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psnet.ahrq.gov/node/837791/psn-pdf
August 05, 2022 - Patient Safety in the Ambulatory Care Setting
August 5, 2022
Schiff G, Mossburg SE, Dowell P, et al. Patient Safety in the Ambulatory Care Setting. PSNet [internet].
2022.
https://psnet.ahrq.gov/perspective/patient-safety-ambulatory-care-setting
Introduction
There is no way to review the year 2021 in quality and …
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psnet.ahrq.gov/web-mm/delayed-clozapine-prescription-elderly-man-dementia
August 06, 2014 - Delayed Clozapine Prescription in an Elderly Man With Dementia
Citation Text:
Tsourounis C, Ghomeshi KK. Delayed Clozapine Prescription in an Elderly Man With Dementia. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2019.
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psnet.ahrq.gov/node/867850/psn-pdf
February 26, 2025 - healthcare providers and teams because they are often
trained to rule things out, a key skill in medical decision-making
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psnet.ahrq.gov/node/49583/psn-pdf
April 01, 2009 - Eptifibatide Epilogue
April 1, 2009
Churchill WW, Fiumara K. Eptifibatide Epilogue. PSNet [internet]. 2009.
https://psnet.ahrq.gov/web-mm/eptifibatide-epilogue
The Case
A 62-year-old man was admitted at 11:00 PM on a Saturday night with the provisional diagnosis of acute
coronary syndrome. Serial testing for mark…
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psnet.ahrq.gov/node/49778/psn-pdf
December 01, 2016 - One Dose, Two Errors
December 1, 2016
Filice GA. One Dose, Two Errors. PSNet [internet]. 2016.
https://psnet.ahrq.gov/web-mm/one-dose-two-errors
The Case
A 65-year-old woman was admitted to the intensive care unit (ICU) with severe sepsis and respiratory
failure secondary to community-acquired pneumonia. The pati…
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psnet.ahrq.gov/node/49857/psn-pdf
March 01, 2019 - Duplicate Insulin Order
March 1, 2019
Acquisto NM, Cobaugh DJ. Duplicate Insulin Order. PSNet [internet]. 2019.
https://psnet.ahrq.gov/web-mm/duplicate-insulin-order
The Case
A 45-year-old man with a history of insulin-dependent diabetes mellitus was seen in the emergency
department (ED) for complaints of letharg…
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psnet.ahrq.gov/perspective/reducing-safety-hazards-monitor-alert-and-alarm-fatigue
May 01, 2016 - Reducing the Safety Hazards of Monitor Alert and Alarm Fatigue
Samantha Jacques, PhD, and Eric Williams, MD, MS, MMM | May 1, 2016
Also Read a Conversation
View more articles from the same authors.
Citation Text:
Jacques S, Williams E. Reducing the Safety Hazar…
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psnet.ahrq.gov/node/49777/psn-pdf
December 01, 2016 - Suicidal Ideation in the Family Medicine Clinic
December 1, 2016
Moutier C. Suicidal Ideation in the Family Medicine Clinic. PSNet [internet]. 2016.
https://psnet.ahrq.gov/web-mm/suicidal-ideation-family-medicine-clinic
Case Objectives
Recognize suicide as a major public health problem and the critical role of pri…
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psnet.ahrq.gov/node/49855/psn-pdf
March 01, 2019 - Which Line: Ordering Provider or Proceduralist?
March 1, 2019
Blackmore CC. Which Line: Ordering Provider or Proceduralist? PSNet [internet]. 2019.
https://psnet.ahrq.gov/web-mm/which-line-ordering-provider-or-proceduralist
Case Objectives
Review the role of mistake-proofing to block errors from leading to adverse…
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psnet.ahrq.gov/perspective/conversation-witheric-g-poon-md-mph
September 01, 2008 - In Conversation with…Eric G. Poon, MD, MPH
September 1, 2008
Also Read an Essay
Citation Text:
In Conversation with…Eric G. Poon, MD, MPH. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 20…
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psnet.ahrq.gov/node/72563/psn-pdf
December 07, 2020 - In Conversation With... Katie J. Suda, PharmD, MS
December 7, 2020
In Conversation With.. Katie J. Suda, PharmD, MS . PSNet [internet]. 2020.
https://psnet.ahrq.gov/perspective/conversation-katie-j-suda-pharmd-ms
Editor’s Note: Katie J. Suda, PharmD, MS is a professor at the University of Pittsburgh School of Medic…
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psnet.ahrq.gov/web-mm/delayed-sepsis-management-due-ambiguous-allergy
January 13, 2021 - Delayed Sepsis Management Due to Ambiguous Allergy
Citation Text:
Blumenthal K. Delayed Sepsis Management Due to Ambiguous Allergy. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2019.
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Format:
Google Schol…
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psnet.ahrq.gov/node/33572/psn-pdf
December 15, 2024 - Checklists
December 15, 2024
Checklists. PSNet [internet]. 2019.
https://psnet.ahrq.gov/primer/checklists
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 safety field. Last reviewed in 2024.
Background
…
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psnet.ahrq.gov/node/33751/psn-pdf
January 01, 2014 - Strengthening the Business Case for Patient Safety
May 1, 2013
Lindenauer PK. Strengthening the Business Case for Patient Safety. PSNet [internet]. 2013.
https://psnet.ahrq.gov/perspective/strengthening-business-case-patient-safety
Perspective
After more than a decade in the national spotlight, the problem of pati…
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psnet.ahrq.gov/node/854849/psn-pdf
October 31, 2023 - can understand a patient’s condition, how it evolved, and what thought processes affected clinical
decision-making
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psnet.ahrq.gov/web-mm/mobility-lost-icu
August 01, 2018 - access to physiologic data for monitoring.( 14 ) There are 3 distinct sets of criteria to inform decision-making … Criteria to inform decision-making for exercising patients in the ICU.
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psnet.ahrq.gov/issue/changing-narratives-patient-safety
April 17, 2019 - Commentary
Changing the narratives for patient safety.
Citation Text:
Pronovost P, Sutcliffe K, Basu L, et al. Changing the narratives for patient safety. Bull World Health Organ. 2017;95(6):478-480. doi:10.2471/BLT.16.178392.
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DOI Google Scholar PubMed…
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psnet.ahrq.gov/issue/reality-check-checklists
April 21, 2015 - Commentary
Classic
Reality check for checklists.
Citation Text:
Bosk CL, Dixon-Woods M, Goeschel CA, et al. Reality check for checklists. Lancet. 2009;374(9688):444-5.
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Format:
Google Scholar PubMed BibTeX EndNote X3 XML EndNote 7 XM…
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psnet.ahrq.gov/issue/tablet-splitting-common-yet-not-so-innocent-practice
August 31, 2022 - Study
Tablet-splitting: a common yet not so innocent practice.
Citation Text:
Verrue C, Mehuys E, Boussery K, et al. Tablet-splitting: a common yet not so innocent practice. J Adv Nurs. 2011;67(1):26-32. doi:10.1111/j.1365-2648.2010.05477.x.
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DOI Goog…
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psnet.ahrq.gov/issue/ethical-issues-patient-safety-implications-nursing-management
June 10, 2020 - Commentary
Ethical issues in patient safety: implications for nursing management.
Citation Text:
Kangasniemi M, Vaismoradi M, Jasper M, et al. Ethical issues in patient safety: Implications for nursing management. Nurs Ethics. 2013;20(8):904-16. doi:10.1177/0969733013484488.
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