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3541. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49687/psn-pdf
      August 21, 2013 - Emergency Error August 21, 2013 Symons NRA. Emergency Error. PSNet [internet]. 2013. https://psnet.ahrq.gov/web-mm/emergency-error Case Objectives State that emergency surgery is high risk and has high mortality. Appreciate that emergency laparotomy is a particularly high-risk procedure with a high likelihood of …

3542. In Conversation with...Patrick Tighe about Artificial Intelligence | PSNet
      psnet.ahrq.gov/perspective/conversation-withpatrick-tighe-about-artificial-intelligence
      March 27, 2024 - More See More About The Topic Hospitals Facility and Group Administrators Nurse

3543. EMS Patient Safety in the Field | PSNet
      psnet.ahrq.gov/perspective/ems-patient-safety-field
      July 28, 2021 - EMS Patient Safety in the Field July 28, 2021  Also Read the Conversation View more articles from the same authors. Citation Text: Augustine JJ, Fitall E, Hall KK, et al. EMS Patient Safety in the Field. PSNet [internet]. Rockville (MD): Agency for Healthcare Re…

3544. Emergency Error | PSNet
      psnet.ahrq.gov/web-mm/emergency-error
      January 18, 2013 - SPOTLIGHT CASE Emergency Error Citation Text: Symons NRA. Emergency Error. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2013. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endnote…

3545. New Oral Anticoagulants | PSNet
      psnet.ahrq.gov/web-mm/new-oral-anticoagulants
      July 01, 2011 - SPOTLIGHT CASE New Oral Anticoagulants Citation Text: Fang MC. New Oral Anticoagulants. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2013. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNote …

3546. Navigating Complications: The Unintended Journey of a Guidewire During Dialysis Catheter Placement | PSNet
      psnet.ahrq.gov/web-mm/navigating-complications-unintended-journey-guidewire-during-dialysis-catheter-placement
      February 23, 2022 - Navigating Complications: The Unintended Journey of a Guidewire During Dialysis Catheter Placement Citation Text: Vuyyuru S, Kapa N. Navigating Complications: The Unintended Journey of a Guidewire During Dialysis Catheter Placement. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Qualit…

3547. Transfusion Thresholds in Gastrointestinal Bleeding | PSNet
      psnet.ahrq.gov/web-mm/transfusion-thresholds-gastrointestinal-bleeding
      November 26, 2014 - SPOTLIGHT CASE Transfusion Thresholds in Gastrointestinal Bleeding Citation Text: Strate L, Swanson S. Transfusion Thresholds in Gastrointestinal Bleeding. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2017. Copy Citati…

3548. Periodic Issue | PSNet
      psnet.ahrq.gov/periodic-issue/periodic-issue-469
      December 31, 2024 - January 8, 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, reports…

3549. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/847934/psn-pdf
      April 26, 2023 - Patient Safety Indicators April 26, 2023 Tokareva I, Romano P. Patient Safety Indicators. PSNet [internet]. 2023. https://psnet.ahrq.gov/primer/patient-safety-indicators Background Over the past 25 years, policymakers and providers, payers, and purchasers of health care have increasingly focused attention on pati…

3550. “This is the wrong patient's blood!”: Evaluating a Near-Miss Wrong Transfusion Event | PSNet
      psnet.ahrq.gov/web-mm/wrong-patients-blood-evaluating-near-miss-wrong-transfusion-event
      July 01, 2017 - More See More About The Topic Outpatient Surgery Operating Room Physicians Nurses

3551. Fecal Contamination of the Peritoneum from Laparoscopic Trocar Injury: A Routine Operation Goes Wrong. | PSNet
      psnet.ahrq.gov/web-mm/fecal-contamination-peritoneum-laparoscopic-trocar-injury-routine-operation-goes-wrong
      March 03, 2021 - November 24, 2021 Nurses' perception of medication administration errors and factors

3552. A Loss of Trust and a Missed Diagnosis | PSNet
      psnet.ahrq.gov/web-mm/loss-trust-and-missed-diagnosis
      October 31, 2023 - Medication reconciliation at hospital discharge: a qualitative exploration of acute care nurses

3553. Bad Writing, Wrong Medication | PSNet
      psnet.ahrq.gov/web-mm/bad-writing-wrong-medication
      March 01, 2015 - SPOTLIGHT CASE Bad Writing, Wrong Medication Citation Text: Devine B. Bad Writing, Wrong Medication. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2010. Copy Citation Format: Google Scholar BibTeX EndNote X3…

3554. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49729/psn-pdf
      April 01, 2015 - Dissecting the Presentation April 1, 2015 Suat-Ooi SB. Dissecting the Presentation. PSNet [internet]. 2015. https://psnet.ahrq.gov/web-mm/dissecting-presentation Case Objectives Define aortic dissection. Describe the epidemiology of acute aortic dissection. State the common and uncommon presentation of acute aor…

3555. Missed Diagnosis of Addison’s Disease in Adolescent Presenting with Fatigue. | PSNet
      psnet.ahrq.gov/web-mm/missed-diagnosis-addisons-disease-adolescent-presenting-fatigue
      October 28, 2020 - Missed Diagnosis of Addison’s Disease in Adolescent Presenting with Fatigue. Citation Text: Jimenez S, Crossen S. Missed Diagnosis of Addison’s Disease in Adolescent Presenting with Fatigue.. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Serv…

3556. The Lung Nodule That Refused To Grow | PSNet
      psnet.ahrq.gov/web-mm/lung-nodule-refused-grow
      March 01, 2004 - SPOTLIGHT CASE The Lung Nodule That Refused To Grow Citation Text: Balekian AA, Gould MK. The Lung Nodule That Refused To Grow. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2012. Copy Citation Format: Googl…

3557. In Conversation with...Atul Gawande, MD, MA, MPH | PSNet
      psnet.ahrq.gov/perspective/conversation-withatul-gawande-md-ma-mph
      September 01, 2007 - The nurses describe the fact that in the operating room they never witness from my generation of surgeons

3558. Overdose of Gabapentin and Oxycodone in a Patient with End-Stage Renal Disease: A Case for Appropriate Interruptive Drug-Disease Alerts. | PSNet
      psnet.ahrq.gov/web-mm/overdose-gabapentin-and-oxycodone-patient-end-stage-renal-disease-case-appropriate
      June 24, 2020 - These dose adjustments were recommended or endorsed by a team that included surgeons, nurses, and pharmacists

3559. Health Care Delivery and Pharmacists During the COVID-19 Pandemic | PSNet
      psnet.ahrq.gov/perspective/health-care-delivery-and-pharmacists-during-covid-19-pandemic
      June 29, 2020 - We’ve heard from members that physicians and nurses have access to it first and then the pharmacists

3560. The Role of the National Quality Forum (NQF) in the Quest for Transparency in U.S. Hospitals' Patient Safety Performance | PSNet
      psnet.ahrq.gov/perspective/role-national-quality-forum-nqf-quest-transparency-us-hospitals-patient-safety
      April 01, 2010 - These are all areas where multiple providers—physicians, nurses, pharmacists, health educators, others—contribute