-
psnet.ahrq.gov/node/60858/psn-pdf
August 26, 2020 - effort was made in this case to ensure that the patient received the discharge medications prior to going
-
psnet.ahrq.gov/node/73153/psn-pdf
April 28, 2021 - or “they told me that I was going to have the packing
removed but I feel like there is something still
-
psnet.ahrq.gov/perspective/conversation-withkatie-boston-leary-about-patient-safety-amid-nursing-workforce
April 24, 2024 - committed to saying, no matter what, “As much as these challenges and impediments are in place, I’m still going
-
psnet.ahrq.gov/perspective/patient-safety-amid-nursing-workforce-challenges
April 24, 2024 - committed to saying, no matter what, “As much as these challenges and impediments are in place, I’m still going
-
psnet.ahrq.gov/perspective/ensuring-patient-and-workforce-safety-culture-healthcare
March 27, 2024 - mistake could all potentially negatively affect HCWs’ psychological safety and suppress employee voice going
-
psnet.ahrq.gov/web-mm/misdiagnosis-small-bowel-obstruction-setting-previous-abdominal-operations
September 27, 2023 - A nurse documented his pain going from 8 to 10 before the morphine, then back to 8 afterwards.
-
psnet.ahrq.gov/web-mm/when-meds-dont-reach-bed
May 16, 2022 - effort was made in this case to ensure that the patient received the discharge medications prior to going
-
psnet.ahrq.gov/web-mm/missed-opportunities-suicide-risk-assessment
September 27, 2023 - March 31, 2022
‘You’re going to release him when he was hurting himself?’
-
psnet.ahrq.gov/node/867672/psn-pdf
February 26, 2025 - A nurse documented his pain going from 8 to 10 before the
morphine, then back to 8 afterwards.
-
psnet.ahrq.gov/node/43423/psn-pdf
August 12, 2014 - Deafening silence? Time to reconsider whether
organisations are silent or deaf when things go wrong.
August 12, 2014
Jones A, Kelly D. Deafening silence? Time to reconsider whether organisations are silent or deaf when
things go wrong. BMJ Qual Saf. 2014;23(9):709-13. doi:10.1136/bmjqs-2013-002718.
https://psnet.a…
-
psnet.ahrq.gov/node/49564/psn-pdf
July 01, 2008 - Dependence vs. Pain
July 1, 2008
Gordon AJ. Dependence vs. Pain . PSNet [internet]. 2008.
https://psnet.ahrq.gov/web-mm/dependence-vs-pain
Case Objectives
Define opioid dependence and opioid withdrawal syndrome.
Describe the treatment of opioid withdrawal syndrome including the use of the Clinical Opioid
Withdra…
-
psnet.ahrq.gov/node/43098/psn-pdf
August 25, 2015 - Who do hospital physicians and nurses go to for advice
about medications? A social network analysis and
examination of prescribing error rates.
August 25, 2015
Creswick N, Westbrook JI. Who Do Hospital Physicians and Nurses Go to for Advice About Medications? A
Social Network Analysis and Examination of Prescribin…
-
psnet.ahrq.gov/node/33709/psn-pdf
July 01, 2011 - What Have We Learned About Safe Inpatient Handovers?
March 1, 2011
Kripalani S. What Have We Learned About Safe Inpatient Handovers? PSNet [internet]. 2011.
https://psnet.ahrq.gov/perspective/what-have-we-learned-about-safe-inpatient-handovers
Perspective
The care of hospitalized patients is marked by numerous tra…
-
psnet.ahrq.gov/perspective/video-improve-patient-safety-clinical-and-educational-uses
March 01, 2004 - Video to Improve Patient Safety: Clinical and Educational Uses
Yan Xiao, PhD; Colin F. Mackenzie, MB, ChB; and F. Jacob Seagull, PhD | May 1, 2015
View more articles from the same authors.
Citation Text:
Xiao Y, Mackenzie CF, Seagull JF. Video to Improve Patient S…
-
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 …
-
psnet.ahrq.gov/node/49799/psn-pdf
July 01, 2017 - Delayed Recognition of a Positive Blood Culture
July 1, 2017
Doernberg S. Delayed Recognition of a Positive Blood Culture. PSNet [internet]. 2017.
https://psnet.ahrq.gov/web-mm/delayed-recognition-positive-blood-culture
The Case
A 58-year-old woman with metastatic breast cancer recently treated with immunosuppress…
-
psnet.ahrq.gov/node/33723/psn-pdf
December 01, 2011 - Implementing a Fall Prevention Program
December 1, 2011
Healey F. Implementing a Fall Prevention Program. PSNet [internet]. 2011.
https://psnet.ahrq.gov/perspective/implementing-fall-prevention-program
Perspective
Throughout the developed world, most hospital beds are occupied by older people, many of whom have
b…
-
psnet.ahrq.gov/node/49408/psn-pdf
July 01, 2003 - Check the Wristband
July 1, 2003
Rosenthal M. Check the Wristband. PSNet [internet]. 2003.
https://psnet.ahrq.gov/web-mm/check-wristband
The Case
The patient was a 28-year-old female awaiting ambulatory surgery. She was very anxious about the
impending surgery. The patient spoke English and appeared to be of aver…
-
psnet.ahrq.gov/web-mm/transfusion-thresholds-gastrointestinal-bleeding
November 26, 2014 - SPOTLIGHT CASE
Transfusion Thresholds in Gastrointestinal Bleeding
Citation Text:
Strate L, Swanson S. Transfusion Thresholds in Gastrointestinal Bleeding. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2017.
Copy Citati…
-
psnet.ahrq.gov/web-mm/delayed-recognition-positive-blood-culture
January 29, 2020 - Delayed Recognition of a Positive Blood Culture
Citation Text:
Doernberg S. Delayed Recognition of a Positive Blood Culture. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2017.
Copy Citation
Format:
Google Scholar BibT…