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psnet.ahrq.gov/perspective/beyond-pandemic-creating-total-systems-safety
August 30, 2023 - Beyond the Pandemic: Creating Total Systems Safety
Patricia McGaffigan, MS, RN, CPPS; Cindy Manaoat Van, MHSA, CPPS; Sarah E. Mossburg, RN, PhD
| August 30, 2023
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Van CM, Mossb…
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psnet.ahrq.gov/perspective/conversation-wanda-pratt-phd
November 01, 2017 - In Conversation With… Wanda Pratt, PhD
November 1, 2017
Also Read an Essay
Citation Text:
In Conversation With… Wanda Pratt, PhD. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2017.
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psnet.ahrq.gov/perspective/health-care-acquired-urinary-tract-infection-problem-and-solutions
November 01, 2008 - Health Care–Acquired Urinary Tract Infection: The Problem and Solutions
Lindsay E. Nicolle, MD | November 1, 2008
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Citation Text:
Nicolle LE. Health Care–Acquired Urinary Tract Infection: The Pr…
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psnet.ahrq.gov/web-mm/dependence-vs-pain
October 30, 2019 - SPOTLIGHT CASE
Dependence vs. Pain
Citation Text:
Gordon AJ. Dependence vs. Pain . PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2008.
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psnet.ahrq.gov/node/49720/psn-pdf
December 01, 2014 - A Stroke of Error
December 1, 2014
Barrett KM. A Stroke of Error. PSNet [internet]. 2014.
https://psnet.ahrq.gov/web-mm/stroke-error
Case Objectives
State the key clinical factors to assess in a patient with suspected stroke.
Appreciate the relationship between elevated blood pressure and stroke in the acute sett…
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psnet.ahrq.gov/web-mm/need-eat
February 10, 2021 - The Need to Eat
Citation Text:
Widaman AM. The Need to Eat. 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/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…
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psnet.ahrq.gov/weekly-resource/rss.xml
January 01, 2024 - PSNet
PSNet
PSNet Weekly Resource
(Review) The role of AI in detecting and mitigating human errors in safety-critical industries: a review.
Artificial intelligence (AI) and machine learning (ML) are being used and tested in numerous ways. This review highlights how they are being used to detect and mitigate human err…
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psnet.ahrq.gov/primer/retained-surgical-items-causation-and-prevention
January 04, 2024 - Retained Surgical Items: Causation and Prevention
Citation Text:
Gibbs V, Romano P. Retained Surgical Items: Causation and Prevention. PSNet [internet]. Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2025.
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psnet.ahrq.gov/perspective/evolution-patient-safety-surgery
August 01, 2017 - The Evolution of Patient Safety in Surgery
Robert M. Wachter, MD | December 1, 2017
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Citation Text:
Wachter R. The Evolution of Patient Safety in Surgery. PSNet [internet]. Rockville (MD): Agency…
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psnet.ahrq.gov/perspective/patient-and-family-roles-safety
June 14, 2023 - We hear from staff, clinicians, and leaders positive reports about the power of these educational sessions
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psnet.ahrq.gov/issue/accelerating-uptake-safety-initiatives-and-guidelines-role-implementation-science
November 26, 2014 - International Meeting/Conference
Accelerating the Uptake of Safety Initiatives and Guidelines: Role of Implementation Science.
Citation Text:
American Society of Health-system Pharmacists. June 21, 2023, 1:00-2:00 PM (eastern).
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psnet.ahrq.gov/issue/root-cause-analysis-action-building-foundations
August 19, 2020 - Meeting/Conference
Root Cause Analysis-in-Action: Building Foundations.
Citation Text:
ECRI, Institute for Safe Medication Practices. September 12 and 14, 2023.
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psnet.ahrq.gov/issue/innovations-improve-patient-safety
May 25, 2016 - Book/Report
Innovations to improve patient safety.
Citation Text:
Agency for Healthcare Research and Quality. Health Care Innovations Exchange. May 18, 2016.
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psnet.ahrq.gov/issue/accuracy-every-step-challenge-medication-reconciliation
September 28, 2005 - Newspaper/Magazine Article
Accuracy at every step: the challenge of medication reconciliation.
Citation Text:
Institute for Healthcare Improvement. 2006.
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psnet.ahrq.gov/issue/mri-safety-week
January 29, 2021 - Multi-use Website
MRI Safety Week.
Citation Text:
International Society for Magnetic Resonance in Medicine.
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June 27, 2007
I…
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psnet.ahrq.gov/issue/junior-medics-bullied-lie-about-hours-doctors-ordered-work-without-proper-training
April 27, 2016 - Newspaper/Magazine Article
Junior medics bullied to lie about hours: doctors ordered to work without proper training.
Citation Text:
Revill J.
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psnet.ahrq.gov/issue/reducing-patient-risk-prescription-instruction-errors-six-sigma-approach
October 17, 2012 - Audiovisual Presentation
Reducing patient risk from prescription instruction errors—a six sigma approach.
Citation Text:
O'Dell ML; Andell JL; American Society for Quality; ASQ; Creative Healthcare USA.
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psnet.ahrq.gov/node/33846/psn-pdf
November 01, 2017 - The Role of Patient-facing Technologies to Empower
Patients and Improve Safety
November 1, 2017
Rozenblum R, Bates DW. The Role of Patient-facing Technologies to Empower Patients and Improve
Safety. PSNet [internet]. 2017.
https://psnet.ahrq.gov/perspective/role-patient-facing-technologies-empower-patients-and-imp…
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psnet.ahrq.gov/node/49471/psn-pdf
December 01, 2004 - Carpe Diem (Seize the Day)
December 1, 2004
Krumholz A. Carpe Diem (Seize the Day). PSNet [internet]. 2004.
https://psnet.ahrq.gov/web-mm/carpe-diem-seize-day
The Case
A 53-year-old man presented for a new patient visit at a local medical clinic. He had several chronic
medical conditions including hypertension, h…