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9461. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49728/psn-pdf
      March 01, 2015 - Medication Mix-Up: From Bad to Worse March 1, 2015 Wollitz A, O'Connor MF. Medication Mix-Up: From Bad to Worse. PSNet [internet]. 2015. https://psnet.ahrq.gov/web-mm/medication-mix-bad-worse The Case A 69-year-old man with chronic kidney disease and essential hypertension was admitted to the hospital with chest …

9462. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49662/psn-pdf
      August 01, 2012 - Wrong Turn through Colon: Misplaced PEG August 1, 2012 Sorokin R, Conn M. Wrong Turn through Colon: Misplaced PEG. PSNet [internet]. 2012. https://psnet.ahrq.gov/web-mm/wrong-turn-through-colon-misplaced-peg The Case An 87-year-old man was admitted for congestive heart failure (CHF) exacerbation. In addition, a pa…

9463. PowerPoint Presentation (ppt file)
      psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.323_slideshow.ppt
      May 01, 2014 - PowerPoint Presentation Spotlight Medication Reconciliation With a Twist (or Dare We Say, a Patch?) This presentation is based on the May 2014 AHRQ WebM&M Spotlight Case See the full article at http://webmm.ahrq.gov CME credit is available Commentary by: Janice Kwan, MD, Department of Medicine, University of Tor…

9464. Risk Mitigation Using the Anesthesia Risk Alert Program: Applying a Proactive Approach With Data Review & Collaborating With a Second Practitioner | PSNet
      psnet.ahrq.gov/innovation/risk-mitigation-using-anesthesia-risk-alert-program-applying-proactive-approach-data
      February 26, 2025 - Risk Mitigation Using the Anesthesia Risk Alert Program: Applying a Proactive Approach With Data Review & Collaborating With a Second Practitioner Save Save to your library Print Download PDF Share Facebook Twitter Linkedin Copy URL A…

9465. Psn-Pdf (pdf file)
      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…

9466. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49696/psn-pdf
      December 01, 2013 - New Oral Anticoagulants December 1, 2013 Fang MC. New Oral Anticoagulants. PSNet [internet]. 2013. https://psnet.ahrq.gov/web-mm/new-oral-anticoagulants Case Objectives Review properties of newer target-specific oral anticoagulants (TSOACs) such as dabigatran, rivaroxaban, and apixaban. State key perioperative c…

9467. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49490/psn-pdf
      September 01, 2005 - The Wrong Channel September 1, 2005 Gosbee JW. The Wrong Channel . PSNet [internet]. 2005. https://psnet.ahrq.gov/web-mm/wrong-channel The Case A 28-year-old woman in labor began receiving treatment with magnesium sulfate for preeclampsia. Initial dosing started at 50 mL/hour using a multi-channel medication pump…

9468. Remote Response Team and Customized Alert Settings Help Improve Management of Sepsis | PSNet
      psnet.ahrq.gov/innovation/remote-response-team-and-customized-alert-settings-help-improve-management-sepsis
      February 26, 2025 - Remote Response Team and Customized Alert Settings Help Improve Management of Sepsis Save Save to your library Print Download PDF Share Facebook Twitter Linkedin Copy URL May 31, 2023 Innovation Contact …

9469. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/836941/psn-pdf
      April 27, 2022 - Post-Acute Transitional Services: Safety in Home-Based Care Programs April 27, 2022 McElroy V, Ordona RB, Bakerjian D. Post-Acute Transitional Services: Safety in Home-Based Care Programs. PSNet [internet]. 2022. https://psnet.ahrq.gov/primer/post-acute-transitional-services-safety-home-based-care-programs Backgr…

9470. Spotlight Case [MONTH] 2003 (ppt file)
      psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.110_slideshow.ppt
      December 01, 2005 - Spotlight Case [MONTH] 2003 Spotlight Case December 2005 Low on the Totem Pole Source and Credits This presentation is based on the Dec. 2005 Spotlight Case in Surgery/Anesthesia See the full article at http://webmm.ahrq.gov CME credit is available through the Web site Commentary by: Robert Wachter, MD, …

9471. 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, …

9472. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/33604/psn-pdf
      December 15, 2024 - Pharmacist's Role in Medication Safety December 15, 2024 The Pharmacist's Role in Medication Safety. PSNet [internet]. 2019. https://psnet.ahrq.gov/primer/pharmacists-role-medication-safety PSNet primers are regularly reviewed and updated by the UC Davis PSNet Editorial Team to ensure that they reflect current res…

9473. Opioid Stewardship | PSNet
      psnet.ahrq.gov/curated-library/opioid-stewardship
      December 15, 2024 - Breadcrumb Home The PSNet Collection Curated Libraries Subscribed Opioid Stewardship  Download  Share Facebook Twitter Linkedin Copy URL Subscribe Created By: AHRQ Date Created: January 24, 2025 …

9474. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/33559/psn-pdf
      December 15, 2024 - Medication Reconciliation December 15, 2024 Medication Reconciliation. PSNet [internet]. 2019. https://psnet.ahrq.gov/primer/medication-reconciliation 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…

9475. Care Managers Use Software-Aided Medication Review Protocol for Frail, Community-Dwelling Seniors, Leading to More Appropriate Medication Use | PSNet
      psnet.ahrq.gov/innovation/care-managers-use-software-aided-medication-review-protocol-frail-community-dwelling
      September 13, 2023 - Care Managers Use Software-Aided Medication Review Protocol for Frail, Community-Dwelling Seniors, Leading to More Appropriate Medication Use Save Save to your library Print Download PDF Share Facebook Twitter Linkedin Copy URL March 31…

9476. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/60328/psn-pdf
      May 27, 2020 - Fatal Patient-Controlled Analgesia (PCA) Opioid-Induced Respiratory Depression May 27, 2020 Fazio S, Firestone R. Fatal Patient-Controlled Analgesia (PCA) Opioid-Induced Respiratory Depression. PSNet [internet]. 2020. https://psnet.ahrq.gov/web-mm/fatal-patient-controlled-analgesia-pca-opioid-induced-respiratory- …

9477. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/848124/psn-pdf
      April 26, 2023 - In Conversation with... Susan McGrath, PhD and George Blike, MD about Surveillance Monitoring April 26, 2023 In Conversation with.. Susan McGrath, PhD and George Blike, MD about Surveillance Monitoring. PSNet [internet]. 2023. https://psnet.ahrq.gov/perspective/conversation-susan-mcgrath-phd-and-george-blike-md-ab…

9478. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/50755/psn-pdf
      December 18, 2019 - The Need to Eat December 18, 2019 Widaman AM. The Need to Eat. PSNet [internet]. 2019. https://psnet.ahrq.gov/web-mm/need-eat The Case A 62-year-old man with a history of Wernicke–Korsakoff encephalopathy – a degenerative brain disorder caused by the lack of vitamin B1 – was admitted for possible aspiration pneum…

9479. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/848110/psn-pdf
      April 26, 2023 - Failure to Ensure Patient Safety Leads to Patient Falls in Nursing Homes. April 26, 2023 Failure to Ensure Patient Safety Leads to Patient Falls in Nursing Homes. PSNet [internet]. 2023. https://psnet.ahrq.gov/web-mm/failure-ensure-patient-safety-leads-patient-falls-nursing-homes Disclosure of Relevant Financial R…

9480. Rehearsing Team Care for Relatively Rare Obstetric Emergencies Leads to Improved Outcomes | PSNet
      psnet.ahrq.gov/innovation/rehearsing-team-care-relatively-rare-obstetric-emergencies-leads-improved-outcomes
      July 23, 2024 - Rehearsing Team Care for Relatively Rare Obstetric Emergencies Leads to Improved Outcomes Save Save to your library Print Download PDF Share Facebook Twitter Linkedin Copy URL December 22, 2020 Innovation Contact …