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  1. psnet.ahrq.gov/issue/national-center-patient-safety-ncps
    March 27, 2005 - Multi-use Website National Center for Patient Safety (NCPS). Citation Text: National Center for Patient Safety (NCPS). Department of Veterans Affairs. 24 Frank Lloyd Wright Drive, M2100, Post Office Box 486, Ann Arbor, MI 48106-0486. Phone: (734) 930-5890. Copy Citation …
  2. psnet.ahrq.gov/issue/special-section-human-factors-and-ergonomics-operating-room-contributions-advance-surgical
    September 01, 2018 - Special or Theme Issue Special Section on Human Factors and Ergonomics in the Operating Room: Contributions That Advance Surgical Practice. Citation Text: Special Section on Human Factors and Ergonomics in the Operating Room: Contributions That Advance Surgical Practice. Hallbeck MS, Paq…
  3. psnet.ahrq.gov/issue/patient-safety-investigating-and-reporting-serious-clinical-incidents
    November 10, 2017 - Book/Report Patient Safety: Investigating and Reporting Serious Clinical Incidents. Citation Text: Patient Safety: Investigating and Reporting Serious Clinical Incidents. Kelsey R. CRC Press: Boca Raton, FL; 2017. ISBN: 9781498781169. Copy Citation Save Save to yo…
  4. psnet.ahrq.gov/issue/monitoring-diagnostic-process-inpatient-neurology-service
    November 03, 2015 - Study Monitoring the diagnostic process on an inpatient neurology service. Citation Text: Dhand A, Bucelli R, Varadhachary A, et al. Monitoring the Diagnostic Process on an Inpatient Neurology Service. Neurohospitalist. 2017;7(3):132-136. doi:10.1177/1941874416677681. Copy Citation …
  5. psnet.ahrq.gov/issue/diagnostic-excellence-age-friendly-health-systems-dxex-afhs-seed-grant-program-improving
    September 16, 2020 - Grant Announcement Diagnostic Excellence– Age-Friendly Health Systems (DxEx–AFHS) Seed Grant Program Improving Diagnosis for Older Adults. Citation Text: Diagnostic Excellence– Age-Friendly Health Systems (DxEx–AFHS) Seed Grant Program Improving Diagnosis for Older Adults. Boston, MA: In…
  6. psnet.ahrq.gov/issue/advancing-safety-acute-pain-management
    January 08, 2020 - Book/Report Advancing the Safety of Acute Pain Management. Citation Text: Advancing the Safety of Acute Pain Management. Boston, MA: Institute for Healthcare Improvement; 2019. Copy Citation Save Save to your library Print Download PDF Share …
  7. psnet.ahrq.gov/sites/default/files/2020-06/final_june-spotlight_case_slides_06.12.2020.pdf
    January 01, 2020 - Microsoft PowerPoint - FINAL June-Spotlight Case Slides_06.12.2020.pptx Spotlight When the Indications for Drug Administration Blur Source and Credits • This presentation is based on the June 2020 AHRQ WebM&M Spotlight Case o See the full article at https://psnet.ahrq.gov/webmm • Commentary by: Julia Munsch,…
  8. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/33582/psn-pdf
    September 15, 2024 - Detection of Safety Hazards September 15, 2024 Detection of Safety Hazards. PSNet [internet]. 2019. https://psnet.ahrq.gov/primer/detection-safety-hazards PSNet primers are regularly reviewed and updated by the UC Davis PSNet Editorial Team to ensure that they reflect current research and practice in the patient s…
  9. psnet.ahrq.gov/primer/detection-safety-hazards
    March 30, 2022 - Detection of Safety Hazards Citation Text: Detection of Safety Hazards. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2019. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged PubMed…
  10. psnet.ahrq.gov/perspective/conversation-chalapathy-venkatesan-and-kathy-helak-about-application-safety-ii
    August 28, 2024 - adverse events by using tools such as root cause analysis to evaluate contributing factors and risk assessments
  11. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/867804/psn-pdf
    February 26, 2025 - Are We Safer Today? February 26, 2025 Bates DW, Lee M, Mossburg SE. Are We Safer Today? PSNet [internet]. 2025. https://psnet.ahrq.gov/perspective/are-we-safer-today In the 1999 report, To Err Is Human: Building a Safer Health System, the Institute of Medicine (now the National Academy of Medicine) drew on two lar…
  12. psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.200_slideshow.ppt
    May 01, 2009 - Spotlight Case July 2008 Spotlight Case Delirium or Dementia? Source and Credits This presentation is based on the May 2009 AHRQ WebM&M Spotlight Case See the full article at http://webmm.ahrq.gov CME credit is available Commentary by: James L. Rudolph, MD, SM Editor, AHRQ WebM&M: Robert Wachter, MD Sp…
  13. psnet.ahrq.gov/perspective/where-does-risk-adjusted-mortality-fit-safety-measurement-program
    March 01, 2015 - hospitals, lower morale and public confidence, and encourage "gaming"—for example by upgrading risk assessments—or
  14. psnet.ahrq.gov/web-mm/spotlight-mistaken-attribution-diagnostic-misstep
    July 01, 2011 - Inpatient diagnostic assessments: 1. accuracy of structured vs. unstructured interviews.
  15. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/73398/psn-pdf
    June 30, 2021 - 19 is going to be just another scenario that we are going to have to look at when we do these risk assessments
  16. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/848110/psn-pdf
    April 26, 2023 - However, even in cases where there is no history of falls, resident fall risk assessments should be
  17. psnet.ahrq.gov/web-mm/do-you-want-everything-done-clarifying-code-status
    March 27, 2024 - Periodic assessments of residency hours and individual resident performance should attempt to determine
  18. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/867651/psn-pdf
    February 26, 2025 - Common responses are five to twelve steps.25,26 These assessments of the work of medication administration
  19. psnet.ahrq.gov/perspective/conversation-brian-jarman-phd
    March 01, 2015 - hospitals, lower morale and public confidence, and encourage "gaming"—for example by upgrading risk assessments—or
  20. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/73906/psn-pdf
    October 06, 2021 - Black patients have higher pain scores after C-section and get less pain medicine and get fewer pain assessments

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