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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/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/collaboration-focused-priority-issues-promotes-safety
May 05, 2018 - May 2, 2018
Misprogramming PCA concentration leads to dosing errors.
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psnet.ahrq.gov/issue/benefits-and-risks-including-patients-rca-teams
May 02, 2018 - May 5, 2018
Misprogramming PCA concentration leads to dosing errors.
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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/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/some-red-rules-shouldnt-rule-hospitals
May 07, 2014 - May 5, 2018
Misprogramming PCA concentration leads to dosing errors.
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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/use-tall-man-letters-gaining-wide-acceptance
May 02, 2018 - May 5, 2018
Misprogramming PCA concentration leads to dosing errors.
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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/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/dont-underestimate-impact-change-risk-potential
May 02, 2018 - May 5, 2018
Misprogramming PCA concentration leads to dosing errors.
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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.
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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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www.uspreventiveservicestaskforce.org/uspstf/recommendation/abdominal-aortic-aneurysm-screening-february-2005
February 15, 2005 - large AAAs (5.5 cm or more) in men aged 65 to 75 who have ever smoked (current and former smokers) leads … : The USPSTF found good evidence that screening for AAA in men aged 65 to 75 who have never smoked leads … There is good evidence that screening and early treatment leads to important harms, including an increased …
- Open surgical repair for an AAA of at least 5.5 cm leads to an estimated 43-percent reduction in … for the conversion. 31 , 32
Although open surgical repair remains the only proven intervention that leads
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psnet.ahrq.gov/issue/building-case-medication-reconciliation
June 10, 2018 - May 7, 2018
The absence of a drug–disease interaction alert leads to a child's death.
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psnet.ahrq.gov/issue/how-has-current-economy-affected-patient-safety
May 07, 2018 - May 7, 2018
Failed check system for chemotherapy leads to pharmacist's "no contest" plea
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psnet.ahrq.gov/issue/inattentional-blindness-what-captures-your-attention
May 07, 2018 - June 30, 2021
Electronic prescribing vulnerabilities: height and weight mix-up leads
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psnet.ahrq.gov/issue/i-cant-turn-my-brain
December 14, 2016 - December 14, 2016
Fear of Covid-19 leads other patients to decline critical treatment
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psnet.ahrq.gov/issue/ismps-second-quarterwatch-report-shows-sharp-increase-reports-serious-adverse-drug-events
June 10, 2018 - May 2, 2018
Misprogramming PCA concentration leads to dosing errors.