-
psnet.ahrq.gov/node/33605/psn-pdf
March 12, 2021 - Medication Administration Errors
March 12, 2021
MacDowell P, Cabri A, Davis M. Medication Administration Errors. PSNet [internet]. 2021.
https://psnet.ahrq.gov/primer/medication-administration-errors
Updated in March 2021. Originally published in January 2018 by researchers at the University of California,
San Fra…
-
psnet.ahrq.gov/web-mm/two-wrongs-dont-make-right-kidney
April 01, 2010 - SPOTLIGHT CASE
Two Wrongs Don't Make a Right (Kidney)
Citation Text:
DeVine JG. Two Wrongs Don't Make a Right (Kidney). PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2015.
Copy Citation
Format:
Google Schola…
-
psnet.ahrq.gov/node/50949/psn-pdf
February 26, 2020 - encountered during the analytic phase typically resides with improper instrument
operation, faulty reagents
-
psnet.ahrq.gov/node/33573/psn-pdf
March 15, 2025 - Disruptive and Unprofessional Behavior
March 15, 2025
Disruptive and Unprofessional Behavior. PSNet [internet]. 2019.
https://psnet.ahrq.gov/primer/disruptive-and-unprofessional-behavior
PSNet primers are regularly reviewed and updated by the UC Davis PSNet Editorial Team to ensure that
they reflect current resear…
-
psnet.ahrq.gov/node/33592/psn-pdf
December 15, 2024 - Adverse Events, Near Misses, and Errors
December 15, 2024
Adverse Events, Near Misses, and Errors. PSNet [internet]. 2019.
https://psnet.ahrq.gov/primer/adverse-events-near-misses-and-errors
PSNet primers are regularly reviewed and updated by the UC Davis PSNet Editorial Team to ensure that
they reflect current re…
-
psnet.ahrq.gov/perspective/conversation-dr-michelle-schreiber-measuring-patient-safety
December 14, 2022 - example, AHRQ is an important measure steward for some patient experience measures and the patient safety indicators … AHRQ’s Patient Safety Indicators (PSIs) focus on measuring if potentially preventable complications
-
psnet.ahrq.gov/perspective/measuring-patient-safety
December 14, 2022 - AHRQ’s Patient Safety Indicators (PSIs) focus on measuring if potentially preventable complications … example, AHRQ is an important measure steward for some patient experience measures and the patient safety indicators
-
psnet.ahrq.gov/perspective/role-patient-improving-patient-safety
March 01, 2007 - "( 5 ) The more that performance measures are understood by the public and perceived as important indicators
-
psnet.ahrq.gov/perspective/unfinished-patient-safety-agenda
August 01, 2005 - It is a continuing puzzle that health care does not respond to economic and research indicators the same
-
psnet.ahrq.gov/node/49522/psn-pdf
November 01, 2006 - For example, patient safety indicators derived from administrative data sources can be valuable
https
-
psnet.ahrq.gov/node/49771/psn-pdf
July 01, 2016 - desired, retracts it, and then optionally enters a new but closely related order, and they are useful
indicators
-
psnet.ahrq.gov/web-mm/getting-good-report-card-unintended-consequences-public-reporting-hospital-quality
October 01, 2004 - For example, patient safety indicators derived from administrative data sources can be valuable tools
-
psnet.ahrq.gov/node/866618/psn-pdf
December 31, 2024 - EHR systems should incorporate easily seen indicators and notifications when hemolysis is
detected.
-
psnet.ahrq.gov/perspective/conversation-nicholas-g-castle-mha-phd
August 01, 2012 - Perceived patient safety culture in nursing homes associated with "Nursing Home Compare" performance indicators
-
psnet.ahrq.gov/web-mm/fatal-oversight-misdiagnosis-nocturnal-chest-pain-elevated-d-dimer
May 01, 2005 - Fatal Oversight: Misdiagnosis of Nocturnal Chest Pain with Elevated D-dimer.
Citation Text:
Agusala V, Deen J, Schaefer S. Fatal Oversight: Misdiagnosis of Nocturnal Chest Pain with Elevated D-dimer.. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and H…
-
psnet.ahrq.gov/web-mm/unfamiliar-catheter
November 01, 2006 - The Unfamiliar Catheter
Citation Text:
Swayze SC, James A. The Unfamiliar Catheter. 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 7 XML Endnote t…
-
psnet.ahrq.gov/web-mm/picking-cause-stroke
August 07, 2024 - Picking Up the Cause of the Stroke
Citation Text:
Chopra V. Picking Up the Cause of the Stroke. 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 X…
-
psnet.ahrq.gov/web-mm/harm-alarm-fatigue
February 14, 2018 - SPOTLIGHT CASE
Harm From Alarm Fatigue
Citation Text:
Pelter MM, Drew BJ. Harm From Alarm Fatigue. 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 X…
-
psnet.ahrq.gov/web-mm/one-dose-two-errors
September 29, 2017 - One Dose, Two Errors
Citation Text:
Filice GA. One Dose, Two Errors. 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 Endnote tagged PubMedId …
-
psnet.ahrq.gov/node/60269/psn-pdf
April 29, 2020 - Delayed Management of Necrotizing Soft Tissue Infection
– Who does the Patient Belong To?
April 29, 2020
Rinderknecht T, Utter GH. Delayed Management of Necrotizing Soft Tissue Infection – Who does the
Patient Belong To? PSNet [internet]. 2020.
https://psnet.ahrq.gov/web-mm/delayed-management-necrotizing-soft-tiss…