014 Rockey DC. Liver Biopsy: Proceed With Caution. PSNet [internet]. 2014. https://psnet.ahrq.gov/web-mm/liver-biopsy-proceed-caution The Case A 42-year-old woman with a history of multiple malignancies, including osteosarcoma and recurrent breast cancer, presented t…

2620. Too Many Cooks Spotlight Pdf (pdf file)
      psnet.ahrq.gov/sites/default/files/2020-08/too_many_cooks_spotlight_pdf.pdf
      January 01, 2020 - Spotlight Too Many Cooks in the Kitchen Source and Credits • This presentation is based on the August 2020 AHRQ WebM&M Spotlight Case o See the full article at https://psnet.ahrq.gov/webmm o CME credit is available o Commentary by: Richard P. Dutton, MD, MBA o AHRQ WebM&M Editors in Chief: Patrick Romano, MD…