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psnet.ahrq.gov/issue/dont-underestimate-impact-change-risk-potential
May 02, 2018 - June 10, 2018
Misprogramming PCA concentration leads to dosing errors.
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psnet.ahrq.gov/issue/death-boy-prompts-new-medical-efforts-nationwide
March 22, 2014 - October 30, 2019
Fear of Covid-19 leads other patients to decline critical treatment.
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psnet.ahrq.gov/issue/medical-errors-leave-devastating-impact-families-professionals
August 11, 2010 - November 4, 2015
Parkland knee surgery done by doctor in training leads to amputation
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psnet.ahrq.gov/issue/iv-vincristine-survey-shows-safety-improvements-needed
June 12, 2018 - May 2, 2018
Failed check system for chemotherapy leads to pharmacist's "no contest" plea
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psnet.ahrq.gov/issue/lost-surgical-specimens-lost-opportunities
April 16, 2018 - December 30, 2014
When diagnostic testing leads to harm: a new outcomes-based approach
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psnet.ahrq.gov/issue/national-safety-effort-targets-perinatal-injuries
November 10, 2010 - February 9, 2022
WebM&M Cases
Lack of Sepsis Recognition Leads
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psnet.ahrq.gov/issue/rx-better-prescription-hospital-bans-doctors-using-confusing-medical-abbreviations
February 19, 2010 - November 4, 2020
Fear of Covid-19 leads other patients to decline critical treatment.
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psnet.ahrq.gov/issue/why-false-positives-merit-concern-too
February 19, 2010 - November 7, 2012
Fear of Covid-19 leads other patients to decline critical treatment.
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psnet.ahrq.gov/issue/safe-practice-environment-chapter-proposed-usp
May 02, 2018 - May 5, 2018
Misprogramming PCA concentration leads to dosing errors.
-
psnet.ahrq.gov/issue/alarm-fatigue-factor-2nd-death
September 30, 2015 - December 14, 2022
Leaving a discontinued FentaNYL infusion attached to the patient leads
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psnet.ahrq.gov/issue/exploring-relationships-between-hospital-patient-safety-culture-and-adverse-events
August 27, 2012 - authors highlight the need for further investigation to determine if improving safety culture actually leads
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psnet.ahrq.gov/issue/clash-name-care
April 27, 2016 - September 1, 2011
Parkland knee surgery done by doctor in training leads to amputation
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psnet.ahrq.gov/issue/evidence-under-judgment-can-we-oversee-our-own-decision-making
May 21, 2019 - June 25, 2014
When diagnostic testing leads to harm: a new outcomes-based approach for
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psnet.ahrq.gov/issue/raising-index-suspicion-red-flags-represent-credible-threats-patient-safety
February 13, 2019 - May 7, 2018
Electronic prescribing vulnerabilities: height and weight mix-up leads to
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psnet.ahrq.gov/issue/2012-ismp-international-medication-safety-self-assessment-oncology
January 26, 2023 - Related Resources
Electronic prescribing vulnerabilities: height and weight mix-up leads
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psnet.ahrq.gov/issue/good-intention-uncertain-outcomeour-take-physician-dispensing-offices-and-clinics
February 13, 2019 - June 16, 2019
Electronic prescribing vulnerabilities: height and weight mix-up leads
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psnet.ahrq.gov/issue/prevention-medical-accidents-caused-defective-surgical-instruments
July 31, 2019 - December 9, 2020
WebM&M Cases
Lack of Sepsis Recognition Leads
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psnet.ahrq.gov/issue/our-long-journey-towards-safety-minded-just-culture-part-i-where-weve-been
November 13, 2018 - October 20, 2021
Incorrect use of smart infusion pump in the operating room (OR) leads
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psnet.ahrq.gov/issue/crisis-undiagnosed-cancers-emerging-pandemics-second-year
November 30, 2022 - June 17, 2020
Fear of Covid-19 leads other patients to decline critical treatment.
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psnet.ahrq.gov/issue/how-medical-jargon-can-make-covid-health-disparities-even-worse
July 28, 2021 - June 17, 2020
Fear of Covid-19 leads other patients to decline critical treatment.