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Total Results: 1,062 records

Showing results for "wrong".

161. A biased test kept thousands of Black people from getting a kidney transplant. | PSNet
     psnet.ahrq.gov/issue/biased-test-kept-thousands-black-people-getting-kidney-transplant
     September 02, 2016 - determine eligibility for a kidney transplant and how transplant centers are working to correct that wrong … December 5, 2018 Third wrong-sided brain surgery at R.I. hospital.

162. Fecal Contamination of the Peritoneum from Laparoscopic Trocar Injury: A Routine Operation Goes Wrong. | PSNet
     psnet.ahrq.gov/web-mm/fecal-contamination-peritoneum-laparoscopic-trocar-injury-routine-operation-goes-wrong
     March 03, 2021 - Fecal Contamination of the Peritoneum from Laparoscopic Trocar Injury: A Routine Operation Goes Wrong … Fecal Contamination of the Peritoneum from Laparoscopic Trocar Injury: A Routine Operation Goes Wrong … Fecal Contamination of the Peritoneum from Laparoscopic Trocar Injury: A Routine Operation Goes Wrong … Fecal Contamination of the Peritoneum from Laparoscopic Trocar Injury: A Routine Operation Goes Wrong

163. Hardwiring patient blood management: harnessing information technology to optimize transfusion practice. | PSNet
     psnet.ahrq.gov/issue/hardwiring-patient-blood-management-harnessing-information-technology-optimize-transfusion
     September 20, 2012 - September 20, 2023 Electronic patient identification for sample labeling reduces wrong … March 20, 2019 Factors associated with wrong blood in tube errors: an international case … November 17, 2021 Emergency departments are higher-risk locations for wrong blood in

164. Patients' and physicians' attitudes regarding the disclosure of medical errors. | PSNet
     psnet.ahrq.gov/issue/patients-and-physicians-attitudes-regarding-disclosure-medical-errors
     March 21, 2017 - November 23, 2016 When Things Go Wrong: Voices of Patients and Families. … 18, 2016 More than words: patients' views on apology and disclosure when things go wrong … February 16, 2011 When Things Go Wrong: Responding to Adverse Events.

165. 40 of K | PSNet
     psnet.ahrq.gov/web-mm/40-k
     January 12, 2011 - The abbreviation "K" led to administration of the wrong drug. … accurately and efficiently evaluate medication orders for appropriateness.( 9 ) When an order is not clearly wrong … Available studies demonstrate that ADDs might reduce "wrong time" (usually late) medication errors, but … possibly increase risk for more serious wrong drug and wrong dose errors.( 14 ) The ISMP Medication

166. Strategies to Improve Organizational Health Literacy. | PSNet
     psnet.ahrq.gov/primer/strategies-improve-organizational-health-literacy
     August 30, 2023 - adverse events associated with health literacy include mistakes in diabetes management ; 1 taking the wrong … inhalers and aerosol medications; 4  falls; delays in receiving treatment, surgery, or tests ; and wrong … procedure or wrong site surgery. … WebM&M Cases Medication Errors in Retail Pharmacies: Wrong … Patient, Wrong Instructions.

167. Errors in otolaryngology revisited. | PSNet
     psnet.ahrq.gov/issue/errors-otolaryngology-revisited
     August 11, 2010 - For instance, wrong-site surgeries continue to occur despite garnering major attention over the past … RIS Download Citation Related Resources From the Same Author(s) Wrong-site

168. Adverse Events, Near Misses, and Errors | PSNet
     psnet.ahrq.gov/primer/adverse-events-near-misses-and-errors
     March 30, 2022 - Errors are defined as "an act of commission (doing something wrong) or omission (failing to do the right … Error : a broader term referring to any act of commission (doing something wrong) or omission (failing … June 1, 2022 View More Related WebM&M “This is the wrong patient's blood … : Evaluating a Near-Miss Wrong Transfusion Event January 29, 2020 Near Miss With Neonate October

169. Pharmacy dispensing of electronically discontinued medications. | PSNet
     psnet.ahrq.gov/issue/pharmacy-dispensing-electronically-discontinued-medications
     October 03, 2012 - June 23, 2009 Ventilator-associated pneumonia—the wrong quality measure for benchmarking … September 22, 2021 View More Related Resources Wrong drug and wrong

170. Effectiveness and efficiency of root cause analysis in medicine. | PSNet
     psnet.ahrq.gov/issue/effectiveness-and-efficiency-root-cause-analysis-medicine
     July 11, 2012 - September 14, 2016 Wrong-site and wrong-patient procedures in the Universal Protocol … October 13, 2010 Wrong-site craniotomy: analysis of 35 cases and systems for prevention

171. Case 34-2010: a 65-year-old woman with an incorrect operation on the left hand. | PSNet
     psnet.ahrq.gov/issue/case-34-2010-65-year-old-woman-incorrect-operation-left-hand
     March 13, 2013 - usual clinical focus, this article discusses a never event —a case of a patient who underwent the wrong … February 23, 2011 The wrong foot, and other tales of surgical error.

172. Importance of Following Safe Practices for Infant Feeding and Handling Expressed Breast Milk | PSNet
     psnet.ahrq.gov/web-mm/importance-following-safe-practices-infant-feeding-and-handling-expressed-breast-milk
     January 31, 2024 - The patient was fed EBM from the wrong mother, which resulted in exposure to potentially infectious breast … In this case, failure to follow unit policy in scanning EBM led to administering EBM from the wrong mother … Improving Safety Standardized Processes for Infant Feeding Expressed breast milk being given to the wrong … type of infant feeding, which is intended to prevent expressed breast milk from being given to the wrong … to patient safety by not only alerting the administering team members if they are administering the wrong

173. Innovations | PSNet
     psnet.ahrq.gov/innovations
     February 26, 2025 - EMERGING INNOVATIONS A standardized marking procedure for ENT operations to prevent wrong-site surgery … March 29, 2023 Although wrong-site surgeries are rare, they can be devastating to … Institutional Reporting (3) Never Events (3) Inpatient Suicide (1) Wrong … A standardized marking procedure for ENT operations to prevent wrong-site surgery: development, establishment … Share Facebook Twitter Linkedin Copy URL Although wrong-site

174. ISMP survey on tall man (mixed case) lettering to reduce drug name confusion. | PSNet
     psnet.ahrq.gov/issue/ismp-survey-tall-man-mixed-case-lettering-reduce-drug-name-confusion
     January 26, 2023 - April 25, 2018 Dangerous wrong-route errors with tranexamic acid. … February 18, 2014 Getting the wrong person's medicine at the pharmacy: easy steps consumers

175. A descriptive study of morbidity and mortality conferences and their conformity to medical incident analysis models: results of the morbidity and mortality conference improvement study, phase 1. | PSNet
     psnet.ahrq.gov/issue/descriptive-study-morbidity-and-mortality-conferences-and-their-conformity-medical-incident
     September 28, 2010 - July 1, 2016 Achieving the National Quality Forum's "Never Events": prevention of wrong … site, wrong procedure, and wrong patient operations.

176. ISMP Medication Errors Reporting Program. | PSNet
     psnet.ahrq.gov/issue/ismp-medication-errors-reporting-program
     January 26, 2023 - April 25, 2018 Dangerous wrong-route errors with tranexamic acid. … February 18, 2014 Getting the wrong person's medicine at the pharmacy: easy steps consumers

177. Oral Dosage Forms that Should Not Be Crushed. | PSNet
     psnet.ahrq.gov/issue/oral-dosage-forms-should-not-be-crushed
     January 26, 2023 - April 25, 2018 Dangerous wrong-route errors with tranexamic acid. … February 18, 2014 Getting the wrong person's medicine at the pharmacy: easy steps consumers

178. ISMP Survey on IV Push Medication Practices. | PSNet
     psnet.ahrq.gov/issue/ismp-survey-iv-push-medication-practices
     January 26, 2023 - April 25, 2018 Dangerous wrong-route errors with tranexamic acid. … February 18, 2014 Getting the wrong person's medicine at the pharmacy: easy steps consumers

179. Independent double checks: undervalued and misused. | PSNet
     psnet.ahrq.gov/issue/independent-double-checks-undervalued-and-misused
     July 12, 2023 - April 26, 2023 Administering a saline flush "site unseen" can lead to a wrong … February 17, 2015 A crack in our best armor: "wrong patient" injections from insulin

180. ISMP Medication Safety Self Assessment® for Perioperative Settings. | PSNet
     psnet.ahrq.gov/issue/ismp-medication-safety-self-assessmentr-perioperative-settings
     January 26, 2023 - April 25, 2018 Dangerous wrong-route errors with tranexamic acid. … February 18, 2014 Getting the wrong person's medicine at the pharmacy: easy steps consumers