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  1. Failure to Report | PSNet

    psnet.ahrq.gov/web-mm/failure-report
    July 01, 2008 - SPOTLIGHT CASE Failure to Report Citation Text: Spath P. Failure to Report. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2007. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endnot…

  2. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/866995/psn-pdf
    October 30, 2024 - A Cognitive and Communication Blind Spot Contributes to Permanent Paralysis October 30, 2024 Utter GH. A Cognitive and Communication Blind Spot Contributes to Permanent Paralysis. PSNet [internet]. 2024. https://psnet.ahrq.gov/web-mm/cognitive-and-communication-blind-spot-contributes-permanent-paralysis Disclosur…

  3. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/866992/psn-pdf
    May 29, 2024 - Harm Reduction Strategies to Improve Safety for People Who Use Substances October 30, 2024 Salisbury-Afshar E, Gale B, Mossburg S. Harm Reduction Strategies to Improve Safety for People Who Use Substances . PSNet [internet]. 2024. https://psnet.ahrq.gov/perspective/harm-reduction-strategies-improve-safety-people-w…

  4. Tough Call: Addressing Errors From Previous Providers | PSNet

    psnet.ahrq.gov/web-mm/tough-call-addressing-errors-previous-providers
    July 17, 2024 - SPOTLIGHT CASE Tough Call: Addressing Errors From Previous Providers Citation Text: Martinez W, Hickson GB. Tough Call: Addressing Errors From Previous Providers. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2014. Copy…

  5. When the Lytes Go Out: A Case of Inpatient Cardiac Arrest | PSNet

    psnet.ahrq.gov/web-mm/when-lytes-go-out-case-inpatient-cardiac-arrest
    February 01, 2023 - SPOTLIGHT CASE When the Lytes Go Out: A Case of Inpatient Cardiac Arrest Citation Text: Stripe B, Zuidema D. When the Lytes Go Out: A Case of Inpatient Cardiac Arrest . PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2020.…

  6. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49811/psn-pdf
    November 01, 2017 - Delayed Diagnosis of Endocrinologic Emergencies November 1, 2017 Gomes-Lima C, Burman KD. Delayed Diagnosis of Endocrinologic Emergencies. PSNet [internet]. 2017. https://psnet.ahrq.gov/web-mm/delayed-diagnosis-endocrinologic-emergencies The Cases Case #1: A 47-year-old man with a history of hyperthyroidism and h…

  7. No News May Not Be Good News | PSNet

    psnet.ahrq.gov/web-mm/no-news-may-not-be-good-news
    December 07, 2009 - SPOTLIGHT CASE No News May Not Be Good News Citation Text: Moore CR. No News May Not Be Good News. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2012. Copy Citation Format: Google Scholar BibTeX EndNote X3 X…

  8. In Conversation with… Michael Cohen, RPh, MS, ScD (hon) | PSNet

    psnet.ahrq.gov/perspective/conversation-michael-cohen-rph-ms-scd-hon
    April 01, 2006 - In Conversation with… Michael Cohen, RPh, MS, ScD (hon) April 1, 2006  Also Read an Essay Citation Text: In Conversation with… Michael Cohen, RPh, MS, ScD (hon). PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health …

  9. Coronavirus Disease 2019 (COVID-19) and Safety of Older Adults Residing in Nursing Homes | PSNet

    psnet.ahrq.gov/primer/coronavirus-disease-2019-covid-19-and-safety-older-adults
    April 10, 2024 - Related Patient Safety Primers Long-term Care and Patient Safety April 10, 2024 Discharge … Planning and Transitions of Care March 25, 2020 Editor's Picks COVID-19 in Nursing

  10. Patient Safety in Home Dialysis | PSNet

    psnet.ahrq.gov/perspective/patient-safety-home-dialysis
    April 28, 2021 - Patient Safety in Home Dialysis April 28, 2021  Also Read the Conversation View more articles from the same authors. Citation Text: Morfín JA, Fitall E, Hall KK, et al. Patient Safety in Home Dialysis. PSNet [internet]. Rockville (MD): Agency for Healthcare Rese…

  11. Workplace Safety in Health Care | PSNet

    psnet.ahrq.gov/perspective/workplace-safety-health-care
    January 01, 2017 - Workplace Safety in Health Care Ross W. Simon and Elena G. Canacari, RN | January 1, 2017  Also Read a Conversation View more articles from the same authors. Citation Text: Simon RW, Canacari EG. Workplace Safety in Health Care. PSNet [internet]. Rockville (MD):…

  12. Becoming a Patient Safety Organization | PSNet

    psnet.ahrq.gov/perspective/becoming-patient-safety-organization
    July 01, 2011 - Becoming a Patient Safety Organization Rory Jaffe, MD, MBA | July 1, 2011  Also Read a Conversation View more articles from the same authors. Citation Text: Jaffe R. Becoming a Patient Safety Organization. PSNet [internet]. Rockville (MD): Agency for Healthcare …

  13. Periodic Issue | PSNet

    psnet.ahrq.gov/periodic-issue/periodic-issue-284
    March 15, 2021 - March 24, 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,…

  14. The Wet Read | PSNet

    psnet.ahrq.gov/web-mm/wet-read
    October 01, 2017 - SPOTLIGHT CASE The Wet Read Citation Text: Arenson RL. The Wet Read. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2006. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endnote tagge…

  15. Spotlight

    psnet.ahrq.gov/sites/default/files/2024-10/spotlight_case_delayed_symptomatic_subdural_hematoma_slides.pptx
    January 01, 2024 - Spotlight Spotlight Delayed Symptomatic Subdural Hematoma Following an Initially Normal CT Head 1 Source and Credits This presentation is based on the October 2024 AHRQ WebM&M Spotlight Case See the full article at https://psnet.ahrq.gov/webmm  CME credit is available  Commentary by: Ryan Martin, MD, FCNS and …

  16. Delayed Diagnosis of Endocrinologic Emergencies | PSNet

    psnet.ahrq.gov/web-mm/delayed-diagnosis-endocrinologic-emergencies
    November 13, 2024 - Delayed Diagnosis of Endocrinologic Emergencies Citation Text: Gomes-Lima C, Burman KD. Delayed Diagnosis of Endocrinologic Emergencies. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2017. Copy Citation Format: Google …

  17. Delirium or Dementia? | PSNet

    psnet.ahrq.gov/web-mm/delirium-or-dementia
    September 27, 2023 - SPOTLIGHT CASE Delirium or Dementia? Citation Text: Rudolph JL. Delirium or Dementia?. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2009. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNote 7…

  18. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/861738/psn-pdf
    January 31, 2024 - A Laceration that Needed a Proper Exam, Not an X-Ray January 31, 2024 Wander J, Barnes DK. A Laceration that Needed a Proper Exam, Not an X-Ray. PSNet [internet]. 2024. https://psnet.ahrq.gov/web-mm/laceration-needed-proper-exam-not-x-ray Disclosure of Relevant Financial Relationships: As a provider accredited by t…

  19. Spotlight (pdf file)

    psnet.ahrq.gov/sites/default/files/2024-01/spotlight_case_laceration_needed_exam_not_x-ray_final.pdf
    January 01, 2024 - Spotlight Spotlight Laceration that Needed a Proper Exam, Not an X-Ray Source and Credits • This presentation is based on the January 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: Jazmin A. Wander, MD and David K. Barnes, MD, F…

  20. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/861760/psn-pdf
    January 31, 2024 - Syringe Swap During Regional Block: A Case of Medication Error and Recovery January 31, 2024 Beres K, Gutierrez MC. Syringe Swap During Regional Block: A Case of Medication Error and Recovery. PSNet [internet]. 2024. https://psnet.ahrq.gov/web-mm/syringe-swap-during-regional-block-case-medication-error-and-recover…
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