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841. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/49523/psn-pdf
     November 01, 2006 - Urinary Retention Dilemma November 1, 2006 Joseph AC. Urinary Retention Dilemma. PSNet [internet]. 2006. https://psnet.ahrq.gov/web-mm/urinary-retention-dilemma The Case Following an elective thyroidectomy, a 56-year-old man with a history of benign prostatic hypertrophy (BPH) and urinary hesitancy returned to th…

842. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/49578/psn-pdf
     January 01, 2009 - Hospital Admission Due to High-Dose Methotrexate Drug Interaction January 1, 2009 Siegel LC, Gandhi TK. Hospital Admission Due to High-Dose Methotrexate Drug Interaction. PSNet [internet]. 2009. https://psnet.ahrq.gov/web-mm/hospital-admission-due-high-dose-methotrexate-drug-interaction The Case A 40-year-old wo…

843. Spotlight Case July 2008 (ppt file)
     psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.245_slideshow.ppt
     July 01, 2011 - Spotlight Case July 2008 Spotlight Case Watch the Warfarin! 1 2 Source and Credits This presentation is based on the July 2011 AHRQ WebM&M Spotlight Case See the full article at http://webmm.ahrq.gov CME credit is available Commentary by: Raman Khanna, MD, and Margaret Fang, MD, MPH; University of California, Sa…

844. The Case of Mistaken Intubation | PSNet
     psnet.ahrq.gov/web-mm/case-mistaken-intubation
     July 01, 2016 - SPOTLIGHT CASE The Case of Mistaken Intubation Citation Text: Silveira MJ. The Case of Mistaken Intubation. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2016. Copy Citation Format: Google Scholar BibTeX End…

845. Language barriers and patient safety risks in hospital care. A mixed methods study. | PSNet
     psnet.ahrq.gov/issue/language-barriers-and-patient-safety-risks-hospital-care-mixed-methods-study
     May 18, 2016 - Study Language barriers and patient safety risks in hospital care. A mixed methods study. Citation Text: van Rosse F, de Bruijne M, Suurmond J, et al. Language barriers and patient safety risks in hospital care. A mixed methods study. Int J Nurs Stud. 2016;54:45-53. doi:10.1016/j.ijnurst…

846. The impact of implementation of family-initiated escalation of care for the deteriorating patient in hospital: a systematic review. | PSNet
     psnet.ahrq.gov/issue/impact-implementation-family-initiated-escalation-care-deteriorating-patient-hospital
     December 21, 2018 - Review The impact of implementation of family-initiated escalation of care for the deteriorating patient in hospital: a systematic review. Citation Text: Gill FJ, Leslie GD, Marshall AP. The Impact of Implementation of Family-Initiated Escalation of Care for the Deteriorating Patient in …

847. Medication dosing errors for patients with renal insufficiency in ambulatory care. | PSNet
     psnet.ahrq.gov/issue/medication-dosing-errors-patients-renal-insufficiency-ambulatory-care
     July 31, 2008 - Study Medication dosing errors for patients with renal insufficiency in ambulatory care. Citation Text: Yap C, Dunham D, Thompson JA, et al. Medication Dosing Errors for Patients with Renal Insufficiency in Ambulatory Care. The Joint Commission Journal on Quality and Patient Safety. 2016…

848. When doing wrong feels so right: normalization of deviance. | PSNet
     psnet.ahrq.gov/issue/when-doing-wrong-feels-so-right-normalization-deviance
     September 03, 2011 - Review When doing wrong feels so right: normalization of deviance. Citation Text: Price MR, Williams TC. When Doing Wrong Feels So Right: Normalization of Deviance. J Patient Saf. 2018;14(1):1-2. doi:10.1097/PTS.0000000000000157. Copy Citation Format: DOI Google Scholar Pub…

849. Patient safety and job-related stress: a focus group study. | PSNet
     psnet.ahrq.gov/issue/patient-safety-and-job-related-stress-focus-group-study
     December 05, 2012 - Study Patient safety and job-related stress: a focus group study. Citation Text: Berland A, Natvig GK, Gundersen D. Patient safety and job-related stress: A focus group study. Intensive and Critical Care Nursing. 2007;24(2). doi:10.1016/j.iccn.2007.11.001. Copy Citation Format: …

850. Culture, language, and patient safety: making the link. | PSNet
     psnet.ahrq.gov/issue/culture-language-and-patient-safety-making-link
     June 22, 2009 - Commentary Culture, language, and patient safety: making the link. Citation Text: Johnstone M-J, Kanitsaki O. Culture, language, and patient safety: Making the link. Int J Qual Health Care. 2006;18(5):383-8. Copy Citation Format: Google Scholar PubMed BibTeX EndNote X3 XM…

851. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/49588/psn-pdf
     August 01, 2009 - Nurse Staffing Ratios: The Crucible of Money, Policy, Research, and Patient Care August 1, 2009 Rich V. Nurse Staffing Ratios: The Crucible of Money, Policy, Research, and Patient Care. PSNet [internet]. 2009. https://psnet.ahrq.gov/web-mm/nurse-staffing-ratios-crucible-money-policy-research-and-patient-care Case…

852. Dual Therapy Debacle | PSNet
     psnet.ahrq.gov/web-mm/dual-therapy-debacle
     February 01, 2007 - Dual Therapy Debacle Citation Text: Kayser SR. Dual Therapy Debacle. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2015. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged PubMedId …

853. Urinary Retention Dilemma | PSNet
     psnet.ahrq.gov/web-mm/urinary-retention-dilemma
     March 01, 2013 - Urinary Retention Dilemma Citation Text: Joseph AC. Urinary Retention Dilemma. 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 tagged…

854. We need to talk: an observational study of the impact of electronic medical record implementation on hospital communication. | PSNet
     psnet.ahrq.gov/issue/we-need-talk-observational-study-impact-electronic-medical-record-implementation-hospital
     February 22, 2017 - Study We need to talk: an observational study of the impact of electronic medical record implementation on hospital communication. Citation Text: Taylor SP, Ledford R, Palmer V, et al. We need to talk: an observational study of the impact of electronic medical record implementation on ho…

855. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/49639/psn-pdf
     November 01, 2011 - Near Miss with Bedside Medications November 1, 2011 Wu AW. Near Miss with Bedside Medications. PSNet [internet]. 2011. https://psnet.ahrq.gov/web-mm/near-miss-bedside-medications Case Objectives Understanding the definition of near miss—also known as close call. Appreciate the importance of close calls in reducin…

856. Less is more: a project to reduce the number of PIMs (potentially inappropriate medications) on an elderly care ward. | PSNet
     psnet.ahrq.gov/issue/less-more-project-reduce-number-pims-potentially-inappropriate-medications-elderly-care-ward
     September 27, 2017 - Commentary Less is more: a project to reduce the number of PIMs (potentially inappropriate medications) on an elderly care ward. Citation Text: Aung TH, Beck AJ, Siese T, et al. Less is more: a project to reduce the number of PIMs (potentially inappropriate medications) on an elderly car…

857. Experiences with diagnostic delay among underserved racial and ethnic patients: a systematic review of the qualitative literature. | PSNet
     psnet.ahrq.gov/issue/experiences-diagnostic-delay-among-underserved-racial-and-ethnic-patients-systematic-review
     November 03, 2015 - Review Experiences with diagnostic delay among underserved racial and ethnic patients: a systematic review of the qualitative literature. Citation Text: Faugno E, Galbraith AA, Walsh KE, et al. Experiences with diagnostic delay among underserved racial and ethnic patients: a systematic r…

858. Drug-related morbidity and mortality and the economic impact of pharmaceutical care. | PSNet
     psnet.ahrq.gov/issue/drug-related-morbidity-and-mortality-and-economic-impact-pharmaceutical-care
     December 23, 2008 - Study Drug-related morbidity and mortality and the economic impact of pharmaceutical care. Citation Text: Johnson JA, Bootman JL. Drug-related morbidity and mortality and the economic impact of pharmaceutical care. Am J Health Syst Pharm. 1997;54(5):554-8. Copy Citation Format: …

859. Handoffs causing patient harm: a survey of medical and surgical house staff. | PSNet
     psnet.ahrq.gov/issue/handoffs-causing-patient-harm-survey-medical-and-surgical-house-staff
     July 10, 2008 - Study Handoffs causing patient harm: a survey of medical and surgical house staff. Citation Text: Kitch BT, Cooper JB, Zapol WM, et al. Handoffs causing patient harm: a survey of medical and surgical house staff. Jt Comm J Qual Patient Saf. 2008;34(10):563-70. Copy Citation Format:…

860. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/49695/psn-pdf
     October 01, 2013 - Finding Fault With the Default Alert October 1, 2013 Baysari M. Finding Fault With the Default Alert. PSNet [internet]. 2013. https://psnet.ahrq.gov/web-mm/finding-fault-default-alert The Case A 33-year-old man with known refractory epilepsy and developmental delay was admitted to the hospital after experiencing …