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psnet.ahrq.gov/issue/automated-dynamic-radiation-oncology-prescription-checking-system
October 27, 2010 - June 16, 2019
Electronic prescribing vulnerabilities: height and weight mix-up leads
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psnet.ahrq.gov/issue/when-systems-fail
February 10, 2011 - April 14, 2021
Error in body weight estimation leads to inadequate parenteral anticoagulation
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psnet.ahrq.gov/issue/auto-identification-technology-and-its-impact-patient-safety-operating-room-future
June 22, 2009 - June 28, 2023
WebM&M Cases
Saline Flush Leads to Acute
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psnet.ahrq.gov/issue/measuring-errors-surgical-pathology-real-life-practice-defining-what-does-and-does-not-matter
January 14, 2011 - September 27, 2017
When diagnostic testing leads to harm: a new outcomes-based approach
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psnet.ahrq.gov/issue/using-multidisciplinary-rounds-improve-patient-safety-through-venous-thromboembolism
April 20, 2016 - Cases
Be Picky about your PICCs—Fragmented Care and Poor Communication at Discharge Leads
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psnet.ahrq.gov/issue/understanding-safer-practices-health-care-prologue-role-indicators
May 07, 2008 - November 21, 2012
Learning through simulated independent practice leads to better future
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psnet.ahrq.gov/issue/possible-solutions-barriers-incident-reporting-residents
April 14, 2011 - March 2, 2011
An anesthesiology department leads culture change at a hospital system
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psnet.ahrq.gov/issue/oxytocin-high-alert-medication-implications-perinatal-patient-safety
September 29, 2010 - Related Resources
WebM&M Cases
Sleep Deprivation Leads
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psnet.ahrq.gov/issue/detection-classification-and-correction-defective-chemotherapy-orders-through-nursing-and
May 27, 2011 - June 16, 2019
Electronic prescribing vulnerabilities: height and weight mix-up leads
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psnet.ahrq.gov/issue/differences-day-and-night-shift-clinical-performance-anesthesiology
September 29, 2017 - Related Resources
WebM&M Cases
Sleep Deprivation Leads
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psnet.ahrq.gov/issue/interruptions-during-delivery-high-risk-medications
September 26, 2016 - February 3, 2021
Electronic prescribing vulnerabilities: height and weight mix-up leads
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psnet.ahrq.gov/issue/anaesthetists-management-oxygen-pipeline-failure-room-improvement
January 28, 2009 - WebM&M Cases
Uterine Artery Injury during Cesarean Delivery Leads
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psnet.ahrq.gov/issue/using-enhanced-oral-chemotherapy-computerized-provider-order-entry-system-reduce-prescribing
October 20, 2014 - May 11, 2019
Electronic prescribing vulnerabilities: height and weight mix-up leads to
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psnet.ahrq.gov/issue/clinical-triggers-and-vital-signs-influencing-crisis-acknowledgment-and-calls-help
June 15, 2012 - WebM&M Cases
Uterine Artery Injury during Cesarean Delivery Leads
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psnet.ahrq.gov/issue/medication-administration-process-assessment-applying-lessons-learned-commercial-aviation
May 25, 2011 - March 23, 2011
An anesthesiology department leads culture change at a hospital system
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psnet.ahrq.gov/issue/always-having-say-youre-sorry-ethical-response-making-mistakes-professional-practice
September 09, 2011 - February 22, 2017
A medical error leads to tragedy: how do we inform the patient?
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psnet.ahrq.gov/issue/using-multi-method-user-centred-prospective-hazard-analysis-assess-care-quality-and-patient
May 27, 2011 - Cases
Be Picky about your PICCs—Fragmented Care and Poor Communication at Discharge Leads
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psnet.ahrq.gov/issue/last-orders-follow-tests-ordered-day-hospital-discharge
November 03, 2015 - WebM&M Cases
Delay in Treatment: Failure to Contact Patient Leads
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psnet.ahrq.gov/issue/proceed-reasonable-care-when-legal-principles-inform-training-prevent-harm-during-childbirth
July 24, 2013 - January 20, 2021
WebM&M Cases
Lack of Sepsis Recognition Leads
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psnet.ahrq.gov/issue/maturity-hospitals-quality-improvement-systems-associated-measures-quality-and-patient-safety
May 26, 2014 - Implementing an interprofessional patient safety learning initiative: insights from participants, project leads