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4861. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/74226/psn-pdf
      February 01, 2019 - Veterans Health Administration Stratification Tool for Opioid Risk Mitigation (STORM) Shows Promise for Targeting Prevention Interventions to Reduce Mortality in Patients Who Are Prescribed Opioids January 7, 2022 https://psnet.ahrq.gov/innovation/veterans-health-administration-stratification-tool-opioid-risk-miti…

4862. Diagnostic Errors | PSNet
      psnet.ahrq.gov/perspective/diagnostic-errors
      December 01, 2013 - Annual Perspective Diagnostic Errors Urmimala Sarkar, MD; Kaveh Shojania, MD | January 1, 2014  Also Read a Conversation View more articles from the same authors. Citation Text: Sarkar U, Shojania KG. Diagnostic Errors. PSNet [internet]. Rockville (MD): Ag…

4863. Playing Well with Others: "Translocational Research" in Patient Safety | PSNet
      psnet.ahrq.gov/perspective/playing-well-others-translocational-research-patient-safety
      September 01, 2005 - Playing Well with Others: "Translocational Research" in Patient Safety Robert M. Wachter, MD | September 1, 2005  Also Read a Conversation View more articles from the same authors. Citation Text: Wachter R. Playing Well with Others: "Translocational Research" in…

4864. Integrating Multiple Medication Decision Support Systems: How Will We Make It All Work? | PSNet
      psnet.ahrq.gov/perspective/integrating-multiple-medication-decision-support-systems-how-will-we-make-it-all-work
      May 01, 2008 - Integrating Multiple Medication Decision Support Systems: How Will We Make It All Work? Josh Peterson, MD, MPH | May 1, 2018  Also Read a Conversation View more articles from the same authors. Citation Text: Peterson JF. Integrating Multiple Medication Decision …

4865. Preparing for Health Reform: The Federal Government and the Nursing Workforce | PSNet
      psnet.ahrq.gov/perspective/preparing-health-reform-federal-government-and-nursing-workforce
      September 01, 2012 - Preparing for Health Reform: The Federal Government and the Nursing Workforce Peter I. Buerhaus, PhD, RN | September 1, 2012  Also Read a Conversation View more articles from the same authors. Citation Text: Buerhaus P. Preparing for Health Reform: The Federal G…

4866. Health Care at the Crossroads: Strategies for Improving the Medical Liability System and Preventing Patient Injury. | PSNet
      psnet.ahrq.gov/issue/health-care-crossroads-strategies-improving-medical-liability-system-and-preventing-patient
      September 07, 2005 - Book/Report Health Care at the Crossroads: Strategies for Improving the Medical Liability System and Preventing Patient Injury. Citation Text: Oakbrook Terrace, IL: Joint Commission on Accreditation of Healthcare Organizations; 2005. Copy Citation Save Save to y…

4867. ACR White Paper on Magnetic Resonance (MR) Safety: Combined Papers of 2002 and 2004. | PSNet
      psnet.ahrq.gov/issue/acr-white-paper-magnetic-resonance-mr-safety-combined-papers-2002-and-2004
      August 13, 2008 - Commentary ACR White Paper on Magnetic Resonance (MR) Safety: Combined Papers of 2002 and 2004. Citation Text: Kanal E; Borgstede JP; Barkovich AJ; Bell C; Bradley WG; Etheridge S; Felmlee JP; Froelich JW; Hayden J; Kaminski EM; Lester JW Jr; Scoumis EA; Zaremba LA; Zinninger MD; Ameri…

4868. Door-to-Doc Patient Safety Toolkit. | PSNet
      psnet.ahrq.gov/issue/door-doc-patient-safety-toolkit
      August 17, 2011 - Multi-use Website Door-to-Doc Patient Safety Toolkit. Citation Text: Banner Health. Copy Citation Save Save to your library Print Share Facebook Twitter Linkedin Copy URL January 9, 2008 Banner Health. Th…

4869. Fatigue and risk: are train drivers safer than doctors? | PSNet
      psnet.ahrq.gov/issue/fatigue-and-risk-are-train-drivers-safer-doctors
      September 03, 2016 - Commentary Fatigue and risk: are train drivers safer than doctors? Citation Text: Fatigue and risk: are train drivers safer than doctors? BMJ. 2017;359:j5107. doi:10.1136/bmj.j5107. Copy Citation Format: DOI Google Scholar PubMed BibTeX EndNote X3 XML EndNote 7 XML Endnote …

4870. Central, not Epidural | PSNet
      psnet.ahrq.gov/web-mm/central-not-epidural
      August 28, 2024 - Central, not Epidural Citation Text: Simmons D. Central, not Epidural. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2011. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged PubMedI…

4871. Mixup Beyond the Medication Label | PSNet
      psnet.ahrq.gov/web-mm/mixup-beyond-medication-label
      June 01, 2014 - Mixup Beyond the Medication Label Citation Text: Pervanas H, VanValkenburgh D. Mixup Beyond the Medication Label. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2018. Copy Citation Format: Google Scholar BibTeX EndNote …

4872. Medication Overdose | PSNet
      psnet.ahrq.gov/web-mm/medication-overdose
      September 01, 2011 - Medication Overdose Citation Text: Kaushal R. Medication Overdose. 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 PubMedId RI…

4873. Is It Safe to Be Direct? | PSNet
      psnet.ahrq.gov/web-mm/it-safe-be-direct
      September 30, 2015 - Is It Safe to Be Direct? Citation Text: Kulkarni NS, Williams M. Is It Safe to Be Direct?. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2008. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNote 7 XML En…

4874. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49851/psn-pdf
      January 01, 2019 - One Bronchoscopy, Two Errors January 1, 2019 Leiten E, Nielsen R. One Bronchoscopy, Two Errors. PSNet [internet]. 2019. https://psnet.ahrq.gov/web-mm/one-bronchoscopy-two-errors The Case A 67-year-old man with a history of hypertension was admitted to the intensive care unit (ICU) with hypoxic respiratory failure…

4875. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49629/psn-pdf
      June 01, 2011 - Say It Again June 1, 2011 Henriksen K, Hall KK. Say It Again. PSNet [internet]. 2011. https://psnet.ahrq.gov/web-mm/say-it-again The Case A 72-year-old man was admitted to the hospital with community-acquired pneumonia and hyponatremia. During his third hospital night, the on-call physician was contacted by the c…

4876. Microsoft PowerPoint - FINAL June-Spotlight Case Slides_06.12.2020.pptx (pdf file)
      psnet.ahrq.gov/sites/default/files/2020-06/final_june-spotlight_case_slides_06.12.2020.pdf
      January 01, 2020 - Microsoft PowerPoint - FINAL June-Spotlight Case Slides_06.12.2020.pptx Spotlight When the Indications for Drug Administration Blur Source and Credits • This presentation is based on the June 2020 AHRQ WebM&M Spotlight Case o See the full article at https://psnet.ahrq.gov/webmm • Commentary by: Julia Munsch,…

4877. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/60746/psn-pdf
      July 29, 2020 - Misdiagnosis of a Pelvic Mass versus Pregnancy July 29, 2020 Leiserowitz GS, Herding H. Misdiagnosis of a Pelvic Mass versus Pregnancy. PSNet [internet]. 2020. https://psnet.ahrq.gov/web-mm/misdiagnosis-pelvic-mass-versus-pregnancy The Case A 28-year-old woman arrived at the Emergency Department (ED) complaining o…

4878. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/840255/psn-pdf
      November 16, 2022 - Using Human Factors Engineering and the SEIPS Model to Advance Patient Safety in Care Transitions November 16, 2022 Carayon P, Werner N, Makkenchery A, et al. Using Human Factors Engineering and the SEIPS Model to Advance Patient Safety in Care Transitions . PSNet [internet]. 2022. https://psnet.ahrq.gov/perspecti…

4879. Spotlight (pdf file)
      psnet.ahrq.gov/sites/default/files/2021-06/final_spotlight_miscommunication_possible_artifact_06.21.2021.pdf
      January 01, 2021 - Spotlight Spotlight The Consequences of Miscommunication Regarding a Possible Artifact Source and Credits • This presentation is based on the June 2021 AHRQ WebM&M Spotlight Case o See the full article at https://psnet.ahrq.gov/webmm o CME credit is available o Commentary by: Kriti Gwal, MD o AHRQ WebM&M Edit…

4880. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49683/psn-pdf
      April 01, 2013 - Acute Care Admission of the Behavioral Health Patient April 1, 2013 Weiss AP, Rosenbaum JF. Acute Care Admission of the Behavioral Health Patient. PSNet [internet]. 2013. https://psnet.ahrq.gov/web-mm/acute-care-admission-behavioral-health-patient The Case A 25-year-old man presented to the emergency department (E…