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  1. Spotlight (pdf file)

    psnet.ahrq.gov/sites/default/files/2021-06/final_spotlight_miscommunication_possible_artifact_06.21.2021.pdf
    January 01, 2021 - Spotlight Spotlight The Consequences of Miscommunication Regarding a Possible Artifact Source and Credits • This presentation is based on the June 2021 AHRQ WebM&M Spotlight Case o See the full article at https://psnet.ahrq.gov/webmm o CME credit is available o Commentary by: Kriti Gwal, MD o AHRQ WebM&M Edit…
  2. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/37791/psn-pdf
    September 29, 2017 - Controversy and quality improvement: lingering questions about ethics, oversight, and patient safety research. September 29, 2017 Kass N, Pronovost P, Sugarman J, et al. Controversy and quality improvement: lingering questions about ethics, oversight, and patient safety research. Jt Comm J Qual Patient Saf. 2008;3…
  3. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/38434/psn-pdf
    June 15, 2011 - Trends in healthcare incident reporting and relationship to safety and quality data in acute hospitals: results from the National Reporting and Learning System. June 15, 2011 Hutchinson A, Young TA, Cooper KL, et al. Trends in healthcare incident reporting and relationship to safety and quality data in acute hospi…
  4. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/60241/psn-pdf
    February 24, 2022 - Coronavirus Disease 2019 (COVID-19) and Safety of Older Adults Residing in Nursing Homes February 24, 2022 Bakerjian D. Coronavirus Disease 2019 (COVID-19) and Safety of Older Adults Residing in Nursing Homes. PSNet [internet]. 2022. https://psnet.ahrq.gov/primer/coronavirus-disease-2019-covid-19-and-safety-older-…
  5. Spotlight (pdf file)

    psnet.ahrq.gov/sites/default/files/2021-05/final_psnet_spotlight_inadvertent_bolus_of_norepinephrine_pp.pdf
    January 01, 2021 - Spotlight Spotlight An Inadvertent Bolus of Norepinephrine Source and Credits • This presentation is based on the May 2021 AHRQ WebM&M Spotlight Case o See the full article at https://psnet.ahrq.gov/webmm o CME credit is available o Commentary by: Sarina Fazio, PhD, RN, Emma Blackmon, PhD, RN, Amy Doroy, PhD,…
  6. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/42231/psn-pdf
    June 18, 2013 - Identification of doctors at risk of recurrent complaints: a national study of healthcare complaints in Australia. June 18, 2013 Bismark M, Spittal MJ, Gurrin LC, et al. Identification of doctors at risk of recurrent complaints: a national study of healthcare complaints in Australia. BMJ Qual Saf. 2013;22(7):532-40…
  7. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/46515/psn-pdf
    December 22, 2018 - A contemporary medicolegal analysis of outpatient medication management in chronic pain. December 22, 2018 Abrecht CR, Brovman EY, Greenberg P, et al. A Contemporary Medicolegal Analysis of Outpatient Medication Management in Chronic Pain. Anesth Analg. 2017;125(5):1761-1768. doi:10.1213/ANE.0000000000002499. htt…
  8. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49589/psn-pdf
    August 01, 2009 - This file is licensed under the Creative Commons Attribution ShareAlike 3.0, Attribution ShareAlike … In short: you are free to share and make derivative works of the file under the conditions that you
  9. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49751/psn-pdf
    January 01, 2016 - New Patient Mistakenly Checked in as Another January 1, 2016 Green RA, Adelman JS. New Patient Mistakenly Checked in as Another. PSNet [internet]. 2016. https://psnet.ahrq.gov/web-mm/new-patient-mistakenly-checked-another The Case A 55-year-old man, presented to a primary care physician's office for an initial vis…
  10. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/41223/psn-pdf
    March 21, 2012 - High-profile investigations into hospital safety problems in England did not prompt patients to switch providers. March 21, 2012 Laverty AA, Smith PC, Pape UJ, et al. High-profile investigations into hospital safety problems in England did not prompt patients to switch providers. Health Aff (Millwood). 2012;31(3):5…
  11. psnet.ahrq.gov/issue/how-make-emergency-department-visit-safe-one
    November 02, 2005 - Government Resource How to Make an Emergency Department Visit a Safe One. Citation Text: How to Make an Emergency Department Visit a Safe One. Clancy CM. Copy Citation Save Save to your library Print Download PDF Share Facebook Twitte…
  12. psnet.ahrq.gov/issue/handwritten-prescription-ban-puts-pharmacists-awkward-position-enforcers
    September 21, 2005 - Newspaper/Magazine Article Handwritten-prescription ban puts pharmacists in awkward position as "enforcers." Citation Text: Handwritten-prescription ban puts pharmacists in awkward position as "enforcers." Ostrom CM. Seattle Times. June 22, 2006 Copy Citation Save …
  13. psnet.ahrq.gov/issue/hospitals-tear-bills-medical-mistakes
    July 05, 2006 - Newspaper/Magazine Article Hospitals to tear up bills for medical mistakes. Citation Text: Hospitals to tear up bills for medical mistakes. Ostrom CM. Seattle Times. January 29, 2008. Copy Citation Save Save to your library Print Download PDF …
  14. psnet.ahrq.gov/issue/popular-blood-thinner-causing-deaths-injuries-nursing-homes
    May 03, 2017 - Newspaper/Magazine Article Popular blood thinner causing deaths, injuries in nursing homes. Save Save to your library Print Download PDF Share Facebook Twitter Linkedin Copy URL July 22, 2015 View more articles from the …
  15. psnet.ahrq.gov/issue/settlement-be-used-hospital-training-labeling-medicines
    May 04, 2015 - Newspaper/Magazine Article Settlement to be used for hospital training in labeling medicines. Citation Text: Settlement to be used for hospital training in labeling medicines. Ostrom CM. The Seattle Times. September 13, 2005. Copy Citation Save Save to your li…
  16. psnet.ahrq.gov/issue/training-health-care-professionals-patient-safety
    July 09, 2008 - Commentary Training health care professionals for patient safety. Citation Text: Training health care professionals for patient safety. Clancy CM. Copy Citation Save Save to your library Print Download PDF Share Facebook Twitter …
  17. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/60044/psn-pdf
    March 16, 2020 - Patient Safety in Medical, Nursing, and Other Clinical Education March 16, 2020 Howley LD, Hall KK, Fitall E. Patient Safety in Medical, Nursing, and Other Clinical Education . PSNet [internet]. 2020. https://psnet.ahrq.gov/perspective/patient-safety-medical-nursing-and-other-clinical-education Background Despit…
  18. psnet.ahrq.gov/perspective/updates-role-health-it-patient-safety
    January 31, 2020 - Annual Perspective Updates in the Role of Health IT in Patient Safety February 21, 2020  View more articles from the same authors. Citation Text: Hall KK, Fitall E, Hettinger AZ. Updates in the Role of Health IT in Patient Safety. PSNet [internet]. Rockville …
  19. psnet.ahrq.gov/issue/investigation-role-clinical-pharmacy-services-helping-identify-and-reduce-high-risk
    September 29, 2021 - Book/Report Investigation into the Role of Clinical Pharmacy Services in Helping to Identify and Reduce High-risk Prescribing Errors in Hospital. Citation Text: Investigation into the Role of Clinical Pharmacy Services in Helping to Identify and Reduce High-risk Prescribing Errors in Hos…
  20. psnet.ahrq.gov/issue/california-pharmacies-are-making-millions-mistakes-theyre-fighting-keep-secret
    October 14, 2020 - Newspaper/Magazine Article California pharmacies are making millions of mistakes. They’re fighting to keep that secret. Citation Text: California pharmacies are making millions of mistakes. They’re fighting to keep that secret. Peterson M. Los Angeles Times. September 5, 2023. Copy C…

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