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  1. psnet.ahrq.gov/web-mm/new-oral-anticoagulants
    July 01, 2011 - SPOTLIGHT CASE New Oral Anticoagulants Citation Text: Fang MC. New Oral Anticoagulants. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2013. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNote …
  2. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49760/psn-pdf
    May 01, 2016 - Mismanagement of Delirium May 1, 2016 Merrilees J, Lee KP. Mismanagement of Delirium. PSNet [internet]. 2016. https://psnet.ahrq.gov/web-mm/mismanagement-delirium The Case An 85-year-old man with early stage vascular dementia fell on the sidewalk and fractured his leg. Although fitted with a cast at a regional ho…
  3. psnet.ahrq.gov/web-mm/hyperbilirubinemia-refractory-phototherapy
    March 01, 2006 - Hyperbilirubinemia Refractory to Phototherapy Citation Text: Bhutani VK, Wong RJ. Hyperbilirubinemia Refractory to Phototherapy. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2017. Copy Citation Format: Google Scholar …
  4. psnet.ahrq.gov/sites/default/files/2023-07/spotlight_a_complicated_course.pdf
    January 01, 2023 - Microsoft PowerPoint - FINAL Spotlight Case_A Complicated Course-Severe Alcohol Withdrawal - SLIDES.pptx Spotlight A Complicated Course: Severe Alcohol Withdrawal with Dexmedetomidine Infusion Source and Credits • This presentation is based on the July 2023 AHRQ WebM&M Spotlight Case o See the full article at ht…
  5. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/46644/psn-pdf
    June 20, 2018 - The Science of Teamwork. June 20, 2018 McDaniel SH, Salas E, eds. Am Psychol. 2018;73:305-600. https://psnet.ahrq.gov/issue/science-teamwork Effective teams are core to safe practice in a wide range of work environments. This special issue explores team psychology with an emphasis on high-risk industries such as s…
  6. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/40008/psn-pdf
    January 04, 2011 - How is medication prescribing ceased? A systematic review. January 4, 2011 Ostini R, Jackson C, Hegney D, et al. How is medication prescribing ceased? A systematic review. Med Care. 2011;49(1):24-36. doi:10.1097/MLR.0b013e3181ef9a7e. https://psnet.ahrq.gov/issue/how-medication-prescribing-ceased-systematic-review …
  7. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/41711/psn-pdf
    September 26, 2012 - Beyond FMEA: the structured what-if technique (SWIFT). September 26, 2012 Card AJ, Ward JR, Clarkson PJ. Beyond FMEA: The structured what-if technique (SWIFT). J Healthc Risk Manag. 2012;31(4):23-29. doi:10.1002/jhrm.20101. https://psnet.ahrq.gov/issue/swift-new-tool-identifying-prospective-hazards This commentary…
  8. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/851568/psn-pdf
    July 31, 2023 - A Complicated Course: Severe Alcohol Withdrawal with Dexmedetomidine Infusion July 31, 2023 Duong T, Boctor N, Bourgeois JA. A Complicated Course: Severe Alcohol Withdrawal with Dexmedetomidine Infusion. PSNet [internet]. 2023. https://psnet.ahrq.gov/web-mm/complicated-course-severe-alcohol-withdrawal-dexmedetomid…
  9. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/34105/psn-pdf
    December 24, 2008 - Barcode technology: its role in increasing the safety of blood transfusion. December 24, 2008 Turner CL, Casbard AC, Murphy MF. Barcode technology: its role in increasing the safety of blood transfusion. Transfusion (Paris). 2004;43(9). doi:10.1046/j.1537-2995.2003.00428.x. https://psnet.ahrq.gov/issue/barcode-tec…
  10. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/42875/psn-pdf
    January 22, 2014 - Communication in the operating theatre. January 22, 2014 Weldon S-M, Korkiakangas T, Bezemer J, et al. Communication in the operating theatre. Br J Surg. 2013;100(13):1677-88. doi:10.1002/bjs.9332. https://psnet.ahrq.gov/issue/communication-operating-theatre This systematic review of communication in the operating…
  11. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/844753/psn-pdf
    September 18, 2019 - Detecting medication administration errors. September 18, 2019 Durham ML, Jankiewicz A. Detecting Medication Administration Errors. J Patient Saf. 2019;15(3):181-183. doi:10.1097/PTS.0000000000000384. https://psnet.ahrq.gov/issue/detecting-medication-administration-errors Considerable effort has been devoted to op…
  12. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/39824/psn-pdf
    December 06, 2010 - Team working in intensive care: current evidence and future endeavors. December 6, 2010 Richardson J, West MA, Cuthbertson BH. Team working in intensive care: current evidence and future endeavors. Curr Opin Crit Care. 2010;16(6):643-8. doi:10.1097/MCC.0b013e32833e9731. https://psnet.ahrq.gov/issue/team-working-in…
  13. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49803/psn-pdf
    January 01, 2018 - Point-of-care Mixup: 1 Shot Turns Into 3 August 1, 2017 Berberich RF. Point-of-care Mixup: 1 Shot Turns Into 3. PSNet [internet]. 2017. https://psnet.ahrq.gov/web-mm/point-care-mixup-1-shot-turns-3 The Case A 2-month-old boy was brought in for a routine 2-month well-child visit. The exam was completed and the app…
  14. psnet.ahrq.gov/primer/computerized-provider-order-entry
    March 15, 2025 - Computerized Provider Order Entry Citation Text: Computerized Provider Order Entry. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2019. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endnote t…
  15. psnet.ahrq.gov/web-mm/communication-consultants
    October 01, 2018 - Communication With Consultants Citation Text: Cohn SL. Communication With Consultants. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2016. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endnot…
  16. psnet.ahrq.gov/primer/handoffs
    October 18, 2023 - Handoffs Citation Text: Handoffs and Signouts. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2019. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged PubMedId RIS Download…
  17. psnet.ahrq.gov/issue/obtaining-best-possible-medication-history-hospital-admission-description-pharmacy-technician
    October 31, 2023 - Study Obtaining the best possible medication history at hospital admission: description of a pharmacy technician-driven program to identify medication discrepancies. Citation Text: Kabir R, Liaw S, Cerise J, et al. Obtaining the best possible medication history at hospital admission: des…
  18. psnet.ahrq.gov/issue/does-suggested-diagnosis-general-practitioners-referral-question-impact-diagnostic-reasoning
    September 14, 2022 - Study Does a suggested diagnosis in a general practitioners' referral question impact diagnostic reasoning: an experimental study. Citation Text: Staal J, Speelman M, Brand R, et al. Does a suggested diagnosis in a general practitioners’ referral question impact diagnostic reasoning: an …
  19. psnet.ahrq.gov/issue/impact-pharmacists-led-medicines-reconciliation-healthcare-outcomes-secondary-care-systematic
    August 07, 2024 - Review Emerging Classic The impact of pharmacists-led medicines reconciliation on healthcare outcomes in secondary care: a systematic review and meta-analysis of randomized controlled trials. Citation Text: Cheema E, Alhomoud FK, Kinsara ASA-D, et al. The impact…
  20. psnet.ahrq.gov/issue/nursing-implications-early-warning-system-implemented-reduce-adverse-events-qualitative-study
    October 27, 2021 - Study Nursing implications of an early warning system implemented to reduce adverse events: a qualitative study. Citation Text: Braun EJ, Singh S, Penlesky AC, et al. Nursing implications of an early warning system implemented to reduce adverse events: a qualitative study. BMJ Qual Saf. …

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