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Showing results for "initiative".

  1. Primary Workaround, Secondary Complication | PSNet

    psnet.ahrq.gov/web-mm/primary-workaround-secondary-complication
    January 24, 2018 - Primary Workaround, Secondary Complication Citation Text: Debono D, Levett-Jones T. Primary Workaround, Secondary Complication. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2018. Copy Citation Format: Google Scholar B…

  2. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49512/psn-pdf
    May 01, 2006 - Right? Left? Neither! May 1, 2006 Chassin MR, Howell EA. Right? Left? Neither!. PSNet [internet]. 2006. https://psnet.ahrq.gov/web-mm/right-left-neither Case Objectives Appreciate the role of Reason's Swiss Cheese Model in medical errors Understand the process of analyzing a single error Provide suggestions for …

  3. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/33618/psn-pdf
    September 01, 2005 - Playing Well with Others: "Translocational Research" in Patient Safety September 1, 2005 Wachter R. Playing Well with Others: "Translocational Research" in Patient Safety. PSNet [internet]. 2005. https://psnet.ahrq.gov/perspective/playing-well-others-translocational-research-patient-safety Perspective Translation…

  4. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/60609/psn-pdf
    June 24, 2020 - When the Indications for Drug Administration Blur June 24, 2020 Munsch J, Doroy A. When the Indications for Drug Administration Blur . PSNet [internet]. 2020. https://psnet.ahrq.gov/web-mm/when-indications-drug-administration-blur Disclosure of Relevant Financial Relationships: As a provider accredited by the Accre…

  5. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49554/psn-pdf
    January 01, 2008 - Chemotherapy Extravasation January 1, 2008 Schulmeister L. Chemotherapy Extravasation. PSNet [internet]. 2008. https://psnet.ahrq.gov/web-mm/chemotherapy-extravasation The Case A 73-year-old woman with no past medical history was diagnosed with stage IIIA breast cancer. She and her oncologist decided to begin sys…

  6. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49706/psn-pdf
    January 01, 2015 - Clostridium Difficile Relapse Secondary to Medication Access Issue April 1, 2014 Walker PC, Nagel J. Clostridium Difficile Relapse Secondary to Medication Access Issue. PSNet [internet]. 2014. https://psnet.ahrq.gov/web-mm/clostridium-difficile-relapse-secondary-medication-access-issue The Case A 24-year-old wom…

  7. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49426/psn-pdf
    November 01, 2003 - Don't Push November 1, 2003 Meltzer HY. Don't Push. PSNet [internet]. 2003. https://psnet.ahrq.gov/web-mm/dont-push The Case A 37-year-old HIV-positive woman was brought to the emergency room by her family because she had exhibited altered mentation for 3 days. The patient had been diagnosed with HIV infection 3 …

  8. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49856/psn-pdf
    March 01, 2019 - Premature Extubation March 1, 2019 Sagana R, Hyzy RC. Premature Extubation. PSNet [internet]. 2019. https://psnet.ahrq.gov/web-mm/premature-extubation The Case A 73-year-old woman with a history of carotid artery stenosis was admitted for an elective carotid endarterectomy. The procedure was initially thought to …

  9. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49668/psn-pdf
    October 01, 2012 - Buprenorphine and the Medically Ill Patient October 1, 2012 McCance-Katz EF. Buprenorphine and the Medically Ill Patient. PSNet [internet]. 2012. https://psnet.ahrq.gov/web-mm/buprenorphine-and-medically-ill-patient The Case A 60-year-old man with a 15-year history of oxycodone dependence presented to a substance …

  10. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/33721/psn-pdf
    November 01, 2011 - Lesson from the VA's Team Training Program November 1, 2011 Neily J, Mills PD, Paull DE, et al. Lesson from the VA's Team Training Program . PSNet [internet]. 2011. https://psnet.ahrq.gov/perspective/lesson-vas-team-training-program Perspective Introduction The Veterans Health Administration (VHA) National Center…

  11. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49665/psn-pdf
    September 01, 2012 - Undetected Foreign Object September 1, 2012 Cima RR. Undetected Foreign Object. PSNet [internet]. 2012. https://psnet.ahrq.gov/web-mm/undetected-foreign-object The Case A 75-year-old man with a past medical history of end-stage renal disease (on hemodialysis), hypertension, and diabetes was found to have obstruct…

  12. A Costly Colonoscopy Leads to a Delay in Diagnosis | PSNet

    psnet.ahrq.gov/web-mm/costly-colonoscopy-leads-delay-diagnosis
    September 01, 2014 - A Costly Colonoscopy Leads to a Delay in Diagnosis Citation Text: Moriates C. A Costly Colonoscopy Leads to a Delay in Diagnosis. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2018. Copy Citation Format: Google Scholar…

  13. Lost in the Black Hole | PSNet

    psnet.ahrq.gov/web-mm/lost-black-hole
    December 01, 2005 - Lost in the Black Hole Citation Text: Wachter R. Lost in the Black Hole. 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 PubMe…

  14. The Next Step: Use of a Pre-Operative Checklist to Prevent Missteps | PSNet

    psnet.ahrq.gov/web-mm/next-step-use-pre-operative-checklist-prevent-missteps
    April 24, 2018 - The Next Step: Use of a Pre-Operative Checklist to Prevent Missteps Citation Text: Sauder C, Kleber KT. The Next Step: Use of a Pre-Operative Checklist to Prevent Missteps. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2022. Copy …

  15. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49763/psn-pdf
    June 01, 2016 - July Syndrome June 1, 2016 Young JQ. July Syndrome. PSNet [internet]. 2016. https://psnet.ahrq.gov/web-mm/july-syndrome The Case A 64-year-old man was seen in the thoracic surgery clinic in June after being diagnosed with a right lower lobe lung cancer. The attending surgeon saw the patient along with his fellow,…

  16. Finding Fault With the Default Alert | PSNet

    psnet.ahrq.gov/web-mm/finding-fault-default-alert
    August 28, 2024 - Finding Fault With the Default Alert Citation Text: Baysari M. Finding Fault With the Default Alert. 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 EndNot…

  17. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/840175/psn-pdf
    November 16, 2022 - Mechanical Prosthetic Valve Thrombosis with Thromboembolism. November 16, 2022 Hedayati N, White RO. Mechanical Prosthetic Valve Thrombosis with Thromboembolism. PSNet [internet]. 2022. https://psnet.ahrq.gov/web-mm/mechanical-prosthetic-valve-thrombosis-thromboembolism The Case A 61-year-old woman presented to …

  18. Risk Management and Patient Safety | PSNet

    psnet.ahrq.gov/perspective/risk-management-and-patient-safety
    December 01, 2010 - Risk Management and Patient Safety Barry M. Manuel, MD; Jack L. McCarthy; William Berry, MD, MPH; Kathy Dwyer | December 1, 2010  Also Read a Conversation View more articles from the same authors. Citation Text: Manuel BM, McCarthy JL, Berry WR, et al. Risk Mana…

  19. In Conversation With… David Juurlink, MD, PhD | PSNet

    psnet.ahrq.gov/perspective/conversation-david-juurlink-md-phd
    May 22, 2017 - In Conversation With… David Juurlink, MD, PhD May 1, 2017  Also Read an Essay Citation Text: In Conversation With… David Juurlink, MD, PhD. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 20…

  20. In Conversation with David W. Bates about Are We Safer Today? | PSNet

    psnet.ahrq.gov/perspective/conversation-david-w-bates-about-are-we-safer-today
    February 26, 2025 - In Conversation with David W. Bates about Are We Safer Today? David W. Bates, MD, MSc; Merton Lee, PharmD, PhD; Sarah E. Mossburg, RN, PhD | February 26, 2025  Also Read the Essay View more articles from the same authors. Citation Text: Bates DW, Lee M, Mossburg…
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