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  1. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49773/psn-pdf
    July 01, 2016 - Near Miss With Neonate October 1, 2016 Malana J, Lyndon A. Near Miss With Neonate. PSNet [internet]. 2016. https://psnet.ahrq.gov/web-mm/near-miss-neonate The Case A 37-year-old pregnant woman was admitted to the hospital for scheduled induction of labor for postterm dates. Early the next morning, intravenous oxy…
  2. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49862/psn-pdf
    May 01, 2019 - The Magnetic Deflection May 1, 2019 Kanal E. The Magnetic Deflection. PSNet [internet]. 2019. https://psnet.ahrq.gov/web-mm/magnetic-deflection The Case A 68-year-old woman with a prior history of cerebrovascular accident and hypertension presented to the hospital with new left-sided weakness and hypertensive urg…
  3. psnet.ahrq.gov/web-mm/lap-burn
    March 01, 2018 - Lap Burn Citation Text: Ball K. Lap Burn. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2004. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged PubMedId RIS Download Cita…
  4. psnet.ahrq.gov/web-mm/informed-or-misled
    April 24, 2018 - Informed or Misled? Citation Text: White SM. Informed or Misled? . 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 Endnote tagged PubMedId…
  5. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/33715/psn-pdf
    July 01, 2011 - Becoming a Patient Safety Organization July 1, 2011 Jaffe R. Becoming a Patient Safety Organization. PSNet [internet]. 2011. https://psnet.ahrq.gov/perspective/becoming-patient-safety-organization Perspective While I was the first employee of the California Hospital Patient Safety Organization (CHPSO), its story …
  6. psnet.ahrq.gov/perspective/adverse-events-dentistry
    December 22, 2020 - KH : Going back to our discussion about specific adverse events, we had talked about infection control
  7. psnet.ahrq.gov/issue/new-world-patient-safety-23rd-annual-samuel-jason-mixter-lecture
    November 02, 2014 - Commentary New world of patient safety. 23rd Annual Samuel Jason Mixter Lecture. Citation Text: Leape L. New world of patient safety: 23rd Annual Samuel Jason Mixter lecture. Arch Surg. 2009;144(5):394-8. doi:10.1001/archsurg.2009.78. Copy Citation Format: DOI Google Schola…
  8. psnet.ahrq.gov/issue/devastatingly-human-analysis-registered-nurses-medication-error-accounts
    June 27, 2018 - Study Devastatingly human: an analysis of registered nurses' medication error accounts. Citation Text: Treiber LA, Jones JH. Devastatingly human: an analysis of registered nurses' medication error accounts. Qual Health Res. 2010;20(10):1327-42. doi:10.1177/1049732310372228. Copy Cita…
  9. psnet.ahrq.gov/issue/many-faces-error-disclosure-common-set-elements-and-definition
    December 16, 2009 - Study Classic The many faces of error disclosure: a common set of elements and a definition. Citation Text: Fein SP, Hilborne LH, Spiritus EM, et al. The many faces of error disclosure: a common set of elements and a definition. J Gen Intern Med. 2007;22(6):75…
  10. psnet.ahrq.gov/issue/more-words-interpersonal-communication-cognitive-bias-and-diagnostic-errors
    March 11, 2013 - Commentary 'More than words' - interpersonal communication, cognitive bias and diagnostic errors. Citation Text: Dahm MR, Williams M, Crock C. ‘More than words’ – Interpersonal communication, cognitive bias and diagnostic errors. Patient Educ Couns. 2022;105(1):252-256. doi:10.1016/j.pec…
  11. psnet.ahrq.gov/issue/disclosing-adverse-events-patients-international-norms-and-trends
    July 29, 2020 - Study Disclosing adverse events to patients: international norms and trends. Citation Text: Wu AW, McCay L, Levinson W, et al. Disclosing Adverse Events to Patients: International Norms and Trends. J Patient Saf. 2017;13(1):43-49. doi:10.1097/PTS.0000000000000107. Copy Citation For…
  12. psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.104_slideshow.ppt
    September 01, 2005 - Spotlight Case [MONTH] 2003 Spotlight Case September 2005 Double Trouble Source and Credits This presentation is based on the Sept. 2005 AHRQ WebM&M Spotlight Case See the full article at http://webmm.ahrq.gov CME credit is available through the Web site Commentary by: Jerry H. Gurwitz, MD, University of…
  13. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/33802/psn-pdf
    February 01, 2016 - Relationships Between Physician Professional Satisfaction and Patient Safety February 1, 2016 Friedberg MW. Relationships Between Physician Professional Satisfaction and Patient Safety. PSNet [internet]. 2016. https://psnet.ahrq.gov/perspective/relationships-between-physician-professional-satisfaction-and-patient-…
  14. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/50929/psn-pdf
    February 26, 2020 - Discharged with IV antibiotics: When issues arise, who manages the complications? February 26, 2020 Donnelley M, Gintjee TJ, Go J. Discharged with IV antibiotics: When issues arise, who manages the complications? PSNet [internet]. 2020. https://psnet.ahrq.gov/web-mm/discharged-iv-antibiotics-when-issues-arise-who-…
  15. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49728/psn-pdf
    March 01, 2015 - Medication Mix-Up: From Bad to Worse March 1, 2015 Wollitz A, O'Connor MF. Medication Mix-Up: From Bad to Worse. PSNet [internet]. 2015. https://psnet.ahrq.gov/web-mm/medication-mix-bad-worse The Case A 69-year-old man with chronic kidney disease and essential hypertension was admitted to the hospital with chest …
  16. psnet.ahrq.gov/web-mm/missing-trauma
    March 03, 2011 - Missing Trauma Citation Text: Jurkovich GJ. Missing Trauma. 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 XML Endnote tagged PubMedId RIS …
  17. psnet.ahrq.gov/web-mm/missing-abscess-radiology-reads-digital-era
    January 01, 2009 - SPOTLIGHT CASE The Missing Abscess: Radiology Reads in the Digital Era Citation Text: Siegel EL. The Missing Abscess: Radiology Reads in the Digital Era. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2017. Copy Citation…
  18. psnet.ahrq.gov/web-mm/lost-transition
    November 17, 2010 - SPOTLIGHT CASE Lost in Transition Citation Text: Beach C. Lost in Transition. 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 Endn…
  19. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/36317/psn-pdf
    October 11, 2006 - Medication errors. October 11, 2006 Hartigan-Go K. Int J Risk Safety Med. 2006;18(3):181-186. https://psnet.ahrq.gov/issue/medication-errors The author discusses causes of medication errors and drug safety and provides case examples of safe medication practices from the Philippines. https://psnet.ahrq.gov/issue/m…
  20. psnet.ahrq.gov/issue/near-miss-events-detected-using-emergency-department-trigger-tool
    August 24, 2022 - Study Near-miss events detected using the emergency department trigger tool. Citation Text: Griffey RT, Schneider RM, Todorov AA. Near-miss events detected using the emergency department trigger tool. J Patient Saf. 2023;19(2):59-66. doi:10.1097/pts.0000000000001092. Copy Citation …

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