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  1. Patient and Family Centered I-PASS (Family-Centered Communication Program to Reduce Medical Errors and Improve Family Experience and Communication Processes) | PSNet

    psnet.ahrq.gov/innovation/patient-and-family-centered-i-pass-family-centered-communication-program-reduce-medical
    February 26, 2025 - Patient and Family Centered I-PASS (Family-Centered Communication Program to Reduce Medical Errors and Improve Family Experience and Communication Processes) Save Save to your library Print Download PDF Share Facebook Twitter Linkedin Copy URL …

  2. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/843234/psn-pdf
    January 01, 2013 - Overdose of Gabapentin and Oxycodone in a Patient with End-Stage Renal Disease: A Case for Appropriate Interruptive Drug-Disease Alerts. February 1, 2023 Keenan CR, MacDonald S, Takeshita A, et al. Overdose of Gabapentin and Oxycodone in a Patient with End-Stage Renal Disease: A Case for Appropriate Interruptive D…

  3. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/857059/psn-pdf
    November 29, 2023 - The Risks of a Malpositioned Gastrostomy Tube and Poor Communication November 29, 2023 Hight RA. The Risks of a Malpositioned Gastrostomy Tube and Poor Communication. PSNet [internet]. 2023. https://psnet.ahrq.gov/web-mm/risks-malpositioned-gastrostomy-tube-and-poor-communication Disclosure of Relevant Financial …

  4. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/33569/psn-pdf
    June 15, 2024 - Readmissions and Adverse Events After Discharge June 15, 2024 Readmissions and Adverse Events After Discharge. PSNet [internet]. 2019. https://psnet.ahrq.gov/primer/readmissions-and-adverse-events-after-discharge PSNet primers are regularly reviewed and updated by the UC Davis PSNet Editorial Team to ensure that t…

  5. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/33836/psn-pdf
    June 01, 2017 - The Weekend Effect in Cardiology: Is It Real? If So, Can It Be Fixed? June 1, 2017 Martin VK, Mirnateghi N, Khoshchehreh M. The Weekend Effect in Cardiology: Is It Real? If So, Can It Be Fixed? . PSNet [internet]. 2017. https://psnet.ahrq.gov/perspective/weekend-effect-cardiology-it-real-if-so-can-it-be-fixed Per…

  6. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/33671/psn-pdf
    July 01, 2008 - The Soil, Not the Seed: The Real Problem with Root Cause Analysis July 1, 2008 Spath P, Minogue W. The Soil, Not the Seed: The Real Problem with Root Cause Analysis. PSNet [internet]. 2008. https://psnet.ahrq.gov/perspective/soil-not-seed-real-problem-root-cause-analysis Perspective Throughout most of his life, …

  7. Spotlight Case July 2008 (ppt file)

    psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.254_slideshow.ppt
    November 01, 2011 - Spotlight Case July 2008 Spotlight Case Near Miss with Bedside Medications * * Source and Credits This presentation is based on the November 2011 AHRQ WebM&M Spotlight Case See the full article at http://webmm.ahrq.gov CME credit is available Commentary by: Albert W. Wu, MD, MPH, Johns Hopkins Bloomberg S…

  8. Spotlight Case [MONTH] 2003 (ppt file)

    psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.104_slideshow.ppt
    September 01, 2005 - Spotlight Case [MONTH] 2003 Spotlight Case September 2005 Double Trouble Source and Credits This presentation is based on the Sept. 2005 AHRQ WebM&M Spotlight Case See the full article at http://webmm.ahrq.gov CME credit is available through the Web site Commentary by: Jerry H. Gurwitz, MD, University of…

  9. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/33563/psn-pdf
    September 16, 2024 - Culture of Safety September 16, 2024 Culture of Safety. PSNet [internet]. 2019. https://psnet.ahrq.gov/primer/culture-safety 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 …

  10. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/60362/psn-pdf
    April 13, 2018 - Statewide Telehealth Program Enhances Access to Care, Improves Outcomes for High-Risk Pregnancies in Rural Area June 12, 2020 https://psnet.ahrq.gov/innovation/statewide-telehealth-program-enhances-access-care-improves-outcomes- high-risk Summary Formerly known as the Antenatal and Neonatal Guidelines, Education…

  11. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/60744/psn-pdf
    July 29, 2020 - The NSTEMI Curbside Consultation July 29, 2020 Villablanca AC, Wong GX. The NSTEMI Curbside Consultation. PSNet [internet]. 2020. https://psnet.ahrq.gov/web-mm/nstemi-curbside-consultation Disclosure of Relevant Financial Relationships: As a provider accredited by the Accreditation Council for Continuing Medical E…

  12. Spotlight (pdf file)

    psnet.ahrq.gov/sites/default/files/2024-03/final_spotlight_case_not_missing_sepsis_needles_in_viral_haystacks_slides_march_date.pdf
    January 01, 2024 - Spotlight Spotlight Do Not Miss Sepsis Needles in Viral Haystacks! Source and Credits • This presentation is based on the March 2024 AHRQ WebM&M Spotlight Case o See the full article at https://psnet.ahrq.gov/webmm o CME credit is available o Commentary by: Michelle Hamline, MD, PhD, MAS and Ulfat Shaikh, MD, M…

  13. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/867676/psn-pdf
    February 26, 2025 - Responding to Patient Safety Events February 26, 2025 Shaikh U. Responding to Patient Safety Events. PSNet [internet]. 2025. https://psnet.ahrq.gov/primer/responding-patient-safety-events Background Patient safety events that occur in health care facilities require prompt action to ensure that further harm is mit…

  14. Periodic Issue | PSNet

    psnet.ahrq.gov/periodic-issue/periodic-issue-293
    May 26, 2021 - May 26, 2021 Weekly Issue PSNet highlights the latest patient safety literature, news, and expert commentary, including Weekly Updates, WebM&M, and Perspectives on Safety. The current issue highlights what's new this week in patient safety literature, news, conferences, reports, a…

  15. Periodic Issue | PSNet

    psnet.ahrq.gov/periodic-issue/periodic-issue-297
    June 30, 2021 - June 23, 2021 Weekly Issue PSNet highlights the latest patient safety literature, news, and expert commentary, including Weekly Updates, WebM&M, and Perspectives on Safety. The current issue highlights what's new this week in patient safety literature, news, conferences, reports, …

  16. Periodic Issue | PSNet

    psnet.ahrq.gov/periodic-issue/periodic-issue-281
    March 15, 2021 - March 3, 2021 Weekly Issue PSNet highlights the latest patient safety literature, news, and expert commentary, including Weekly Updates, WebM&M, and Perspectives on Safety. The current issue highlights what's new this week in patient safety literature, news, conferences, reports, …

  17. Periodic Issue | PSNet

    psnet.ahrq.gov/periodic-issue/periodic-issue-278
    February 10, 2021 - February 10, 2021 Weekly Issue PSNet highlights the latest patient safety literature, news, and expert commentary, including Weekly Updates, WebM&M, and Perspectives on Safety. The current issue highlights what's new this week in patient safety literature, news, conferences, repor…

  18. Periodic Issue | PSNet

    psnet.ahrq.gov/periodic-issue/periodic-issue-309
    September 29, 2021 - September 15, 2021 Weekly Issue PSNet highlights the latest patient safety literature, news, and expert commentary, including Weekly Updates, WebM&M, and Perspectives on Safety. The current issue highlights what's new this week in patient safety literature, news, conferences, repo…

  19. Periodic Issue | PSNet

    psnet.ahrq.gov/periodic-issue/periodic-issue-403
    August 30, 2023 - August 9, 2023 Weekly Issue PSNet highlights the latest patient safety literature, news, and expert commentary, including Weekly Updates, WebM&M, and Perspectives on Safety. The current issue highlights what's new this week in patient safety literature, news, conferences, reports,…

  20. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/50611/psn-pdf
    October 30, 2019 - The Lost Start Date: an Unknown Risk of E-prescribing October 30, 2019 Wright A, Schiff G. The Lost Start Date: an Unknown Risk of E-prescribing. PSNet [internet]. 2019. https://psnet.ahrq.gov/web-mm/lost-start-date-unknown-risk-e-prescribing Case Objectives List the most common errors associated with computerized…
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