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4401. Microsoft PowerPoint - FINAL Spotlight Case_Medication Error During Procedural Sedation in the Pediatric ED_03.27.2023.pptx (pdf file)
      psnet.ahrq.gov/sites/default/files/2023-04/april_2023_spotlight_the_dose_makes_the_poison.pdf
      January 01, 2023 - Microsoft PowerPoint - FINAL Spotlight Case_Medication Error During Procedural Sedation in the Pediatric ED_03.27.2023.pptx Spotlight The Dose Makes the Poison: Medication Error During Procedural Sedation in the Pediatric Emergency Department Source and Credits • This presentation is based on the April 2023 AH…

4402. In Conversation With... Anna Legreid Dopp, Pharm. D | PSNet
      psnet.ahrq.gov/perspective/conversation-anna-legreid-dopp-pharm-d
      June 29, 2020 - Today during COVID, many of the shortages are being caused by the sharp increases in demand due to the

4403. In Conversation With... Joel Willis, DO, PA, MA, MPhiL and Neal Sikka, MD | PSNet
      psnet.ahrq.gov/perspective/conversation-joel-willis-do-pa-ma-mphil-and-neal-sikka-md
      May 14, 2020 - aspects of telehealth, and as patients’ understanding of both the benefits and limitations of telehealth increases

4404. Inpatient Transitions of Care: Challenges and Safety Practices | PSNet
      psnet.ahrq.gov/primer/inpatient-transitions-care-challenges-and-safety-practices
      June 15, 2024 - Inpatient Transitions of Care: Challenges and Safety Practices Citation Text: Satake A, McElroy V. Inpatient Transitions of Care: Challenges and Safety Practices. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2024. Copy Citation …

4405. Waiting Too Long | PSNet
      psnet.ahrq.gov/web-mm/waiting-too-long
      February 01, 2013 - Waiting Too Long Citation Text: Rosen MA. Waiting Too Long. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2003. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged PubMedId RIS …

4406. It's All in the Syringe | PSNet
      psnet.ahrq.gov/web-mm/its-all-syringe
      February 01, 2013 - It's All in the Syringe Citation Text: Weingart SN. It's All in the Syringe. 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 Endnote tagged P…

4407. Critical Order Set Change and Critical Limb Ischemia | PSNet
      psnet.ahrq.gov/web-mm/critical-order-set-change-and-critical-limb-ischemia
      July 02, 2019 - Critical Order Set Change and Critical Limb Ischemia Citation Text: Clay B. Critical Order Set Change and Critical Limb Ischemia. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2019. Copy Citation Format: Google Scholar…

4408. Two Pills, Same Drug | PSNet
      psnet.ahrq.gov/web-mm/two-pills-same-drug
      May 27, 2011 - Two Pills, Same Drug Citation Text: Horsky J, Patel VL. Two Pills, Same Drug. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2005. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged …

4409. The Context Is the Intervention | PSNet
      psnet.ahrq.gov/perspective/context-intervention
      August 05, 2020 - The Context Is the Intervention Dr. John Øvretveit | October 1, 2011  View more articles from the same authors. Citation Text: Øvretveit J. The Context Is the Intervention. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department …

4410. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/73229/psn-pdf
      May 26, 2021 - Norepinephrine Dosing Error Associated with Multiple Health System Vulnerabilities May 26, 2021 Duby JJ, Schomer K, Oyewole V, et al. Norepinephrine Dosing Error Associated with Multiple Health System Vulnerabilities. PSNet [internet]. 2021. https://psnet.ahrq.gov/web-mm/norepinephrine-dosing-error-associated-mult…

4411. Dropping the Ball Despite an Integrated EMR | PSNet
      psnet.ahrq.gov/web-mm/dropping-ball-despite-integrated-emr
      January 07, 2015 - Dropping the Ball Despite an Integrated EMR Citation Text: Karsh B-T. Dropping the Ball Despite an Integrated EMR. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2011. Copy Citation Format: Google Scholar BibTeX EndNote…

4412. An Obstructed View | PSNet
      psnet.ahrq.gov/web-mm/obstructed-view
      August 07, 2019 - An Obstructed View Citation Text: Carter J. An Obstructed View. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2015. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged PubMedId RIS …

4413. Deciphering the Code | PSNet
      psnet.ahrq.gov/web-mm/deciphering-code
      November 16, 2022 - Deciphering the Code Citation Text: Goldstein MK. Deciphering the Code. 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 Endnote tagged PubMed…

4414. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/861882/psn-pdf
      January 31, 2024 - Patient Safety in Office-Based Care Settings January 31, 2024 Ricciardi R, Lee M, Mossburg S. Patient Safety in Office-Based Care Settings. PSNet [internet]. 2024. https://psnet.ahrq.gov/perspective/patient-safety-office-based-care-settings The Institute of Medicine’s 2000 publication To Err Is Human summarized res…

4415. Glucose Roller Coaster | PSNet
      psnet.ahrq.gov/web-mm/glucose-roller-coaster
      February 02, 2022 - Glucose Roller Coaster Citation Text: Sharpe B. Glucose Roller Coaster. 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 PubMed…

4416. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/33597/psn-pdf
      April 10, 2024 - Long-term Care and Patient Safety April 10, 2024 Bakerjian D. Long-term Care and Patient Safety. PSNet [internet]. 2024. https://psnet.ahrq.gov/primer/long-term-care-and-patient-safety Background For many years, the patient safety field focused on improving safety in hospital and ambulatory care settings. More re…

4417. The Dropped Lung | PSNet
      psnet.ahrq.gov/web-mm/dropped-lung
      February 06, 2012 - The Dropped Lung Citation Text: Heffner JR. The Dropped Lung. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2003. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged PubMedId RIS …

4418. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/850678/psn-pdf
      June 14, 2023 - Advance Alert Monitor Program: An Automated Early Warning System for Adults At Risk for In-Hospital Clinical Deterioration June 14, 2023 https://psnet.ahrq.gov/innovation/advance-alert-monitor-program-automated-early-warning-system-adults- risk-hospital Summary To address a well-documented hospital adverse outco…

4419. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49489/psn-pdf
      September 01, 2005 - Double Trouble September 1, 2005 Gurwitz JH. Double Trouble. PSNet [internet]. 2005. https://psnet.ahrq.gov/web-mm/double-trouble Case Objectives Appreciate the incidence of adverse drug events in older persons List preventative measures that can be used to minimize medication errors in this population Encourage…

4420. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49473/psn-pdf
      March 01, 2005 - The tendency to take shortcuts and save time is a very human one, but it also increases the risk of … Lack of predictability greatly increases the risk of mistakes.