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  1. psnet.ahrq.gov/perspective/conversation-matthew-weinger-md
    August 01, 2018 - Some other countries do more simulation, but there's a fundamental cultural belief that's still hard
  2. psnet.ahrq.gov/perspective/conversation-andrew-gettinger-md
    September 01, 2017 - safety exists as a subset of an organization's overall safety programs, and it depends on the same cultural
  3. psnet.ahrq.gov/web-mm/dose-makes-poison-medication-error-during-procedural-sedation-pediatric-emergency-department
    January 23, 2017 - SPOTLIGHT CASE The Dose Makes the Poison: Medication Error During Procedural Sedation in the Pediatric Emergency Department. Citation Text: Amashta ML, Barnes DK. The Dose Makes the Poison: Medication Error During Procedural Sedation in the Pediatric Emergency Department.. PSNet [internet]. Rockv…
  4. psnet.ahrq.gov/sites/default/files/2023-04/april_2023_spotlight_the_dose_makes_the_poison.pdf
    January 01, 2023 - Microsoft PowerPoint - FINAL Spotlight Case_Medication Error During Procedural Sedation in the Pediatric ED_03.27.2023.pptx Spotlight The Dose Makes the Poison: Medication Error During Procedural Sedation in the Pediatric Emergency Department Source and Credits • This presentation is based on the April 2023 AH…
  5. psnet.ahrq.gov/perspective/ongoing-journey-prevent-patient-falls
    December 18, 2024 - The Ongoing Journey to Prevent Patient Falls Patricia Dykes, PhD, MA, RN, FAAN, FACMI, Zoe Sousane, BS, Sarah E. Mossburg, RN, PhD | December 18, 2024  Also Read the Conversation View more articles from the same authors. Citation Text: Dykes PC, Sousane Z, Mossb…
  6. psnet.ahrq.gov/perspective/conversation-patricia-dykes-about-ongoing-journey-prevent-patient-falls
    December 18, 2024 - In Conversation with Patricia Dykes about The Ongoing Journey to Prevent Patient Falls Patricia Dykes, PhD, MA, RN, FAAN, FACMI, Zoe Sousane, BS, Sarah E. Mossburg, RN, PhD | December 18, 2024  Also Read the Essay View more articles from the same authors. Citation…
  7. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49581/psn-pdf
    March 21, 2009 - Double Dosing, by the Rules March 21, 2009 Cohen H. Double Dosing, by the Rules. PSNet [internet]. 2009. https://psnet.ahrq.gov/web-mm/double-dosing-rules The Case A 65-year-old woman with rheumatoid arthritis and chronic obstructive pulmonary disease (COPD) was admitted to a medical unit during the night with wo…
  8. psnet.ahrq.gov/perspective/relationships-between-physician-professional-satisfaction-and-patient-safety
    September 29, 2017 - Relationships Between Physician Professional Satisfaction and Patient Safety Mark Friedberg, MD, MPP | February 1, 2016  View more articles from the same authors. Citation Text: Friedberg MW. Relationships Between Physician Professional Satisfaction and Patient Saf…
  9. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/73387/psn-pdf
    March 17, 2021 - COVID-19 and the Built Environment June 30, 2021 Joseph A, Scanlon MM, Fitall E, et al. COVID-19 and the Built Environment. PSNet [internet]. 2021. https://psnet.ahrq.gov/perspective/covid-19-and-built-environment Introduction The “built environment” in healthcare refers to the hospital structure and any other fix…
  10. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49409/psn-pdf
    July 01, 2003 - Feeling No Pain July 1, 2003 Bogner MS. Feeling No Pain. PSNet [internet]. 2003. https://psnet.ahrq.gov/web-mm/feeling-no-pain The Case A 33-year-old female underwent hysterectomy for refractory endometriosis. For pain post-operatively, the patient was placed on a Patient-Controlled Analgesia (PCA) pump containin…
  11. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49548/psn-pdf
    October 01, 2007 - Toxic Tachycardia October 1, 2007 Wartofsky L. Toxic Tachycardia. PSNet [internet]. 2007. https://psnet.ahrq.gov/web-mm/toxic-tachycardia The Case A 66-year-old woman with a past medical history of hypertension and breast cancer was admitted with abdominal pain. She complained of 3 weeks of progressive severe rig…
  12. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49635/psn-pdf
    September 01, 2011 - Central, not Epidural September 1, 2011 Simmons D. Central, not Epidural. PSNet [internet]. 2011. https://psnet.ahrq.gov/web-mm/central-not-epidural The Case A 55-year-old man with lung cancer recently had the lower lobe of his left lung removed. Post-operatively, he was awake, alert, and oriented to time, place,…
  13. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/72737/psn-pdf
    February 09, 2021 - Geisinger’s Outpatient Addiction Medicine Specialty Program Uses Data-Driven Decision Making and MAT to Reduce Mortality Rates February 9, 2021 https://psnet.ahrq.gov/innovation/geisingers-outpatient-addiction-medicine-specialty-program-uses-data- driven-decision Summary The team at Geisinger sought to develop a…
  14. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49830/psn-pdf
    May 01, 2018 - Suicide Risk in the Hospital May 1, 2018 Mills PD. Suicide Risk in the Hospital. PSNet [internet]. 2018. https://psnet.ahrq.gov/web-mm/suicide-risk-hospital The Case A 37-year-old woman with a past medical history of depression, anxiety, and posttraumatic stress disorder presented to the emergency department (ED)…
  15. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49390/psn-pdf
    February 01, 2003 - Flying Object Hits MRI February 1, 2003 Gosbee JW, Gosbee LL. Flying Object Hits MRI. PSNet [internet]. 2003. https://psnet.ahrq.gov/web-mm/flying-object-hits-mri The Case A child was brought to the Magnetic Resonance Imaging (MRI) room for a brain scan. Accompanied by an anesthesiologist, the child was receiving…
  16. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/866395/psn-pdf
    July 23, 2024 - Rescue Improvement Conference Innovation Summary July 23, 2024 https://psnet.ahrq.gov/innovation/rescue-improvement-conference-innovation-summary Summary The Rescue Improvement Conference (RIC)1 was designed at the University of Michigan to address failure to rescue with a particular focus on communication and com…
  17. psnet.ahrq.gov/primer/measurement-patient-safety
    September 15, 2024 - Measurement of Patient Safety Citation Text: Measurement of Patient Safety. 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 Pu…
  18. psnet.ahrq.gov/perspective/burnout-among-health-professionals-and-its-effect-patient-safety
    December 22, 2018 - Annual Perspective Burnout Among Health Professionals and Its Effect on Patient Safety Audrey Lyndon, PhD | January 1, 2015  View more articles from the same authors. Citation Text: Lyndon A. Burnout Among Health Professionals and Its Effect on Patient Safety…
  19. psnet.ahrq.gov/web-mm/life-threatening-infant-overdose-sodium-chloride
    December 23, 2020 - Life-Threatening Infant Overdose of Sodium Chloride Citation Text: Hamline M, McGlynn G, Lee A, et al. Life-Threatening Infant Overdose of Sodium Chloride. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2020. Copy Citation Form…
  20. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/836850/psn-pdf
    March 31, 2022 - Annual Perspective: Topics in Medication Safety March 31, 2022 Harris IB, Dowell P, Mossburg SE. Annual Perspective: Topics in Medication Safety. PSNet [internet]. 2022. https://psnet.ahrq.gov/perspective/annual-perspective-topics-medication-safety Introduction Issues with medication management and errors in medi…

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