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psnet.ahrq.gov/perspective/role-undergraduate-nursing-education-patient-safety
November 27, 2023 - Though the role has primarily been implemented in acute care, the CNL has been effectively implemented … Perspective
Surveillance Monitoring to Improve Patient Safety in Acute
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psnet.ahrq.gov/web-mm/bloody-bp-cuff
June 21, 2016 - Bloody BP Cuff
Citation Text:
Madan AK. Bloody BP Cuff. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2003.
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psnet.ahrq.gov/web-mm/transfusion-slip
June 14, 2011 - Transfusion "Slip"
Citation Text:
Kaplan HS. Transfusion "Slip". PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2004.
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psnet.ahrq.gov/node/49529/psn-pdf
February 01, 2007 - Crossed Coverage
February 1, 2007
Kayser SR. Crossed Coverage. PSNet [internet]. 2007.
https://psnet.ahrq.gov/web-mm/crossed-coverage
The Case
A 27-year-old woman with a history of congenital heart disease was admitted for cardiac transplantation
evaluation. She had already undergone multiple surgeries, including…
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psnet.ahrq.gov/node/836978/psn-pdf
May 16, 2022 - Check Twice, Transport Once
May 16, 2022
DePew A, Rice J, Chou J. Check Twice, Transport Once. PSNet [internet]. 2022.
https://psnet.ahrq.gov/web-mm/check-twice-transport-once
The Case
Case #1: A 26-year-old woman (Patient A) presented to the Emergency Department (ED) with abdominal
pain and was diagnosed with “s…
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psnet.ahrq.gov/node/836939/psn-pdf
April 27, 2022 - A Virtual Hospitalist Program to Address a Hospital’s
Challenges at the Start of the COVID-19 Pandemic
April 27, 2022
https://psnet.ahrq.gov/innovation/virtual-hospitalist-program-address-hospitals-challenges-start-covid-19-
pandemic
Summary
In the early days of the COVID-19 pandemic, New York Presbyterian Weill …
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psnet.ahrq.gov/web-mm/privacy-gone-awry
February 24, 2011 - Privacy Gone Awry
Citation Text:
Pauker SG, Pauker SP. Privacy Gone Awry. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2004.
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psnet.ahrq.gov/web-mm/waiting-too-long
February 01, 2013 - Waiting Too Long
Citation Text:
Rosen MA. Waiting Too Long. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2003.
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psnet.ahrq.gov/web-mm/triage-time-bomb
September 01, 2008 - Triage Time Bomb
Citation Text:
Washington DL. Triage Time Bomb. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2004.
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psnet.ahrq.gov/web-mm/aspergillus-mediastinitis-endocarditis-pediatric-patient-complicating-cardiac-surgery-and
November 16, 2022 - An enhanced strategy for daily disinfection in acute care hospital rooms: a randomized clinical trial
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psnet.ahrq.gov/web-mm/death-pca
January 06, 2017 - Patient-controlled drug delivery for acute postoperative pain management: a review of current and emerging
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psnet.ahrq.gov/node/73642/psn-pdf
August 25, 2021 - associated with a trend
toward faster initiation of appropriate interventions and fewer errors.23 In acute
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psnet.ahrq.gov/node/61082/psn-pdf
July 23, 2020 - Nursing, University of Missouri
Columbia, MO
Charles A Crecelius, MD, PhD
Medical Director, Post-Acute
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psnet.ahrq.gov/node/49840/psn-pdf
September 01, 2018 - steroids-and-safety-preventing-medication-adverse-events-during-transitions-care
The hospitalist, oncologist, and endocrinologist all believed that all of her acute
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psnet.ahrq.gov/perspective/are-we-getting-better-measuring-patient-safety
November 10, 2015 - psnet
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psnet.ahrq.gov/web-mm/crossed-coverage
September 01, 2015 - Crossed Coverage
Citation Text:
Kayser SR. Crossed Coverage. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2007.
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…
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psnet.ahrq.gov/web-mm/multiple-high-risk-events-involving-workflow-wasting-medications-used-anesthesia
August 29, 2021 - Related Resources
WebM&M Cases
Saline Flush Leads to Acute
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psnet.ahrq.gov/web-mm/dangerous-shift
July 24, 2013 - heavily slanted toward safety goals will likely change over time in response to feedback to respond to acute
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psnet.ahrq.gov/web-mm/crossing-line
December 01, 2012 - November 16, 2022
Opioid prescribing for acute pain management in children and adolescents
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psnet.ahrq.gov/web-mm/case-mistaken-intubation
July 01, 2016 - that the patient had been intubated because his wishes were not clear when he arrived to the ED in acute