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Total Results: 5,540 records

Showing results for "wrong".

181. Preventing wrong site, procedure, and patient events using a common cause analysis. | PSNet
     psnet.ahrq.gov/issue/preventing-wrong-site-procedure-and-patient-events-using-common-cause-analysis
     October 03, 2017 - Study Preventing wrong site, procedure, and patient events using a common cause analysis … Preventing wrong site, procedure, and patient events using a common cause analysis. … Preventing wrong site, procedure, and patient events using a common cause analysis. … June 27, 2018 Wrong-site and wrong-patient procedures in the Universal Protocol era: … Site, Wrong Procedure and Wrong Person Surgery.

182. Descriptive analysis of patient misidentification from incident report system data in a large academic hospital federation. | PSNet
     psnet.ahrq.gov/issue/descriptive-analysis-patient-misidentification-incident-report-system-data-large-academic
     August 24, 2022 - Of the 293 reported incidents, the most common errors were missing wristbands , wrong charts or notes … in files, administrative issues, and wrong labeling. … March 29, 2023 Adding automation and independent dual verification to reduce wrong blood … : Evaluating a Near-Miss Wrong Transfusion Event January 29, 2020 … May 29, 2019 Wrong-patient blood transfusion error: leveraging technology to overcome

183. Advancing Patient Safety in Cataract Surgery: A Betsy Lehman Center Expert Panel Report. | PSNet
     psnet.ahrq.gov/issue/advancing-patient-safety-cataract-surgery-betsy-lehman-center-expert-panel-report
     May 03, 2023 - Cataract surgery , one of the most common procedures in the United States, is vulnerable to wrong-site … September 20, 2011 Wrong site surgery. … 2011 Prevention of 3 "never events" in the operating room: fires, gossypiboma, and wrong-site … April 4, 2011 Achieving the National Quality Forum's "Never Events": prevention of wrong … site, wrong procedure, and wrong patient operations.

184. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/47994/psn-pdf
     July 16, 2019 - Newborn naming conventions and wrong-patient errors. July 16, 2019 ISMP Medication Safety Alert! … https://psnet.ahrq.gov/issue/whats-name-newborn-naming-conventions-and-wrong-patient-errors Newborns … assigned temporary names are at increased risk for patient misidentification and wrong-patient errors … /issue/use-temporary-names-newborns-and-associated-risks https://psnet.ahrq.gov/primer/wrong-site-wrong-procedure-and-wrong-patient-surgery … https://psnet.ahrq.gov/primer/wrong-site-wrong-procedure-and-wrong-patient-surgery https://psnet.ahrq.gov

185. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/50804/psn-pdf
     January 15, 2020 - site, wrong procedure and wrong person surgery; however, these errors persist. … In an effort to reduce wrong-patient charting and near-miss events involving anesthesia, this study … After implementation, only one instance of wrong-patient charting was documented; however, baseline … use-patient-digital-facial-images-confirm-patient-identity-childrens-hospitals-anesthesia https://psnet.ahrq.gov/issue/universal-protocol-preventing-wrong-site-wrong-procedure-wrong-person-surgery … https://psnet.ahrq.gov/primer/wrong-site-wrong-procedure-and-wrong-patient-surgery

186. Lambert, Bruce | Digital Healthcare Research
     digital.ahrq.gov/principal-investigator/lambert-bruce
     January 01, 2023 - Lambert, Bruce Preventing Wrong-Drug and Wrong-Patient Errors With Indication … Preventing Wrong-Drug and Wrong-Patient Errors With Indication Alerts in CPOE Systems – Final Report. … Principal Investigator Lambert, Bruce Project Name Preventing Wrong-Drug and Wrong-Patient … Principal Investigator Lambert, Bruce Project Name Preventing Wrong-Drug and Wrong-Patient … Principal Investigator Lambert, Bruce Project Name Preventing Wrong-Drug and Wrong-Patient

187. Determining the state of knowledge for implementing the Universal Protocol recommendations: an integrative review of the literature. | PSNet
     psnet.ahrq.gov/issue/determining-state-knowledge-implementing-universal-protocol-recommendations-integrative
     March 15, 2016 - April 30, 2014 The pain of wrong site surgery. … Site, Wrong Procedure and Wrong Person Surgery. … October 20, 2010 Operating room briefings and wrong-site surgery. … July 28, 2010 Avoiding wrong site surgery: a systematic review. … May 26, 2010 Doing the "right" things to correct wrong-site surgery.

188. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/73535/psn-pdf
     July 28, 2021 - Wrong-patient orders in obstetrics. … Wrong-patient orders in obstetrics. … https://psnet.ahrq.gov/issue/wrong-patient-orders-obstetrics Patient misidentification errors can result … https://psnet.ahrq.gov/issue/wrong-patient-orders-obstetrics https://psnet.ahrq.gov/primer/wrong-site-wrong-procedure-and-wrong-patient-surgery … https://psnet.ahrq.gov/issue/wrong-goodbye https://psnet.ahrq.gov/issue/wrong-patient-ordering-errors-peripartum-mother-newborn-pairs-unique-patient-safety-challenge

189. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/845361/psn-pdf
     March 29, 2023 - A standardized marking procedure for ENT operations to prevent wrong-site surgery: development, establishment … https://psnet.ahrq.gov/innovation/standardized-marking-procedure-ent-operations-prevent-wrong-site- … surgery-development Although wrong-site surgeries are rare, the consequences can be very serious. … Despite being classified as a never event, wrong site surgery continues to be an issue in otolaryngology … https://psnet.ahrq.gov/primer/wrong-site-wrong-procedure-and-wrong-patient-surgery https://psnet.ahrq.gov

190. The Other Side | PSNet
     psnet.ahrq.gov/web-mm/other-side
     May 01, 2007 - Understand the key components of the Universal Protocol for eliminating wrong site, wrong procedure, … wrong person surgery. … Recently, JCAHO released a Universal Protocol for preventing wrong person, wrong procedure, and wrong … Universal Protocol for Preventing Wrong Site, Wrong Procedure, Wrong Person Surgery. [ go to related … Universal Protocol for Preventing Wrong Site, Wrong Procedure, Wrong Person Surgery. [ go to related

191. A national survey assessing the number of records allowed open in electronic health records at hospitals and ambulatory sites. | PSNet
     psnet.ahrq.gov/issue/national-survey-assessing-number-records-allowed-open-electronic-health-records-hospitals-and
     May 29, 2019 - Wrong-patient errors can occur during computerized provider order entry , particularly if ordering … September 4, 2019 Evaluating serial strategies for preventing wrong-patient orders in … January 26, 2022 Retrospective cohort study of wrong-patient imaging order errors: how … December 31, 2014 Effect of number of open charts on intercepted wrong-patient medication … October 13, 2018 Wrong-patient orders in obstetrics.

192. Applying the Universal Protocol to improve patient safety in radiology services. | PSNet
     psnet.ahrq.gov/issue/applying-universal-protocol-improve-patient-safety-radiology-services
     March 27, 2018 - Exploring causes of wrong-site, wrong patient, and wrong procedure errors in radiology, this piece … September 27, 2016 Wrong-patient medication errors: an analysis of event reports in Pennsylvania … September 20, 2011 The wrong foot, and other tales of surgical error. … December 16, 2009 Wrong site surgery near misses and actual occurrences.

193. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/72649/psn-pdf
     January 20, 2021 - Wrong-site surgery in Pennsylvania during 2015–2019: a study of variables associated with 368 events … Wrong-Site Surgery in Pennsylvania During 2015–2019: A Study of Variables Associated With 368 Events … -368-events-178 Wrong-site surgeries can lead to serious patient harm and are considered never events … The authors present several evidence-based strategies to reduce the likelihood of wrong-site surgery … -368-events-178 https://psnet.ahrq.gov/primer/wrong-site-wrong-procedure-and-wrong-patient-surgery https

194. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/50434/psn-pdf
     September 04, 2019 - Risk of wrong-patient orders among multiple vs singleton births in the neonatal intensive care units … Risk of Wrong-Patient Orders Among Multiple vs Singleton Births in the Neonatal Intensive Care Units … https://psnet.ahrq.gov/issue/risk-wrong-patient-orders-among-multiple-vs-singleton-births-neonatal- … "Babyboy") with one incorporating the mother's first name (e.g., "Marysgirl" or "Marysboy") reduced wrong … https://psnet.ahrq.gov/issue/whats-name-newborn-naming-conventions-and-wrong-patient-errors https://

195. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/851058/psn-pdf
     June 28, 2023 - The AHRQ Report on Diagnostic Errors in the Emergency Department: the wrong answer to the wrong question … The AHRQ Report on Diagnostic Errors in the Emergency Department: the wrong answer to the wrong question … https://psnet.ahrq.gov/issue/ahrq-report-diagnostic-errors-emergency-department-wrong-answer-wrong- … https://psnet.ahrq.gov/issue/ahrq-report-diagnostic-errors-emergency-department-wrong-answer-wrong-question … https://psnet.ahrq.gov/issue/ahrq-report-diagnostic-errors-emergency-department-wrong-answer-wrong-question

196. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/72532/psn-pdf
     December 02, 2020 - Association of display of patient photographs in the electronic health record with wrong-patient order … Association of display of patient photographs in the electronic health record with wrong-patient order … https://psnet.ahrq.gov/issue/association-display-patient-photographs-electronic-health-record-wrong- … The authors suggest this may be a simple and cost-effective strategy for reducing wrong- patient errors … https://psnet.ahrq.gov/primer/wrong-site-wrong-procedure-and-wrong-patient-surgery https://psnet.ahrq.gov

197. Factors contributing to preventing operating room "never events": a machine learning analysis. | PSNet
     psnet.ahrq.gov/issue/factors-contributing-preventing-operating-room-never-events-machine-learning-analysis
     July 26, 2023 - machine learning, this study identified 24 contributing factors to two types of surgical never events - wrong … July 27, 2023 A contemporary analysis of closed claims related to wrong site surgery. … October 20, 2021 Wrong Site Surgery - Wrong Patient: Invasive Procedures in Outpatient … April 7, 2021 Incidence of wrong-site surgery list errors for a 2-year period in a single … Room Quality and Safety Professionals Surgery Retained Surgical Instruments and Sponges Wrong

198. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/74077/psn-pdf
     November 17, 2021 - Factors associated with wrong blood in tube errors: an international case series - The BEST collaborative … https://psnet.ahrq.gov/issue/factors-associated-wrong-blood-tube-errors-international-case-series-best … - collaborative-study Wrong blood in tube (WBIT) errors can be classified as intended patient drawn … /wrong label applied or wrong patient/intended label applied. … https://psnet.ahrq.gov/web-mm/right-patient-wrong-sample https://psnet.ahrq.gov/issue/electronic-patient-identification-sample-labeling-reduces-wrong-blood-tube-errors

199. Develop and Validate Health IT Safety Measures To Capture Violations of the Five Rights of Medication Safety | Digital Healthcare Research
     digital.ahrq.gov/ahrq-funded-projects/develop-and-validate-health-it-safety-measures-capture-violations-five-rights
     January 01, 2023 - , wrong-medication, wrong-route, and wrong-frequency electronic orders in an acute care setting, by extending … Conduct a multisite observational study describing the overall frequency of wrong-patient, wrong-dose … , wrong-medication, wrong-route, and wrong-frequency electronic orders, and describe the frequency in … These measures identify electronic order errors including wrong dosage, wrong route, wrong frequency, … or wrong medication.

200. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/73429/psn-pdf
     June 23, 2021 - Wrong Site Surgery - Wrong Patient: Invasive Procedures in Outpatient Settings. … https://psnet.ahrq.gov/issue/wrong-site-surgery-wrong-patient-invasive-procedures-outpatient-settings … Wrong site/wrong patent surgery is a persistent healthcare never event. … Service (NHS) reporting data to identify how ambulatory patient identification errors contribute to wrong … https://psnet.ahrq.gov/issue/wrong-site-surgery-wrong-patient-invasive-procedures-outpatient-settings