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Showing results for "complications".

  1. 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…
  2. Spotlight (pdf file)

    psnet.ahrq.gov/sites/default/files/2022-08/final_spotlight_latex_allergies-slides.pdf
    January 01, 2022 - Spotlight Spotlight Perioperative Anaphylaxis After Insertion of a Latex Drain in a Patient with Known Latex Allergy Source and Credits • This presentation is based on the August 2022 AHRQ WebM&M Spotlight Case o See the full article at https://psnet.ahrq.gov/webmm o CME credit is available o Commentary by K…
  3. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/33728/psn-pdf
    May 01, 2012 - In Conversation With…David C. Classen, MD, MS May 1, 2012 In Conversation With…David C. Classen, MD, MS. PSNet [internet]. 2012. https://psnet.ahrq.gov/perspective/conversation-withdavid-c-classen-md-ms Editor's note: David C. Classen, MD, MS, is Chief Medical Information Officer for Pascal Metrics and an Associa…
  4. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/838222/psn-pdf
    September 28, 2022 - In Conversation With... Jack Westfall, MD, MPH September 28, 2022 In Conversation With.. Jack Westfall, MD, MPH. PSNet [internet]. 2022. https://psnet.ahrq.gov/perspective/conversation-jack-westfall-md-mph Editor’s note: Jack Westfall, MD, MPH, is a retired professor from the University of Colorado School of Medic…
  5. psnet.ahrq.gov/perspective/conversation-withchristopher-p-landrigan-md
    April 01, 2005 - In Conversation with…Christopher P. Landrigan, MD April 1, 2005  Also Read an Essay Citation Text: In Conversation with…Christopher P. Landrigan, MD. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Se…
  6. psnet.ahrq.gov/perspective/introducing-new-ahrq-webmm-and-ahrq-patient-safety-network-psnet
    April 01, 2005 - Introducing the New AHRQ WebM&M and AHRQ Patient Safety Network (PSNet) Robert M. Wachter, MD | April 1, 2005  Also Read a Conversation View more articles from the same authors. Citation Text: Wachter R. Introducing the New AHRQ WebM&M and AHRQ Patient Safety Ne…
  7. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49714/psn-pdf
    August 21, 2014 - Pitfalls in Diagnosing Necrotizing Fasciitis August 21, 2014 Goh T, Goh LG. Pitfalls in Diagnosing Necrotizing Fasciitis. PSNet [internet]. 2014. https://psnet.ahrq.gov/web-mm/pitfalls-diagnosing-necrotizing-fasciitis Case Objectives State the epidemiology of necrotizing fasciitis. Appreciate the high mortality a…
  8. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49564/psn-pdf
    July 01, 2008 - Dependence vs. Pain July 1, 2008 Gordon AJ. Dependence vs. Pain . PSNet [internet]. 2008. https://psnet.ahrq.gov/web-mm/dependence-vs-pain Case Objectives Define opioid dependence and opioid withdrawal syndrome. Describe the treatment of opioid withdrawal syndrome including the use of the Clinical Opioid Withdra…
  9. psnet.ahrq.gov/sites/default/files/2023-01/spotlight_overdose_of_gabapentin_and_oxycodone_in_a_patient_with_end-stage_renal_disease.pdf
    January 01, 2023 - Microsoft PowerPoint - Spotlight Case_Gabapentin Overdose_12.21.2022 FINAL.pptx Spotlight Overdose of Gabapentin and Oxycodone in a Patient with End-Stage Renal Disease: A Case for Appropriate Interruptive Drug-Disease Alerts Source and Credits • This presentation is based on the January 2023 AHRQ WebM&M Spotli…
  10. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/72911/psn-pdf
    March 15, 2021 - The Impact of Communication on Medication Errors March 15, 2021 Branch J, Hiner D, Jackson V. The Impact of Communication on Medication Errors. PSNet [internet]. 2021. https://psnet.ahrq.gov/web-mm/impact-communication-medication-errors The Case   A 93-year-old man with a history of chronic systolic heart failure…
  11. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/850361/psn-pdf
    June 14, 2023 - Critical Echocardiogram Result Lost to Follow-up June 14, 2023 Boctor N, Molla M. Critical Echocardiogram Result Lost to Follow-up. PSNet [internet]. 2023. https://psnet.ahrq.gov/web-mm/critical-echocardiogram-result-lost-follow The Case A 63-year-old man with history of stroke, systolic heart failure, and ventric…
  12. psnet.ahrq.gov/perspective/interruptions-and-distractions-health-care-improved-safety-mindfulness
    February 01, 2014 - Interruptions and Distractions in Health Care: Improved Safety With Mindfulness Suzanne Beyea, RN, PhD | February 1, 2014  Also Read the Conversations In Conversation With… Enrico Coiera, MB, BS, PhD In Conversation With… Richard Kronick, PhD View more …
  13. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/866993/psn-pdf
    October 30, 2024 - In Conversation with Elizabeth Salisbury-Afshar about Harm Reduction Strategies to Improve Safety for People Who Use Substances October 30, 2024 Salisbury-Afshar E, Gale B, Mossburg S. In Conversation with Elizabeth Salisbury-Afshar about Harm Reduction Strategies to Improve Safety for People Who Use Substances. P…
  14. psnet.ahrq.gov/primer/safety-i-safety-ii-and-new-views-safety
    October 02, 2024 - Safety I, Safety II, and the New Views of Safety Citation Text: Scanlon M, Jacobson N. Safety I, Safety II, and the New Views of Safety. PSNet [internet]. Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2025. Copy Citation Format: Google Scholar BibTeX E…
  15. psnet.ahrq.gov/web-mm/impact-communication-medication-errors
    August 01, 2009 - The Impact of Communication on Medication Errors Citation Text: Branch J, Hiner D, Jackson V. The Impact of Communication on Medication Errors. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2021. Copy Citation Format: …
  16. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/84413/psn-pdf
    February 23, 2022 - A Loss of Trust and a Missed Diagnosis February 23, 2022 Landefeld J, Teasdale S, Jain S. A Loss of Trust and a Missed Diagnosis. PSNet [internet]. 2022. https://psnet.ahrq.gov/web-mm/loss-trust-and-missed-diagnosis Disclosure of Relevant Financial Relationships: As a provider accredited by the Accreditation Counci…
  17. psnet.ahrq.gov/web-mm/loss-trust-and-missed-diagnosis
    October 31, 2023 - SPOTLIGHT CASE A Loss of Trust and a Missed Diagnosis Citation Text: Landefeld J, Teasdale S, Jain S. A Loss of Trust and a Missed Diagnosis. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2022. Copy Citation Format:…
  18. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/867651/psn-pdf
    February 26, 2025 - Safety I, Safety II, and the New Views of Safety February 26, 2025 Scanlon M, Jacobson N. Safety I, Safety II, and the New Views of Safety. PSNet [internet]. 2025. https://psnet.ahrq.gov/primer/safety-i-safety-ii-and-new-views-safety Background and Context Safety I and Safety II (Safety I/II) are not safety method…
  19. psnet.ahrq.gov/web-mm/dependence-vs-pain
    October 30, 2019 - SPOTLIGHT CASE Dependence vs. Pain Citation Text: Gordon AJ. Dependence vs. Pain . PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2008. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNote 7 XM…
  20. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/73202/psn-pdf
    April 28, 2021 - A Postpartum Woman with an Erroneous SARS-CoV-2 Test April 28, 2021 Martin SA, Kanjilal S, Schiff G. A Postpartum Woman with an Erroneous SARS-CoV-2 Test. PSNet [internet]. 2021. https://psnet.ahrq.gov/web-mm/postpartum-woman-erroneous-sars-cov-2-test The Case A full-term pregnant patient was admitted in March 2…

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