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  1. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49535/psn-pdf
    May 01, 2007 - Production Pressures May 1, 2007 Carayon P. Production Pressures. PSNet [internet]. 2007. https://psnet.ahrq.gov/web-mm/production-pressures The Case A 65-year-old man with bipolar disorder was scheduled for maintenance electroconvulsive therapy (ECT), a procedure he had received dozens of times before. These pro…
  2. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/73229/psn-pdf
    May 26, 2021 - Norepinephrine Dosing Error Associated with Multiple Health System Vulnerabilities May 26, 2021 Duby JJ, Schomer K, Oyewole V, et al. Norepinephrine Dosing Error Associated with Multiple Health System Vulnerabilities. PSNet [internet]. 2021. https://psnet.ahrq.gov/web-mm/norepinephrine-dosing-error-associated-mult…
  3. psnet.ahrq.gov/perspective/conversation-joan-stanley-about-role-undergraduate-nursing-education-patient-safety
    November 27, 2023 - In Conversation with... Joan Stanley about The Role of Undergraduate Nursing Education in Patient Safety Joan Stanley, PhD, NP, FAAN, FAANP | November 27, 2023  Also Read the Essay View more articles from the same authors. Citation Text: Stanley J. In Conversat…
  4. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49573/psn-pdf
    January 01, 2009 - Dangerous Shift November 1, 2008 Patterson ES. Dangerous Shift. PSNet [internet]. 2008. https://psnet.ahrq.gov/web-mm/dangerous-shift Case Objectives Review the evidence base on erroneous actions related to shift changes. Understand the limits of standardizing handoffs in preventing errors at shift change. Expla…
  5. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49531/psn-pdf
    March 01, 2007 - Failure to Report March 1, 2007 Spath P. Failure to Report. PSNet [internet]. 2007. https://psnet.ahrq.gov/web-mm/failure-report Case Objectives List common causes of medical errors. Appreciate the magnitude of underreporting of adverse events. List the common barriers to reporting adverse events and near misses…
  6. psnet.ahrq.gov/web-mm/inside-time-out
    March 01, 2004 - The Inside of a Time Out Citation Text: Feldman DL. The Inside of a Time Out. 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 Endnote tagged …
  7. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/863747/psn-pdf
    March 06, 2024 - "Good care is slow enough to be able to pay attention": primary care time scarcity and patient safety. March 6, 2024 Satterwhite S, Nguyen M-LT, Honcharov V, et al. "Good care is slow enough to be able to pay attention": primary care time scarcity and patient safety. J Gen Intern Med. 2024;39(9):1575-1582. doi:10.…
  8. psnet.ahrq.gov/issue/bringing-patient-safety-technology-bedside
    May 27, 2011 - Newspaper/Magazine Article Bringing patient safety technology to the bedside. Save Save to your library Print Download PDF Share Facebook Twitter Linkedin Copy URL August 24, 2005 This case study presents a Louisia…
  9. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/73906/psn-pdf
    October 06, 2021 - In Conversation With….Alison Stuebe, MD, MSc and Kristin Tully, PhD October 6, 2021 In Conversation With….Alison Stuebe, MD, MSc and Kristin Tully, PhD. PSNet [internet]. 2021. https://psnet.ahrq.gov/perspective/conversation-withalison-stuebe-md-msc-and-kristin-tully-phd Editor’s Note: Alison Stuebe, MD, MSc, is a…
  10. psnet.ahrq.gov/web-mm/medication-reconciliation-whose-job-it
    May 01, 2018 - SPOTLIGHT CASE Medication Reconciliation: Whose Job Is It? Citation Text: Poon EG. Medication Reconciliation: Whose Job Is It?. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2007. Copy Citation Format: Googl…
  11. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49615/psn-pdf
    December 01, 2010 - The Forgotten Turn December 1, 2010 Barbour S. The Forgotten Turn. PSNet [internet]. 2010. https://psnet.ahrq.gov/web-mm/forgotten-turn Case Objectives Describe the six stages of pressure ulceration per the National Pressure Ulcer Advisory Panel. List risk factors for the development of pressure ulcers in hospita…
  12. psnet.ahrq.gov/web-mm/dangerous-shift
    July 24, 2013 - SPOTLIGHT CASE Dangerous Shift Citation Text: Patterson ES. Dangerous Shift. 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 Endno…
  13. psnet.ahrq.gov/perspective/conversation-susan-mcgrath-phd-and-george-blike-md-about-surveillance-monitoring
    April 26, 2023 - In Conversation with... Susan McGrath, PhD and George Blike, MD about Surveillance Monitoring April 26, 2023  Also Read the Essay Citation Text: In Conversation with.. Susan McGrath, PhD and George Blike, MD about Surveillance Monitoring. PSNet [internet]. 2023.In…
  14. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/74120/psn-pdf
    November 30, 2021 - Culture Clash No More: Integration and Coordination of Disease Treatment and Palliative Care November 30, 2021 Spero H, Usher AE, Howard B, et al. Culture Clash No More: Integration and Coordination of Disease Treatment and Palliative Care . PSNet [internet]. 2021. https://psnet.ahrq.gov/web-mm/culture-clash-no-mo…
  15. psnet.ahrq.gov/web-mm/duplicate-therapies-retail-pharmacy
    August 05, 2022 - Duplicate Therapies in Retail Pharmacy Citation Text: Punatar N, Molla M, Lee S. Duplicate Therapies in Retail Pharmacy. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2023. Copy Citation Format: Google Scholar BibTeX E…
  16. psnet.ahrq.gov/perspective/conversation-dr-michelle-schreiber-measuring-patient-safety
    December 14, 2022 - improving quality for maternal health, behavioral health, kidney health and organ procurement programs, nursinghomes and long-term care, and prevention and wellness, among others.
  17. psnet.ahrq.gov/web-mm/culture-clash-no-more-integration-and-coordination-disease-treatment-and-palliative-care
    December 23, 2020 - SPOTLIGHT CASE Culture Clash No More: Integration and Coordination of Disease Treatment and Palliative Care Citation Text: Spero H, Usher AE, Howard B, et al. Culture Clash No More: Integration and Coordination of Disease Treatment and Palliative Care . PSNet [internet]. Rockville (MD): Agency f…
  18. 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…
  19. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49570/psn-pdf
    October 01, 2008 - Recurrent Hypoglycemia: A Care Transition Failure? October 1, 2008 Eytan T. Recurrent Hypoglycemia: A Care Transition Failure? PSNet [internet]. 2008. https://psnet.ahrq.gov/web-mm/recurrent-hypoglycemia-care-transition-failure Case Objectives Understand the complementary abilities of an electronic health record a…
  20. psnet.ahrq.gov/issue/medication-errors-during-simulated-paediatric-resuscitations-prospective-observational-human
    February 23, 2022 - Study Medication errors during simulated paediatric resuscitations: a prospective, observational human reliability analysis. Citation Text: Appelbaum N, Clarke J, Feather C, et al. Medication errors during simulated paediatric resuscitations: a prospective, observational human reliabilit…

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