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3841. Diagnosing Diagnostic Mistakes | PSNet
      psnet.ahrq.gov/web-mm/diagnosing-diagnostic-mistakes
      April 30, 2014 - October 31, 2011 Opioid prescribing for acute pain management in children and adolescents

3842. Microsoft PowerPoint - Spotlight Case_Postop Cervical Hematomas_12.15.2022 FINAL.pptx (pdf file)
      psnet.ahrq.gov/sites/default/files/2023-01/spotlight_respiratory_distress_after_neck_surgery_two_cases_of_postoperative_cervical_hematoma.pdf
      January 01, 2023 - osteoarthritis, and spinal stenosis, status/post two previous spine surgeries and long-term use of opioid

3843. Editorial Team | PSNet
      psnet.ahrq.gov/Information/Editor
      May 23, 2025 - special interest in patient safety and he has authored papers on quality improvement in intensive care, opioid-free

3844. Strongyloides: A Hidden Traveler and Potentially Lethal Missed Diagnosis. | PSNet
      psnet.ahrq.gov/web-mm/strongyloides-hidden-traveler-and-potentially-lethal-missed-diagnosis
      August 25, 2021 - Recurrent Pneumothorax August 25, 2021 Lessons learned in implementing a chronic opioid

3845. Impatient Inpatient Dosing | PSNet
      psnet.ahrq.gov/web-mm/impatient-inpatient-dosing
      June 24, 2020 - WebM&M Cases Fatal Patient-Controlled Analgesia (PCA) Opioid-Induced

3846. The University of Texas System Clinical Safety and Effectiveness Course | PSNet
      psnet.ahrq.gov/perspective/university-texas-system-clinical-safety-and-effectiveness-course
      February 01, 2011 - Quickly Adopted but Questions Remain January 1, 2006 Incident and long-term opioid

3847. The Role of the Patient in Improving Patient Safety | PSNet
      psnet.ahrq.gov/perspective/role-patient-improving-patient-safety
      March 01, 2007 - December 23, 2020 A mixed-methods analysis of patient safety incidents involving opioid

3848. Mismanagement of Delirium | PSNet
      psnet.ahrq.gov/web-mm/mismanagement-delirium
      February 13, 2014 - Mismanagement of Delirium Citation Text: Merrilees J, Lee KP. Mismanagement of Delirium. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2016. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endn…

3849. Novel Drug Misuse | PSNet
      psnet.ahrq.gov/web-mm/novel-drug-misuse
      September 30, 2010 - WebM&M Cases Fatal Patient-Controlled Analgesia (PCA) Opioid-Induced

3850. Spotlight (pdf file)
      psnet.ahrq.gov/sites/default/files/2022-08/final_spotlight_case_mesenteric_ischemia_08.05.2022.pdf
      January 01, 2022 - Spotlight Spotlight Delayed Diagnosis of Mesenteric Ischemia Source and Credits • This presentation is based on the August 2022 AHRQ WebM&M Spotlight Case o See the full article at https://psnet.ahrq.gov/webmm o CME credit is available o Commentary by: Anamaria Robles, MD, and Garth Utter, MD, MSc o AHRQ WebM&M…

3851. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49585/psn-pdf
      May 01, 2009 - Delirium or Dementia? May 1, 2009 Rudolph JL. Delirium or Dementia? PSNet [internet]. 2009. https://psnet.ahrq.gov/web-mm/delirium-or-dementia Case Objectives State the key diagnostic differences between delirium and dementia. Describe the Confusion Assessment Method for workup of suspected delirium. Explain the…

3852. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/837660/psn-pdf
      July 08, 2022 - The trauma team was called to assist and the patient was given additional sedation and opioid analgesia

3853. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49840/psn-pdf
      September 01, 2018 - Steroids and Safety: Preventing Medication Adverse Events During Transitions of Care September 1, 2018 Lucier DJ, Greenwald JL. Steroids and Safety: Preventing Medication Adverse Events During Transitions of Care. PSNet [internet]. 2018. https://psnet.ahrq.gov/web-mm/steroids-and-safety-preventing-medication-adver…

3854. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/74021/psn-pdf
      October 25, 2021 - understand why they're taking their therapy, or counseling on controlled substance utilization or even opioid

3855. Transfusion Overload | PSNet
      psnet.ahrq.gov/web-mm/transfusion-overload
      September 23, 2020 - WebM&M Cases Lost in Transitions of Care: Managing an Opioid-Dependent

3856. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/73104/psn-pdf
      January 04, 2021 - spikes-demand-coronavirus-patients-are-creating-shortages-asthma-drugs-and-sedatives https://psnet.ahrq.gov/issue/special-report-covid-deepens-other-opioid-crisis-shortage-hospital-painkillers

3857. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/848108/psn-pdf
      April 26, 2023 - The Dose Makes the Poison: Medication Error During Procedural Sedation in the Pediatric Emergency Department. April 26, 2023 Amashta ML, Barnes DK. The Dose Makes the Poison: Medication Error During Procedural Sedation in the Pediatric Emergency Department. PSNet [internet]. 2023. https://psnet.ahrq.gov/web-mm/do…

3858. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49831/psn-pdf
      June 01, 2018 - ECRI Institute's Top 10 Patient Safety Concerns for 2018.(11)  1 Diagnostic Errors  2 Opioid safety

3859. Medication Reconciliation With a Twist (or Dare We Say, a Patch?) | PSNet
      psnet.ahrq.gov/web-mm/medication-reconciliation-twist-or-dare-we-say-patch
      April 03, 2024 - December 2, 2020 Incident and long-term opioid therapy among patients with psychiatric

3860. Chest Pain in a Rural Hospital | PSNet
      psnet.ahrq.gov/web-mm/chest-pain-rural-hospital
      June 02, 2021 - ECRI Institute's Top 10 Patient Safety Concerns for 2018.( 11 )  1 Diagnostic Errors  2 Opioid