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461. Identification of common themes from never events data published by NHS England. | PSNet
     psnet.ahrq.gov/issue/identification-common-themes-never-events-data-published-nhs-england
     April 07, 2021 - Study Identification of common themes from never events data published by NHS England. Citation Text: Omar I, Graham Y, Singhal R, et al. Identification of common themes from never events data published by NHS England. World J Surg. 2021;45(3):697-704. doi:10.1007/s00268-020-05867-7. C…

462. Resident-faculty overnight discrepancy rates as a function of number of consecutive nights during a week of night float. | PSNet
     psnet.ahrq.gov/issue/resident-faculty-overnight-discrepancy-rates-function-number-consecutive-nights-during-week
     November 16, 2022 - Study Resident-faculty overnight discrepancy rates as a function of number of consecutive nights during a week of night float. Citation Text: Peterson C, Moore M, Sarwani N, et al. Resident-faculty overnight discrepancy rates as a function of number of consecutive nights during a week of…

463. Assessing the dangers of a hospital stay for patients with developmental disability In England, 2017–19. | PSNet
     psnet.ahrq.gov/issue/assessing-dangers-hospital-stay-patients-developmental-disability-england-2017-19
     October 26, 2022 - Study Assessing the dangers of a hospital stay for patients with developmental disability In England, 2017–19. Citation Text: Friebel R, Maynou L. Assessing the dangers of a hospital stay for patients with developmental disability In England, 2017–19. Health Aff (Millwood). 2022;41(10):1…

464. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/49537/psn-pdf
     June 01, 2007 - Beeline to Spine June 1, 2007 Smetana GW. Beeline to Spine. PSNet [internet]. 2007. https://psnet.ahrq.gov/web-mm/beeline-spine Case Objectives Understand the elements of preoperative medical evaluation. Appreciate the limited role for preoperative laboratory testing. Appreciate the importance of communication a…

465. Guidelines for the prevention of intravascular catheter-related infections. | PSNet
     psnet.ahrq.gov/issue/guidelines-prevention-intravascular-catheter-related-infections
     January 22, 2014 - Clinical Guideline Guidelines for the prevention of intravascular catheter-related infections. Citation Text: O'Grady NP, Alexander M, Burns LA, et al. Guidelines for the prevention of intravascular catheter-related infections. American journal of infection control. 2011;39(4 Suppl 1):…

466. Building safer systems by ecological design: using restoration science to develop a medication safety intervention. | PSNet
     psnet.ahrq.gov/issue/building-safer-systems-ecological-design-using-restoration-science-develop-medication-safety
     February 14, 2024 - Study Building safer systems by ecological design: using restoration science to develop a medication safety intervention. Citation Text: Marck PB, Kwan JA, Preville B, et al. Building safer systems by ecological design: using restoration science to develop a medication safety intervent…

467. Hurried Team Huddle and Poor Communication: Unsafe Practice During Anesthesia for Emergency Cesarean Delivery | PSNet
     psnet.ahrq.gov/web-mm/hurried-team-huddle-and-poor-communication-unsafe-practice-during-anesthesia-emergency
     September 27, 2023 - SPOTLIGHT CASE Hurried Team Huddle and Poor Communication: Unsafe Practice During Anesthesia for Emergency Cesarean Delivery Citation Text: Curtin A, Schloemerkemper N. Hurried Team Huddle and Poor Communication: Unsafe Practice During Anesthesia for Emergency Cesarean Delivery.. PSNet [internet]…

468. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/49701/psn-pdf
     February 01, 2014 - An Easily Forgotten Tube February 1, 2014 Ousey K. An Easily Forgotten Tube. PSNet [internet]. 2014. https://psnet.ahrq.gov/web-mm/easily-forgotten-tube The Case A 45-year-old man was admitted to the intensive care unit (ICU) for acute liver failure secondary to alcohol abuse. His illness was complicated by acute…

469. The NSTEMI Curbside Consultation | PSNet
     psnet.ahrq.gov/web-mm/nstemi-curbside-consultation
     August 04, 2021 - SPOTLIGHT CASE The NSTEMI Curbside Consultation Citation Text: Villablanca AC, Wong GX. The NSTEMI Curbside Consultation. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2020. Copy Citation Format: Google Scho…

470. Leveraging the science of teamwork to sustain handoff improvements in cardiovascular surgery. | PSNet
     psnet.ahrq.gov/issue/leveraging-science-teamwork-sustain-handoff-improvements-cardiovascular-surgery
     November 28, 2018 - Study Leveraging the science of teamwork to sustain handoff improvements in cardiovascular surgery. Citation Text: Keebler JR, Lynch I, Ngo F, et al. Leveraging the science of teamwork to sustain handoff improvements in cardiovascular surgery. Jt Comm J Qual Patient Saf. 2023;49(8):373-3…

471. Medication regimen complexity and hospital readmission for an adverse drug event. | PSNet
     psnet.ahrq.gov/issue/medication-regimen-complexity-and-hospital-readmission-adverse-drug-event
     December 03, 2014 - Study Medication regimen complexity and hospital readmission for an adverse drug event. Citation Text: Willson MN, Greer CL, Weeks DL. Medication regimen complexity and hospital readmission for an adverse drug event. Ann Pharmacother. 2014;48(1):26-32. doi:10.1177/1060028013510898. C…

472. Eight years of decreased methicillin-resistant Staphylococcus aureus health care–associated infections associated with a Veterans Affairs prevention initiative. | PSNet
     psnet.ahrq.gov/issue/eight-years-decreased-methicillin-resistant-staphylococcus-aureus-health-care-associated
     March 23, 2012 - Study Eight years of decreased methicillin-resistant Staphylococcus aureus health care–associated infections associated with a Veterans Affairs prevention initiative. Citation Text: Evans ME, Kralovic SM, Simbartl LA, et al. Eight years of decreased methicillin-resistant Staphylococcus a…

473. Medication errors and adverse drug events in an intensive care unit: direct observation approach for detection. | PSNet
     psnet.ahrq.gov/issue/medication-errors-and-adverse-drug-events-intensive-care-unit-direct-observation-approach
     August 26, 2011 - Study Medication errors and adverse drug events in an intensive care unit: direct observation approach for detection. Citation Text: Kopp BJ, Erstad BL, Allen ME, et al. Medication errors and adverse drug events in an intensive care unit: direct observation approach for detection. Crit…

474. A review of healthcare failure mode and effects analysis (HFMEA) in radiotherapy. | PSNet
     psnet.ahrq.gov/issue/review-healthcare-failure-mode-and-effects-analysis-hfmea-radiotherapy
     June 13, 2011 - Review A review of healthcare failure mode and effects analysis (HFMEA) in radiotherapy. Citation Text: Giardina M, Cantone MC, Tomarchio E, et al. A Review of Healthcare Failure Mode and Effects Analysis (HFMEA) in Radiotherapy. Health Phys. 2016;111(4):317-26. doi:10.1097/HP.0000000000…

475. Medication errors in acute cardiovascular and stroke patients. A scientific statement from the American Heart Association. | PSNet
     psnet.ahrq.gov/issue/medication-errors-acute-cardiovascular-and-stroke-patients-scientific-statement-american
     February 03, 2011 - Organizational Policy/Guidelines Medication errors in acute cardiovascular and stroke patients. A scientific statement from the American Heart Association. Citation Text: Michaels AD, Spinler SA, Leeper B, et al. Medication Errors in Acute Cardiovascular and Stroke Patients. Circulatio…

476. Risk of adverse drug events in neonates treated with opioids and the effect of a bar-code–assisted medication administration system. | PSNet
     psnet.ahrq.gov/issue/risk-adverse-drug-events-neonates-treated-opioids-and-effect-bar-code-assisted-medication
     May 21, 2009 - Study Risk of adverse drug events in neonates treated with opioids and the effect of a bar-code–assisted medication administration system. Citation Text: Morriss FH, Abramowitz PW, Nelson S, et al. Risk of adverse drug events in neonates treated with opioids and the effect of a bar-cod…

477. Incidence, patterns, and prevention of wrong-site surgery. | PSNet
     psnet.ahrq.gov/issue/incidence-patterns-and-prevention-wrong-site-surgery
     September 30, 2010 - Study Classic Incidence, patterns, and prevention of wrong-site surgery. Citation Text: Kwaan MR, Studdert DM, Zinner MJ, et al. Incidence, patterns, and prevention of wrong-site surgery. Arch Surg. 2006;141(4):353-358. Copy Citation Format: Goog…

478. Health professionals' experiences of whistleblowing in maternal and newborn healthcare settings: a scoping review and thematic analysis. | PSNet
     psnet.ahrq.gov/issue/health-professionals-experiences-whistleblowing-maternal-and-newborn-healthcare-settings
     November 02, 2010 - Review Health professionals' experiences of whistleblowing in maternal and newborn healthcare settings: a scoping review and thematic analysis. Citation Text: Capper T, Ferguson B, Muurlink O. Health professionals' experiences of whistleblowing in maternal and newborn healthcare settings…

479. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/74830/psn-pdf
     June 01, 2022 - Norris AH, Shrestha NK, Allison GM, et al. 2018 Infectious Diseases Society of America Clinical Practice … Guideline for the Management of Outpatient Parenteral Antimicrobial Therapy.

480. 2008 Recommendations for Pre-Anesthesia Checkout Procedures.  | PSNet
     psnet.ahrq.gov/issue/2008-recommendations-pre-anesthesia-checkout-procedures
     April 22, 2020 - Organizational Policy/Guidelines 2008 Recommendations for Pre-Anesthesia Checkout Procedures.  Citation Text: 2008 Recommendations for Pre-Anesthesia Checkout Procedures.  ASA Committee on Equipment and Facilities. Park Ridge, IL: American Society of Anesthesiologists; 2008.  Copy Cita…