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  1. Distraction of the Anesthesiologist and Lack of Resuscitation Drugs Resulting in Delayed Treatment of Laryngospasm. | PSNet

    psnet.ahrq.gov/web-mm/distraction-anesthesiologist-and-lack-resuscitation-drugs-resulting-delayed-treatment
    January 29, 2021 - Distraction of the Anesthesiologist and Lack of Resuscitation Drugs Resulting in Delayed Treatment of Laryngospasm. Citation Text: Bohringer C. Distraction of the Anesthesiologist and Lack of Resuscitation Drugs Resulting in Delayed Treatment of Laryngospasm.. PSNet [internet]. Rockville (MD): Agency for He…

  2. Direct Oral Anticoagulants are High-Risk Medications with Potentially Complex Dosing | PSNet

    psnet.ahrq.gov/web-mm/direct-oral-anticoagulants-are-high-risk-medications-potentially-complex-dosing
    August 21, 2005 - Direct Oral Anticoagulants are High-Risk Medications with Potentially Complex Dosing Citation Text: Giannini J, Wong M, Dager W, et al. Direct Oral Anticoagulants are High-Risk Medications with Potentially Complex Dosing. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Depar…

  3. The generalizability of a medication administration discrepancy detection system: quantitative comparative analysis | PSNet

    psnet.ahrq.gov/innovation/generalizability-medication-administration-discrepancy-detection-system-quantitative
    November 04, 2020 - EMERGING INNOVATIONS The generalizability of a medication administration discrepancy detection system: quantitative comparative analysis Citation Text: Kirkendall E, Huth H, Rauenbuehler B, et al. The generalizability of a medication administration discrepancy detection system: quantitative compar…

  4. In Conversation With... José A, Morfín, MD, FASN | PSNet

    psnet.ahrq.gov/perspective/conversation-jose-morfin-md-fasn
    April 28, 2021 - View More See More About The Topic Home Care Nephrology Side Effects/Adverse … Drug Reactions Nosocomial Infections Patient Falls View More

  5. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49867/psn-pdf
    July 02, 2019 - Diuretics and Electrolyte Abnormalities July 2, 2019 Dreischulte T. Diuretics and Electrolyte Abnormalities. PSNet [internet]. 2019. https://psnet.ahrq.gov/web-mm/diuretics-and-electrolyte-abnormalities Case Objectives Recognize that thiazide diuretics can lead to serious adverse events. State how commonly used t…

  6. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49586/psn-pdf
    May 01, 2009 - Vial Mistakes Involving Heparin May 1, 2009 Vanderveen T. Vial Mistakes Involving Heparin. PSNet [internet]. 2009. https://psnet.ahrq.gov/web-mm/vial-mistakes-involving-heparin The Case A 65-year-old man was admitted to the hospital for an elective left carotid endarterectomy. During the procedure, the surgeon re…

  7. Clinician perspectives on electronic health records, communication, and patient safety across diverse medical oncology practices. | PSNet

    psnet.ahrq.gov/issue/clinician-perspectives-electronic-health-records-communication-and-patient-safety-across
    September 23, 2020 - Study Clinician perspectives on electronic health records, communication, and patient safety across diverse medical oncology practices. Citation Text: Patel MR, Friese CR, Mendelsohn-Victor K, et al. Clinician Perspectives on Electronic Health Records, Communication, and Patient Safety A…

  8. Spotlight Case July 2008 (ppt file)

    psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.245_slideshow.ppt
    July 01, 2011 - Spotlight Case July 2008 Spotlight Case Watch the Warfarin! 1 2 Source and Credits This presentation is based on the July 2011 AHRQ WebM&M Spotlight Case See the full article at http://webmm.ahrq.gov CME credit is available Commentary by: Raman Khanna, MD, and Margaret Fang, MD, MPH; University of California, Sa…

  9. Standard Deviations | PSNet

    psnet.ahrq.gov/web-mm/standard-deviations
    January 01, 2006 - SPOTLIGHT CASE Standard Deviations Citation Text: Sabin JE. Standard Deviations. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2009. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNote 7 XML E…

  10. Acute Care Admission of the Behavioral Health Patient | PSNet

    psnet.ahrq.gov/web-mm/acute-care-admission-behavioral-health-patient
    July 19, 2023 - Acute Care Admission of the Behavioral Health Patient Citation Text: Weiss AP, Rosenbaum JF. Acute Care Admission of the Behavioral Health Patient. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2013. Copy Citation Format: …

  11. In Conversation with...Sir Liam Donaldson, MD, MSc | PSNet

    psnet.ahrq.gov/perspective/conversation-withsir-liam-donaldson-md-msc
    May 01, 2007 - In Conversation with...Sir Liam Donaldson, MD, MSc May 1, 2007  Also Read an Essay Citation Text: In Conversation with..Sir Liam Donaldson, MD, MSc. PSNet [internet]. 2007.In Conversation with...Sir Liam Donaldson, MD, MSc. PSNet [internet]. Rockville (MD): Agency…

  12. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/866265/psn-pdf
    July 31, 2024 - Misplaced Vial: Medication Kit Variability Contributes to Medication Error During Patient Transport July 31, 2024 MacDowell P, McGee E. Misplaced Vial: Medication Kit Variability Contributes to Medication Error During Patient Transport. PSNet [internet]. 2024. https://psnet.ahrq.gov/web-mm/misplaced-vial-medicatio…

  13. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49679/psn-pdf
    March 01, 2013 - The Unfamiliar Catheter March 1, 2013 Swayze SC, James A. The Unfamiliar Catheter. PSNet [internet]. 2013. https://psnet.ahrq.gov/web-mm/unfamiliar-catheter The Case A 28-year-old woman, 20 months post–bilateral lung transplant, presented to the emergency department with sudden onset of severe shortness of breath…

  14. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/72564/psn-pdf
    November 14, 2018 - Antibiotic and Opioid Stewardship in Dentistry December 7, 2020 Suda KJ, Fitall E, Hall KK, et al. Antibiotic and Opioid Stewardship in Dentistry. PSNet [internet]. 2020. https://psnet.ahrq.gov/perspective/antibiotic-and-opioid-stewardship-dentistry Introduction Medication stewardship refers to efforts by frontlin…

  15. Fatality involving vinblastine overdose as a result of a complex medical error. | PSNet

    psnet.ahrq.gov/issue/fatality-involving-vinblastine-overdose-result-complex-medical-error
    January 25, 2023 - Study Fatality involving vinblastine overdose as a result of a complex medical error. Citation Text: Kłys M, Konopka T, Scisłowski M, et al. Fatality involving vinblastine overdose as a result of a complex medical error. Cancer Chemother Pharmacol. 2007;59(1):89-95. Copy Citation …

  16. Between a rock and a hard place: disclosing medical errors. | PSNet

    psnet.ahrq.gov/issue/between-rock-and-hard-place-disclosing-medical-errors
    October 19, 2022 - Commentary Between a rock and a hard place: disclosing medical errors. Citation Text: Crone KG, Muraski MB, Skeel JD, et al. Between a rock and a hard place: disclosing medical errors. Clin Chem. 2006;52(9):1809-14. Copy Citation Format: Google Scholar PubMed BibTeX EndNo…

  17. Wide heart monitor use tied to missed alarms. | PSNet

    psnet.ahrq.gov/issue/wide-heart-monitor-use-tied-missed-alarms
    July 19, 2023 - Newspaper/Magazine Article Wide heart monitor use tied to missed alarms. Citation Text: Funk M, Winkler CG, May JL, et al. Unnecessary arrhythmia monitoring and underutilization of ischemia and QT interval monitoring in current clinical practice: baseline results of the Practical Use o…

  18. Survey shows room for improvement with two new ISMP Targeted Medication Safety Best Practices. | PSNet

    psnet.ahrq.gov/issue/survey-shows-room-improvement-two-new-ismp-targeted-medication-safety-best-practices
    February 12, 2020 - Newspaper/Magazine Article Survey shows room for improvement with two new ISMP Targeted Medication Safety Best Practices. Citation Text: Survey shows room for improvement with two new ISMP Targeted Medication Safety Best Practices. ISMP Medication Safety Alert! Acute care edition. July 3…

  19. Reducing harm to patients. Using patient safety dashboards at the board level. | PSNet

    psnet.ahrq.gov/issue/reducing-harm-patients-using-patient-safety-dashboards-board-level
    February 22, 2010 - Newspaper/Magazine Article Reducing harm to patients. Using patient safety dashboards at the board level. Citation Text: Pugh M, Reinertsen JL. Reducing harm to patients. Using patient safety dashboards at the board level. Healthcare executive. 2007;22(6):62, 64-5. Copy Citation …

  20. Returning to the roots of culture: a review and re-conceptualisation of safety culture. | PSNet

    psnet.ahrq.gov/issue/returning-roots-culture-review-and-re-conceptualisation-safety-culture
    December 16, 2020 - Review Returning to the roots of culture: a review and re-conceptualisation of safety culture. Citation Text: Edwards JRD, Davey J, Armstrong K. Returning to the roots of culture: A review and re-conceptualisation of safety culture. Saf Sci. 2013;55. doi:10.1016/j.ssci.2013.01.004. Co…
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