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Total Results: 725 records

Showing results for "wrong".

261. Acute Care Improving Communication and Teamwork Around Antibiotic Prescribing
     www.ahrq.gov/sites/default/files/wysiwyg/antibiotic-use/safety/communication-slides.pptx
     November 01, 2019 - Avoid the issue of who’s right and who’s wrong. Actively avoid being perceived as judgmental.

262. Sustainability: Learning From Defects: Slide Presentation | Agency for Healthcare Research and Quality
     www.ahrq.gov/hai/tools/surgery/modules/sustainability/learn-from-defects-slides.html
     December 01, 2017 - Consider using visualization tools to break down complex defects and discover where steps go wrong.

263. PowerPoint Presentation
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/quality-resources/tools/cauti-ltc/modules/implementation/long-term-modules/module1/safety-modules.pptx
     March 01, 2017 - /index.html 17 Understanding Risk and Human Behavior1 Human Error: Inadvertently completing the wrong

264. Diagnosing Diagnosis Errors: Lessons from a Multi-institutional Collaborative Project (pdf file)
     www.ahrq.gov/downloads/pub/advances/vol2/Schiff.pdf
     January 01, 2005 - It identifies what went wrong, and situates where in the diagnostic process the failure occurred (Table … Taxonomy of where and what errors occurred Where in Diagnostic Process What Went Wrong (~Anatomic … Failure/delay in performing ordered test(s) Suboptimal test sequencing Ordering of wrong … test(s) Performance Sample mix-up/mislabeled (e.g., wrong patient) Technical errors … How did the error in the diagnostic process contribute to making the wrong diagnosis and wrong treatment

265. Diagnosing Diagnosis Errors: Lessons from a Multi-institutional Collaborative Project (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol2/Schiff.pdf
     January 01, 2005 - It identifies what went wrong, and situates where in the diagnostic process the failure occurred (Table … Taxonomy of where and what errors occurred Where in Diagnostic Process What Went Wrong (~Anatomic … Failure/delay in performing ordered test(s) Suboptimal test sequencing Ordering of wrong … test(s) Performance Sample mix-up/mislabeled (e.g., wrong patient) Technical errors … How did the error in the diagnostic process contribute to making the wrong diagnosis and wrong treatment

266. Improving Patient Experience: Data Analysis Methods webcast - Wellstar (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/cahps/news-and-events/events/webinars/data-analysis-webcast-advancing-methods-4.pdf
     March 03, 2021 - informed about care arrival: No calls prior to arrival, No follow-up on concerns, Communicating w/ wrong

267. Overview of the Comprehensive Unit-based Safety Program for Application to Mechanically Ventilated Patients: Slide Presentation | Agency for Healthcare Research and Quality
     www.ahrq.gov/hai/tools/mvp/modules/cusp/overview-cuspmvp-slides.html
     February 01, 2017 - Things have gone completely wrong on a number of fronts.

268. Prologue | Agency for Healthcare Research and Quality
     www.ahrq.gov/patient-safety/reports/liability/prologue.html
     August 01, 2017 - And finally, there are several illuminating studies on working with patients when things go wrong, including

269. The Timeline to Diagnostic Safety SIDM -Research as a Priority (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/news/events/ahrq-research-summit/graber-summit2016.pdf
     January 01, 2017 - • ER The petri dish for diagnostic errors • Inpatients One in ten diagnoses is probably wrong. 36,000

270. Establishing a Culture of Patient Safety Through a Low-tech Approach to Reducing Medication Errors (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol3/Shaha.pdf
     May 01, 2004 - Prescribing- related errors, for example, included wrong or missing dose, and route or frequency of … example illustrates how the use of the Indication column prevented two errors: administration of a wrong … event (ADE), regardless of severity, including those order for which any element of the order was wrong

271. Envisioning Patient Safety in the Year 2025: Eight Perspectives (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol1/Advances-Henriksen_104.pdf
     January 01, 2025 - medical devices have helped to virtually eliminate two of the three most notorious surgical errors—wrong … site/wrong side/wrong patient surgery and retained instruments.

272. Silence A Commentary | Agency for Healthcare Research and Quality
     www.ahrq.gov/patient-safety/reports/liability/silence.html
     August 01, 2017 - When things go wrong: responding to adverse events: a consensus statement of the Harvard Hospitals.

273. Final Progress Report: Creating Learning Cultures Around Mistakes for Residents (pdf file)
     www.ahrq.gov/sites/default/files/2024-02/hoff-report.pdf
     January 01, 2024 - e.g., carelessness, such as moving too fast during a surgical procedure and almost cutting into the wrong … half of the surgical mistakes observed were errors of commission (e.g., performing an intended action wrong … included executing specific technical steps of a surgical procedure incorrectly, getting drug dosages wrong

274. Indwelling Urinary Catheter Insertion Facilitator Notes (doc file)
     www.ahrq.gov/sites/default/files/wysiwyg/hai/tools/clabsi-cauti-icu/urinary-catheter-insertion-notes.docx
     April 01, 2022 - Consider that multiple steps means that something can go wrong at any point in the process. … of just performing a task, the person reflects on what that means to the patient and what could go wrong

275. Communication-Facilitator-Guide (doc file)
     www.ahrq.gov/sites/default/files/wysiwyg/antibiotic-use/long-term-care/communication-facilitator-guide.docx
     June 01, 2021 - . · Avoid the issue of who’s right and who’s wrong. … “Resident-centered care” is not about who is right or who is wrong.

276. Learn From Defects in Care of Mechanically Ventilated Patients: Facilitator Guide | Agency for Healthcare Research and Quality
     www.ahrq.gov/hai/tools/mvp/modules/cusp/learn-from-defects-fac-guide.html
     February 01, 2017 - Where do they tend to go wrong?" … Are there aspects of your patient safety that inadvertently promote doing the wrong thing or engaging

277. Tools for Sustainability: Premortem and Scorecard: Facilitator Guide | Agency for Healthcare Research and Quality
     www.ahrq.gov/hai/tools/mvp/modules/sustainability/premortem-scorecard-fac-guide.html
     February 01, 2017 - Ask: What might have gone wrong? Say: Let’s assume patient care hasn’t improved. … Ask each team member what she or he thinks could go wrong. Ask: Was staff overburdened?

278. Appendix C. Site Visit Protocol | Agency for Healthcare Research and Quality
     www.ahrq.gov/research/findings/final-reports/stpra/stpraapc.html
     April 01, 2018 - What went wrong? How would you have corrected the procedures? … What went wrong? How would you have corrected the procedures?

279. Strategies for Improving Patient Experience with Ambulatory Care: Service Recovery Programs (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/cahps/quality-improvement/improvement-guide/6-strategies-for-improving/access/cahps-strategy-6-p.pdf
     November 02, 2017 - Making sure that someone gets to see a doctor when they show up on the wrong day is an example of the … , the patient or member is a prime candidate for overt retaliation.3 Communication about what went wrong

280. Data Reveal Uneven Impact of COVID-19 on Urban, Rural Hospitals | Agency for Healthcare Research and Quality
     www.ahrq.gov/news/newsletters/e-newsletter/913.html
     May 01, 2024 - definitions or frameworks for understanding diagnostic error in mental health, but several studies of missed, wrong