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psnet.ahrq.gov/node/33633/psn-pdf
May 01, 2006 - Patient Safety in the Physician Office Setting
May 1, 2006
Elder NC. Patient Safety in the Physician Office Setting. PSNet [internet]. 2006.
https://psnet.ahrq.gov/perspective/patient-safety-physician-office-setting
Perspective
Dr. Jones was sure he had increased Mr. H's cholesterol-lowering medication to 80 mg 6 …
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psnet.ahrq.gov/node/49680/psn-pdf
March 01, 2013 - Pathologic Mistake
March 1, 2013
Alaghehbandan R, Raab SS. Pathologic Mistake. PSNet [internet]. 2013.
https://psnet.ahrq.gov/web-mm/pathologic-mistake
The Case
A 32-year-old previously healthy woman experienced abdominal pain and bloating for 6 months. The
discomfort worsened with eating. After losing 15 pounds …
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psnet.ahrq.gov/node/853772/psn-pdf
September 27, 2023 - Insulin Administration: Pen vs Vial – Similar, but Not
Interchangeable
September 27, 2023
Camarillo H. Insulin Administration: Pen vs Vial – Similar, but Not Interchangeable. PSNet [internet]. 2023.
https://psnet.ahrq.gov/web-mm/insulin-administration-pen-vs-vial-similar-not-interchangeable
The Case
A fourteen-ye…
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psnet.ahrq.gov/node/49851/psn-pdf
January 01, 2019 - One Bronchoscopy, Two Errors
January 1, 2019
Leiten E, Nielsen R. One Bronchoscopy, Two Errors. PSNet [internet]. 2019.
https://psnet.ahrq.gov/web-mm/one-bronchoscopy-two-errors
The Case
A 67-year-old man with a history of hypertension was admitted to the intensive care unit (ICU) with hypoxic
respiratory failure…
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psnet.ahrq.gov/node/49704/psn-pdf
March 01, 2014 - Late Anemia Following Rh Disease in a Newborn
March 1, 2014
Newman TB, Maisels JM. Late Anemia Following Rh Disease in a Newborn. PSNet [internet]. 2014.
https://psnet.ahrq.gov/web-mm/late-anemia-following-rh-disease-newborn
The Case
A full-term neonate was delivered uneventfully to an Rh-negative woman who had re…
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psnet.ahrq.gov/node/33745/psn-pdf
February 01, 2013 - Patient Engagement and Patient Safety
February 1, 2013
Weingart SN. Patient Engagement and Patient Safety. PSNet [internet]. 2013.
https://psnet.ahrq.gov/perspective/patient-engagement-and-patient-safety
Perspective
Patient engagement has arrived at the station. A Google search of this phrase identified 335,000 hi…
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psnet.ahrq.gov/node/49572/psn-pdf
October 01, 2008 - Mistaken Identity
October 1, 2008
Hall LW. Mistaken Identity. PSNet [internet]. 2008.
https://psnet.ahrq.gov/web-mm/mistaken-identity
The Case
An 85-year-old Cantonese-speaking woman was admitted to the medical service with altered mental status
and a reported fall. After finding tenderness in her left hip, the p…
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psnet.ahrq.gov/web-mm/central-not-epidural
August 28, 2024 - Central, not Epidural
Citation Text:
Simmons D. Central, not Epidural. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2011.
Copy Citation
Format:
Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged PubMedI…
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psnet.ahrq.gov/node/49502/psn-pdf
February 01, 2006 - Deciphering the Code
February 1, 2006
Goldstein MK. Deciphering the Code. PSNet [internet]. 2006.
https://psnet.ahrq.gov/web-mm/deciphering-code
The Case
An 85-year-old man with advanced oxygen-dependent chronic obstructive pulmonary disease (COPD)
presented to the emergency department (ED) with increasing shortn…
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psnet.ahrq.gov/node/33677/psn-pdf
November 01, 2008 - Health Care–Acquired Urinary Tract Infection: The
Problem and Solutions
November 1, 2008
Nicolle LE. Health Care–Acquired Urinary Tract Infection: The Problem and Solutions. PSNet [internet].
2008.
https://psnet.ahrq.gov/perspective/health-care-acquired-urinary-tract-infection-problem-and-solutions
Perspective
U…
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psnet.ahrq.gov/node/49724/psn-pdf
January 01, 2015 - Bowel Injury After Laparoscopic Surgery
January 1, 2015
Moorthy K. Bowel Injury After Laparoscopic Surgery. PSNet [internet]. 2015.
https://psnet.ahrq.gov/web-mm/bowel-injury-after-laparoscopic-surgery
The Case
A 30-year-old man presented to the hospital for a scheduled laparoscopic inguinal hernia repair with mes…
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/engagingfamilies/howtogetstarted/Ways_To_Learn_More_508.docx
June 02, 2025 - Information to Help Hospitals Get Started
Ways to Learn More
Information to Help Hospitals Get Started
[Type text] [Type text] [Type text]
Information to Help Hospitals Get Started
Guide to Patient and Family Engagement :: 1
Guide to Patient and Family Engagement :: 2
This document contains links to resources on t…
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www.ahrq.gov/hai/tools/ambulatory-surgery/sections/implementation/implementation-guide/app-o-fac-notes.html
May 01, 2017 - Appendix O. Part 2—Disinfection/Sterilization Record Keeping: Facilitator Notes
Implementation Guide
Slide 1: Appendix O. Part 2: A Clear View of Flexible Endoscope Processing: Disinfection/Sterilization Record Keeping
Hi, and welcome to Part 2 of A Clear View on Flexible Endoscope Processing . In this p…
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/ambulatory-surgery/sections/implementation/implementation-guide/appendix-o-part2-transcript.docx
June 02, 2025 - Strategy 2: Communicating to Improve Quality (Tool 3)
AHRQ Safety Program for Ambulatory Surgery
Implementation Guide
Appendix O. A Clear View on Flexible Endoscope Processing – Part 2, Disinfection/Sterilization Record Keeping
Transcript/Facilitator Notes
Sue Klacik:
(Slide 1) Hi, and welcome to Part 2 of A Clea…
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www.ahrq.gov/sites/default/files/wysiwyg/antibiotic-use/ambulatory-care/implementing-stewardship-slides.pptx
September 01, 2022 - Improving Antibiotic Use is a Patient Safety Issue
AHRQ Safety Program for Improving Antibiotic Use
Implementing Antibiotic Stewardship in Your Practice
Ambulatory Care
AHRQ Pub. No. 17(22)-0030
September 2022
Implementing Stewardship
AHRQ Safety Program for Improving Antibiotic Use – Ambulatory Care
1
Objecti…
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www.ahrq.gov/sites/default/files/wysiwyg/antibiotic-use/ambulatory-care/common-cold-slides.pptx
September 01, 2022 - The “Never Antibiotics” Diagnoses: Viral Acute Upper Respiratory Infection: the Common Cold – Slides
The “Never Antibiotics” Diagnoses:
Acute Viral Upper Respiratory Infection:
the Common Cold
Ambulatory Care
AHRQ Safety Program for Improving Antibiotic Use
AHRQ Pub. No. 17(22)-0030
September 2022
Upper Respira…
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/mvp/modules/technical/nursedr-early-mobility-protocols-slides.pptx
January 01, 2017 - Presentation: Program Overview
Nurse-Driven Early Mobility Protocols
AHRQ Safety Program for Mechanically Ventilated Patients
AHRQ Pub. No. 16(17)-0018-52-EF
January 2017
Nurse-Driven Early Mobility ‹#›
AHRQ Safety Program for Mechanically Ventilated Patients
SAY:
You have embarked on a unique journey.
1
Lear…
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/perinatal-care/modules/teamwork/engage/pf-engagement-facilitator-guide.docx
May 01, 2017 - AHRQ Safety Program for Perinatal Care
Engage Patients and Families for Perinatal Safety
Engage Patients and Families for Perinatal Safety
SAY:
The Patient and Family Engagement module focuses on an important topic: making sure patients and their family members understand what is happening during the patient’s hospi…
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www.ahrq.gov/patient-safety/settings/labor-delivery/perinatal-care/modules/teamwork/implement-slides.html
July 01, 2023 - Implement Teamwork and Communication for Perinatal Safety
AHRQ Safety Program for Perinatal Care
Slide 1: AHRQ Safety Program for Perinatal Care
Implement Teamwork and Communication for Perinatal Safety
Slide 2: Learning Objectives
Image: Four ascending steps show the learning objectives:
Recogn…
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www.ahrq.gov/sites/default/files/wysiwyg/hai/tools/mrsa/065-dec-staff-faqs-decolonization.docx
October 01, 2024 - AHRQ Safety Program for MRSA Prevention
Decolonization:
Staff Frequently Asked Questions
CHG, Nasal, & Wound Care
This document provides questions and answers to commonly asked questions. Some questions and answers may not be relevant to your unit. You should remove or edit information to match your unit’s protocols.
…