-
psnet.ahrq.gov/node/46921/psn-pdf
May 02, 2018 - This commentary
reviews three medication safety incidents involving school nurses and emotional difficulties
-
psnet.ahrq.gov/node/45332/psn-pdf
August 27, 2018 - psnet.ahrq.gov/issue/guideline-implementation-prevention-retained-surgical-items
Although incidents involving
-
psnet.ahrq.gov/node/40837/psn-pdf
September 27, 2016 - nurses-behaviors-and-visual-scanning-patterns-may-reduce-patient-identification-errors
https://psnet.ahrq.gov/issue/medication-prescribing-errors-involving-route-administration
-
psnet.ahrq.gov/web-mm/when-looks-arent-all-they-appear-be-medication-error-uncommon-indication
July 02, 2019 - When Looks Aren’t All They Appear to Be: A Medication Error in an Uncommon Indication
Citation Text:
Ton K. When Looks Aren’t All They Appear to Be: A Medication Error in an Uncommon Indication . PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human…
-
psnet.ahrq.gov/perspective/evolution-root-cause-analysis
February 26, 2025 - The Evolution of Root Cause Analysis
Jessica Behrhorst, MPH, CPPS, CPHRM, CPHQ; Bryan Gale, MA; Cindy Manaoat Van, MHSA, CPPS | February 26, 2025
Also Read the Conversation
View more articles from the same authors.
Citation Text:
Behrhorst J, Gale B, Van CM. Th…
-
psnet.ahrq.gov/perspective/conversation-jessica-behrhorst-about-evolution-root-cause-analysis
February 26, 2025 - In Conversation with Jessica Behrhorst about The Evolution of Root Cause Analysis
Jessica Behrhorst, MPH, CPPS, CPHRM, CPHQ; Bryan Gale, MA; Cindy Manaoat Van, MHSA, CPPS | February 26, 2025
Also Read the Essay
View more articles from the same authors.
Citation T…
-
psnet.ahrq.gov/node/49492/psn-pdf
November 01, 2005 - Reconciling Doses
November 1, 2005
Federico F. Reconciling Doses. PSNet [internet]. 2005.
https://psnet.ahrq.gov/web-mm/reconciling-doses
Case Objectives
List the steps involved in medication reconciliation.
Describe the role of each of the stakeholders in medication reconciliation.
Discuss how medication reconc…
-
psnet.ahrq.gov/periodic-issue/periodic-issue-472
February 26, 2025 - February 26, 2025 Weekly Issue
PSNet highlights the latest patient safety literature, news, and expert commentary, including Weekly
Updates, WebM&M, and Perspectives on Safety. The current issue highlights what's new this week in patient
safety literature, news, conferences, repor…
-
psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.167_slideshow.ppt
January 01, 2008 - Spotlight Case [MONTH] 2003
Spotlight Case January 2008
How Do Providers Recover from Errors?
Source and Credits
This presentation is based on the January 2008 AHRQ WebM&M Spotlight Case
See the full article at http://webmm.ahrq.gov
CME credit is available
Commentary by: Colin P. West, MD, PhD, Mayo Clini…
-
psnet.ahrq.gov/node/867497/psn-pdf
February 26, 2025 - Surgical Count Processes
Surgical
Count
A process involving two people who look at items together
-
psnet.ahrq.gov/node/850361/psn-pdf
June 14, 2023 - Involving a patient’s family members, if permitted by
the patient, helps them to understand the patient
-
psnet.ahrq.gov/node/33575/psn-pdf
March 15, 2025 - Patient Engagement and Safety
March 15, 2025
Patient Engagement and Safety. PSNet [internet]. 2019.
https://psnet.ahrq.gov/primer/patient-engagement-and-safety
PSNet primers are regularly reviewed and updated by the UC Davis PSNet Editorial Team to ensure that
they reflect current research and practice in the pati…
-
psnet.ahrq.gov/sites/default/files/2024-11/spotlight_case_neurological_red_flags_final.pptx
January 01, 2024 - Neurological Red Flags: A MISSED STROKE AFTER Intermittent Episodes of Dizziness and Headache
A case involving … considered:
Patient age without traditional vascular risk factors
Recent dental procedure (potentially involving … Seizure-like movements are sometimes seen in patients with basilar artery stroke, often involving both
-
psnet.ahrq.gov/issue/support-and-recovery-strategies-second-victims
January 19, 2022 - Commentary
Support and recovery strategies for second victims.
Citation Text:
Croke L. Support and recovery strategies for second victims. AORN J. 2024;119(2):7-10. doi:10.1002/aorn.14089.
Copy Citation
Format:
DOI Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endnote …
-
psnet.ahrq.gov/issue/evolving-role-health-educators-advancing-patient-safety-forging-partnerships-and-leading
July 22, 2020 - Commentary
The evolving role of health educators in advancing patient safety: forging partnerships and leading change.
Citation Text:
Mercurio A. The evolving role of health educators in advancing patient safety: forging partnerships and leading change. Health Promot Pract. 2007;8(2):119…
-
psnet.ahrq.gov/issue/support-methods-healthcare-professionals-who-are-second-victims-integrative-review
April 27, 2022 - Review
Support methods for healthcare professionals who are second victims: an integrative review.
Citation Text:
Support methods for healthcare professionals who are second victims: an integrative review. Neft MW, Sekula K, Zoucha R, et al. AANA J. 2022;90(3):189-196.
Copy Cit…
-
psnet.ahrq.gov/node/43109/psn-pdf
December 10, 2014 - relates one hospital's experience with engaging physician leadership in quality
improvement efforts by involving
-
psnet.ahrq.gov/node/44559/psn-pdf
April 15, 2016 - Researchers determined that diagnostic errors occurred in 35 of 100 reviewed cases, with the
majority involving
-
psnet.ahrq.gov/node/46501/psn-pdf
March 20, 2018 - blind-obedience-and-unnecessary-workup-hypoglycemia-teachable-moment
This commentary relates an incident involving
-
psnet.ahrq.gov/node/46651/psn-pdf
January 17, 2018 - project to incorporate patient safety and quality improvement content into a larger educational effort
involving