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Total Results: 4,259 records

Showing results for "wrong".

341. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/60172/psn-pdf
     March 01, 2021 - That Includes Prominent Patient Photograph Significantly Reduces Errors Caused by Orders Placed in Wrong … patient; it designated this practice its first National Patient Safety Goal.2 Orders entered into wrong … care due to patient misidentification resulted from a medication or test order being placed in the wrong … have multiple charts open simultaneously, making it possible to mistakenly enter an order into the wrong … received care intended for someone else because of orders being placed in the wrong chart, down 75

342. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/37390/psn-pdf
     December 05, 2007 - Third wrong-sided brain surgery at R.I. hospital. December 5, 2007 Associated Press; AP. … https://psnet.ahrq.gov/issue/third-wrong-sided-brain-surgery-ri-hospital This news article reports repeated … incidents of wrong-side surgery at the same facility, and state and hospital reactions to the errors … https://psnet.ahrq.gov/issue/third-wrong-sided-brain-surgery-ri-hospital https://psnet.ahrq.gov/issue … /incidence-patterns-and-prevention-wrong-site-surgery

343. Time out: an analysis. | PSNet
     psnet.ahrq.gov/issue/time-out-analysis
     October 19, 2022 - October 19, 2022 Using performance improvement to enhance time-out compliance and prevent wrong-site … Related Resources Using performance improvement to enhance time-out compliance and prevent wrong-site … Use of an anatomic marking form as an alternative to the Universal Protocol for Preventing Wrong … Site, Wrong Procedure and Wrong Person Surgery. … February 9, 2011 The wrong foot, and other tales of surgical error.

344. Barcode technology: its role in increasing the safety of blood transfusion. | PSNet
     psnet.ahrq.gov/issue/barcode-technology-its-role-increasing-safety-blood-transfusion
     September 08, 2021 - 27, 2023 View More Related Resources Factors associated with wrong … November 17, 2021 Emergency departments are higher-risk locations for wrong blood in … September 9, 2020 WebM&M Cases “This is the wrong patient's … : Evaluating a Near-Miss Wrong Transfusion Event January 29, 2020 Transfusion … June 2, 2019 Electronic patient identification for sample labeling reduces wrong blood

345. Effectiveness of surgical safety checklists in improving patient safety. | PSNet
     psnet.ahrq.gov/issue/effectiveness-surgical-safety-checklists-improving-patient-safety
     May 29, 2019 - Effect of restriction of the number of concurrently open records in an electronic health record on wrong-patient … June 21, 2023 View More Related Resources Incidence of wrong-site … June 13, 2018 Wrong-site surgery. … July 30, 2014 Preventing wrong-site surgery in Minnesota: a 5-year journey. … December 22, 2010 Avoiding wrong site surgery: a systematic review.

346. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/39211/psn-pdf
     February 08, 2011 - The wrong foot, and other tales of surgical error. February 8, 2011 Altman LK. New York Times.  … https://psnet.ahrq.gov/issue/wrong-foot-and-other-tales-surgical-error This news piece reports on wrong-site … and wrong-patient surgery and describes efforts to prevent surgical errors following a Joint Commission … https://psnet.ahrq.gov/issue/wrong-foot-and-other-tales-surgical-error

347. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/846758/psn-pdf
     March 29, 2023 - evaluating-patient-identification-practices-during-intrahospital-transfers-human-factors https://psnet.ahrq.gov/primer/wrong-site-wrong-procedure-and-wrong-patient-surgery … https://psnet.ahrq.gov/issue/wrong-patient-orders-obstetrics https://psnet.ahrq.gov/issue/seips-101-

348. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/73980/psn-pdf
     October 20, 2021 - Of the 293 reported incidents, the most common errors were missing wristbands, wrong charts or notes … in files, administrative issues, and wrong labeling. … assessment-incorrect-surgical-procedures-within-and-outside-operating-room-follow-study-us https://psnet.ahrq.gov/issue/wrong-site-surgery-wrong-patient-invasive-procedures-outpatient-settings

349. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/848813/psn-pdf
     May 10, 2023 - blood-and-blood-products-transfusion-errors-what-can-we-do-improve-patient- safety Incorrect patient registration, application of the wrong … label, and blood draw from the wrong patient can all cause blood transfusion errors. … transfusion-safety-nature-and-outcomes-errors-patient-registration https://psnet.ahrq.gov/web-mm/transfusion-slip https://psnet.ahrq.gov/web-mm/wrong-patients-blood-evaluating-near-miss-wrong-transfusion-event

350. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/39604/psn-pdf
     November 23, 2016 - Improving the patient, family, and clinician experience after harmful events: the "When Things Go Wrong … Improving the patient, family, and clinician experience after harmful events: the "when things go wrong … psnet.ahrq.gov/issue/improving-patient-family-and-clinician-experience-after-harmful-events-when- things-go-wrong … psnet.ahrq.gov/issue/improving-patient-family-and-clinician-experience-after-harmful-events-when-things-go-wrong … https://psnet.ahrq.gov/issue/when-things-go-wrong-voices-patients-and-families https://psnet.ahrq.gov

351. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/36934/psn-pdf
     September 01, 2011 - Recurrent wrong-route drug error – a professional shame. September 1, 2011 Bell D. … Recurrent wrong-route drug error - a professional shame. Anaesthesia. 2007;62(6):541-5. … https://psnet.ahrq.gov/issue/recurrent-wrong-route-drug-error-professional-shame Referencing three case … from the same issue, the author discusses design changes and regulatory measures aimed at minimizing wrong-route … https://psnet.ahrq.gov/issue/recurrent-wrong-route-drug-error-professional-shame

352. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/37268/psn-pdf
     December 16, 2011 - Prevention of wrong-site tooth extraction: clinical guidelines. … Prevention of wrong-site tooth extraction: clinical guidelines. … https://psnet.ahrq.gov/issue/prevention-wrong-site-tooth-extraction-clinical-guidelines This article … discusses strategies to prevent wrong-site tooth extraction including education, improving referral … https://psnet.ahrq.gov/issue/prevention-wrong-site-tooth-extraction-clinical-guidelines https://psnet.ahrq.gov

353. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/38796/psn-pdf
     April 04, 2011 - A 62-year-old woman with skin cancer who experienced wrong-site surgery. … A 62-year-old woman with skin cancer who experienced wrong-site surgery: review of medical error. … https://psnet.ahrq.gov/issue/62-year-old-woman-skin-cancer-who-experienced-wrong-site-surgery This case … presentation describes a wrong-site surgery incident, provides perspectives from the patient, clinician … https://psnet.ahrq.gov/issue/62-year-old-woman-skin-cancer-who-experienced-wrong-site-surgery

354. Positive Patient Identification. | PSNet
     psnet.ahrq.gov/issue/positive-patient-identification
     June 19, 2024 - February 16, 2022 Wrong Site Surgery–Wrong Tooth Extraction. … August 30, 2023 Automated search methods for identifying wrong patient order entry-a … March 1, 2023 Adding automation and independent dual verification to reduce wrong blood … See More About The Topic Hospitals Ambulatory Care Identification Errors Wrong

355. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/37343/psn-pdf
     December 02, 2008 - The most common adverse events included wrong lens implants and wrong eye operations, and the authors … /issue/surgical-confusions-ophthalmology https://psnet.ahrq.gov/issue/universal-protocol-preventing-wrong-site-wrong-procedure-wrong-person-surgery

356. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/38708/psn-pdf
     April 30, 2014 - Frequency and clinical importance of pages sent to the wrong physician. … Frequency and clinical importance of pages sent to the wrong physician. … https://psnet.ahrq.gov/issue/frequency-and-clinical-importance-pages-sent-wrong-physician Communication … This study discovered that 14% of text pages were sent to the wrong physician, with nearly 50% of them … https://psnet.ahrq.gov/issue/frequency-and-clinical-importance-pages-sent-wrong-physician https://psnet.ahrq.gov

357. Right? Left? Neither! | PSNet
     psnet.ahrq.gov/web-mm/right-left-neither
     November 16, 2022 - Neither should operating on the wrong side of the right patient. … JCAHO has recommended a series of steps to prevent wrong-site, wrong-side, and wrong-person procedures … To strengthen defenses against wrong-site and wrong-patient invasive procedures, hospitals should implement … Universal Protocol for Preventing Wrong Site, Wrong Procedure, Wrong Person Surgery. … January 23, 2019 The wrong patient.

358. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/40636/psn-pdf
     November 21, 2011 - procedures in the Veterans Affairs (VA) system found an overall decline in the number of reported wrong-site … , wrong-patient, and wrong-procedure errors compared with the authors' prior study. … incorrect-surgical-procedures-within-and-outside-operating-room-follow-report https://psnet.ahrq.gov/primer/wrong-site-wrong-procedure-and-wrong-patient-surgery

359. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/39595/psn-pdf
     June 15, 2011 - Application of human error theory in case analysis of wrong procedures. June 15, 2011 Duthie EA. … Application of Human Error Theory in Case Analysis of Wrong Procedures. … https://psnet.ahrq.gov/issue/application-human-error-theory-case-analysis-wrong-procedures This study … examines five wrong-procedure cases by applying James Reason’s human error theory, and describes the … https://psnet.ahrq.gov/issue/application-human-error-theory-case-analysis-wrong-procedures https://psnet.ahrq.gov

360. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/42348/psn-pdf
     March 04, 2015 - Increasing rate of detection of wrong-patient radiographs: use of photographs obtained at time of radiography … Increasing Rate of Detection of Wrong-Patient Radiographs: Use of Photographs Obtained at Time of Radiography … https://psnet.ahrq.gov/issue/increasing-rate-detection-wrong-patient-radiographs-use-photographs- obtained-time-radiography … https://psnet.ahrq.gov/issue/increasing-rate-detection-wrong-patient-radiographs-use-photographs-obtained-time-radiography … https://psnet.ahrq.gov/issue/increasing-rate-detection-wrong-patient-radiographs-use-photographs-obtained-time-radiography