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  1. Premature or Overdue? | PSNet

    psnet.ahrq.gov/web-mm/premature-or-overdue
    December 23, 2020 - Premature or Overdue? Citation Text: Thomas J, Hannah M. Premature or Overdue?. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2003. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endnote tagge…

  2. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/33721/psn-pdf
    November 01, 2011 - Lesson from the VA's Team Training Program November 1, 2011 Neily J, Mills PD, Paull DE, et al. Lesson from the VA's Team Training Program . PSNet [internet]. 2011. https://psnet.ahrq.gov/perspective/lesson-vas-team-training-program Perspective Introduction The Veterans Health Administration (VHA) National Center…

  3. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/73998/psn-pdf
    October 27, 2021 - The Hidden Danger of Unseen Intravenous Catheters October 27, 2021 Vadi MG, Malkin MR. The Hidden Danger of Unseen Intravenous Catheters. PSNet [internet]. 2021. https://psnet.ahrq.gov/web-mm/hidden-danger-unseen-intravenous-catheters The Case A 6-week-old infant underwent a craniotomy and excision of abnormal bra…

  4. Vial Mistakes Involving Heparin | PSNet

    psnet.ahrq.gov/web-mm/vial-mistakes-involving-heparin
    May 11, 2014 - Vial Mistakes Involving Heparin Citation Text: Vanderveen T. Vial Mistakes Involving Heparin. 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…

  5. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/33709/psn-pdf
    July 01, 2011 - What Have We Learned About Safe Inpatient Handovers? March 1, 2011 Kripalani S. What Have We Learned About Safe Inpatient Handovers? PSNet [internet]. 2011. https://psnet.ahrq.gov/perspective/what-have-we-learned-about-safe-inpatient-handovers Perspective The care of hospitalized patients is marked by numerous tra…

  6. Medication Reconciliation Victory After an Avoidable Error | PSNet

    psnet.ahrq.gov/web-mm/medication-reconciliation-victory-after-avoidable-error
    April 01, 2015 - Medication Reconciliation Victory After an Avoidable Error Citation Text: Cutler TW. Medication Reconciliation Victory After an Avoidable Error. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2009. Copy Citation Format: …

  7. Privacy Gone Awry | PSNet

    psnet.ahrq.gov/web-mm/privacy-gone-awry
    February 24, 2011 - Privacy Gone Awry Citation Text: Pauker SG, Pauker SP. Privacy Gone Awry. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2004. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged PubM…

  8. Our Maturing Understanding of Safety Culture: How to Change It and How It Changes Safety | PSNet

    psnet.ahrq.gov/perspective/our-maturing-understanding-safety-culture-how-change-it-and-how-it-changes-safety
    March 01, 2017 - Our concern now is to see if we can convert that into a package that can be reproduced at the next site

  9. In Conversation with... Charles Ornstein | PSNet

    psnet.ahrq.gov/perspective/conversation-charles-ornstein
    October 01, 2009 - Before late 1999, while many people understood that health care could cause harm, this concern was too

  10. First, Do No Harm: Value-driven Patient Safety in the Neonatal Intensive Care Unit | PSNet

    psnet.ahrq.gov/perspective/first-do-no-harm-value-driven-patient-safety-neonatal-intensive-care-unit
    October 30, 2019 - When I first started this work, there was so much concern within the profession that patients would think

  11. In Conversation with…Gerald B. Hickson, MD | PSNet

    psnet.ahrq.gov/perspective/conversation-withgerald-b-hickson-md
    December 01, 2009 - When a colleague behaves in a disruptive manner about a real quality concern, my notion is that we have

  12. The Media: An Essential, If Sometimes Arbitrary, Promoter of Patient Safety | PSNet

    psnet.ahrq.gov/perspective/media-essential-if-sometimes-arbitrary-promoter-patient-safety
    October 01, 2009 - Before late 1999, while many people understood that health care could cause harm, this concern was too

  13. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/33700/psn-pdf
    October 01, 2010 - I had an interaction with a surgeon about concern that a patient had preoperative pneumonia.

  14. Battle Buddy Pocket Card - Final (1) (pdf file)

    psnet.ahrq.gov/sites/default/files/2021-09/Battle%20Buddy%20Pocket%20Card%20-%20final%20(1).pdf
    January 01, 2021 - COVID 19 Battle Buddy Support Program Background: COVID-19 is a pandemic that threatens not only our patients but ourselves and our sense of safety and control. Like soldiers on a battlefield, our front line staff are coping with ongoing uncertainty about the scope of the threat, concerns about adequate PPE, …

  15. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/33591/psn-pdf
    March 15, 2025 - Triggers and Trigger Tools March 15, 2025 Triggers and Trigger Tools. PSNet [internet]. 2019. https://psnet.ahrq.gov/primer/triggers-and-trigger-tools 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 safet…

  16. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/50389/psn-pdf
    September 25, 2019 - of the health care environment, the overwhelming number of potential diagnoses for a given patient concern

  17. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/33820/psn-pdf
    December 01, 2016 - Instead of a typical concern when you talk to people and they say, "Well they won't let us do it."

  18. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/33642/psn-pdf
    November 01, 2006 - RW: How do you balance that goal with the concern that we don't overload people with too many alarms

  19. Misdiagnosis of a Pelvic Mass versus Pregnancy | PSNet

    psnet.ahrq.gov/web-mm/misdiagnosis-pelvic-mass-versus-pregnancy
    November 25, 2020 - Leiserowitz, MD, MS and Herman Hedriana, MD The primary concern in this case was the delay in recognition

  20. A Potent Medication Administered in a Not So Viable Route | PSNet

    psnet.ahrq.gov/web-mm/potent-medication-administered-not-so-viable-route
    July 20, 2016 - Another consideration that went into this decision was our concern that recommending longer durations
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