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psnet.ahrq.gov/node/50841/psn-pdf
January 29, 2020 - “This is the wrong patient's blood!”: Evaluating a Near-
Miss Wrong Transfusion Event
January 29, 2020
Barnhard S. “This is the wrong patient's blood!”: Evaluating a Near-Miss Wrong Transfusion Event. PSNet
[internet]. 2020.
https://psnet.ahrq.gov/web-mm/wrong-patients-blood-evaluating-near-miss-wrong-transfusion-…
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol4/Advances-StJacques_105.pdf
March 29, 2008 - Improving Perioperative Patient Safety Through the Use of Information Technology
1
Improving Perioperative Patient Safety
Through the Use of Information Technology
Paul J. St. Jacques, MD; Michael N. Minear
Abstract
The perioperative care process is a unique and challenging environment. Perioperative …
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psnet.ahrq.gov/web-mm/falling-through-crack-bedrails
February 19, 2020 - SPOTLIGHT CASE
Falling Through the Crack (in the Bedrails)
Citation Text:
Dykes PC, Vacca V, Leung WY. Falling Through the Crack (in the Bedrails). PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2016.
Copy Citation
F…
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effectivehealthcare.ahrq.gov/sites/default/files/pdf/autism-interventions-future_research.pdf
September 01, 2012 - Future Research Needs: Interventions for Adolescents and Young Adults With Autism Spectrum Disorders
Future Research Needs Paper
Number 20
Future Research Needs:
Interventions for
Adolescents and Young
Adults With Autism
Spectrum Disorders
Future Research Needs Paper
Number 20
Future Research Needs: I…
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psnet.ahrq.gov/node/49465/psn-pdf
December 22, 2021 - Electronic Err
October 1, 2004
Tang PC. Electronic Err. PSNet [internet]. 2004.
https://psnet.ahrq.gov/web-mm/electronic-err
The Case
A 75-year-old woman with coronary artery disease presented to the emergency department (ED) with chest
pain that that had not responded to three sublingual nitroglycerin tablets at…
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effectivehealthcare.ahrq.gov/sites/default/files/selecting-evidence.ppt
January 01, 2010 - AHRQ Slide Template 2009
When To Select Observational Studies as Evidence for Comparative Effectiveness Reviews
Prepared for:
The Agency for Healthcare Research and Quality (AHRQ)
Training Modules for Systematic Reviews Methods Guide
www.ahrq.gov
When To Select Observational Studies as Evidence for Comparative Eff…
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effectivehealthcare.ahrq.gov/sites/default/files/related_files/selecting-evidence.ppt
January 01, 2010 - AHRQ Slide Template 2009
When To Select Observational Studies as Evidence for Comparative Effectiveness Reviews
Prepared for:
The Agency for Healthcare Research and Quality (AHRQ)
Training Modules for Systematic Reviews Methods Guide
www.ahrq.gov
When To Select Observational Studies as Evidence for Comparative Eff…
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www.ahrq.gov/sites/default/files/2024-11/stulberg-report.pdf
January 01, 2024 - Nonmedical use of opioids can lead
to adverse drug events (ADEs) and frequently is a pathway to use
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psnet.ahrq.gov/web-mm/wrong-patients-blood-evaluating-near-miss-wrong-transfusion-event
July 01, 2017 - SPOTLIGHT CASE
“This is the wrong patient's blood!”: Evaluating a Near-Miss Wrong Transfusion Event
Citation Text:
Barnhard S. “This is the wrong patient's blood!”: Evaluating a Near-Miss Wrong Transfusion Event. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Dep…
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www.ahrq.gov/sites/default/files/2024-11/gershon-report.pdf
January 01, 2024 - Incidence and Preventability of Adverse Drug Events in Hospitalized Adults.
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www.uspreventiveservicestaskforce.org/uspstf/document/evidence-summary25/screening-for-abnormal-blood-glucose-and-type-2-diabetes-october-2015
April 13, 2015 - Share to Facebook
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archived
Evidence Summary
Abnormal Blood Glucose and Type 2 Diabetes Mellitus: Screening
April 13, 2015
Recommendations made by the USPSTF are independent of the U.S. gov…
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www.uspreventiveservicestaskforce.org/uspstf/document/evidence-summary/healthy-diet-and-physical-activity-counseling-adults-with-high-risk-of-cvd
November 24, 2020 - Share to Facebook
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Evidence Summary
Healthy Diet and Physical Activity for Cardiovascular Disease Prevention in Adults With Cardiovascular Risk Factors: Behavioral Counseling Interventions
November…
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psnet.ahrq.gov/sites/default/files/2023-06/hurried_huddle_0.pdf
January 01, 2023 - Microsoft PowerPoint - Spotlight Case_Anesthesia Error During Cesarean_06.22.2023 - Final.pptx
Spotlight
Hurried Team Huddle and Poor Communication: Unsafe
Practice During Anesthesia for Emergency Cesarean
Delivery
Source and Credits
• This presentation is based on the June 2023 AHRQ WebM&M
Spotlight Case
o See…
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cdsic.ahrq.gov/sites/default/files/2024-02/Innovation%20Center%20Q4%202023%20Progress%20Report_508_01052024.pdf
January 01, 2024 - Pilot testing of checklists to discern adverse drug
reactions and adverse drug events.
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psnet.ahrq.gov/perspective/introducing-new-ahrq-webmm-and-ahrq-patient-safety-network-psnet
April 01, 2005 - daily chart reviews by ICU nurse data abstractors, voluntary reports from staff, and a computerized adverse … drug event detection system.
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psnet.ahrq.gov/perspective/conversation-withchristopher-p-landrigan-md
April 01, 2005 - daily chart reviews by ICU nurse data abstractors, voluntary reports from staff, and a computerized adverse … drug event detection system.
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www.uspreventiveservicestaskforce.org/uspstf/recommendation/obesity-in-children-and-adolescents-screening-june-2017
June 20, 2017 - Share to Facebook
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archived
Final Recommendation Statement
Obesity in Children and Adolescents: Screening
June 20, 2017
Recommendations made by the USPSTF are independent of the U.S. g…
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effectivehealthcare.ahrq.gov/sites/default/files/related_files/crohns-disease_executive.pdf
February 01, 2014 - 1
Comparative Effectiveness Review
Number 131
Pharmacologic Therapies for the Management
of Crohn’s Disease: Comparative Effectiveness
Executive Summary
Description of Crohn’s Disease
Crohn’s disease is a type of inflammatory
bowel disease. Other types of inflammatory
bowel disease include ulcerative colitis
a…
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www.ahrq.gov/sites/default/files/2025-02/silver2-report.pdf
January 01, 2025 - In 1999 Gray et al, using patient self-report, estimated a
20% adverse drug event rate among home health
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www.uspreventiveservicestaskforce.org/uspstf/document/RecommendationStatementFinal/breast-cancer-medications-for-risk-reduction
September 03, 2019 - Share to Facebook
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Final Recommendation Statement
Breast Cancer: Medication Use to Reduce Risk
September 03, 2019
Recommendations made by the USPSTF are independent of the U.S. government. They s…