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  1. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49719/psn-pdf
    September 01, 2014 - No BP During NIBP September 1, 2014 Görges M, Ansermino MJ. No BP During NIBP. PSNet [internet]. 2014. https://psnet.ahrq.gov/web-mm/no-bp-during-nibp The Case An otherwise healthy 49-year-old man with atrial fibrillation was scheduled for ablation in the catheterization laboratory under general endotracheal anes…
  2. psnet.ahrq.gov/web-mm/suicide-risk-hospital
    November 01, 2011 - Suicide Risk in the Hospital Citation Text: Mills PD. Suicide Risk in the Hospital. 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 X3 XML EndNote 7 XML Endnote t…
  3. psnet.ahrq.gov/web-mm/when-psychiatric-symptoms-are-not
    September 20, 2011 - When "Psychiatric" Symptoms Are Not Citation Text: Goldberg RJ. When "Psychiatric" Symptoms Are Not. 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 EndNot…
  4. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/72564/psn-pdf
    November 14, 2018 - Antibiotic and Opioid Stewardship in Dentistry December 7, 2020 Suda KJ, Fitall E, Hall KK, et al. Antibiotic and Opioid Stewardship in Dentistry. PSNet [internet]. 2020. https://psnet.ahrq.gov/perspective/antibiotic-and-opioid-stewardship-dentistry Introduction Medication stewardship refers to efforts by frontlin…
  5. psnet.ahrq.gov/web-mm/walking-patient-missing-drain
    April 01, 2006 - Walking Patient, Missing Drain Citation Text: Olkowski BF, Ravenel M, Stiefel MF. Walking Patient, Missing Drain. 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 …
  6. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49632/psn-pdf
    July 01, 2011 - A Seasonal Care Transition Failure July 1, 2011 Young JQ. A Seasonal Care Transition Failure. PSNet [internet]. 2011. https://psnet.ahrq.gov/web-mm/seasonal-care-transition-failure The Case A 70-year-old healthy man presented to his primary care doctor—a third-year internal medicine resident—for routine follow-up…
  7. psnet.ahrq.gov/web-mm/refused-medication-error
    November 01, 2005 - Refused Medication Error Citation Text: Foley M. Refused Medication Error. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2017. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged Pub…
  8. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/50927/psn-pdf
    February 21, 2020 - Patient Safety in Primary Care February 21, 2020 Schiff G, Hall KK, Fitall E. Patient Safety in Primary Care. PSNet [internet]. 2020. https://psnet.ahrq.gov/perspective/patient-safety-primary-care Introduction A strong primary care system is foundational to achieving high-quality, accessible, efficient healthcare …
  9. psnet.ahrq.gov/web-mm/miscommunication-or-leads-anticoagulation-mishap
    May 08, 2019 - Miscommunication in the OR Leads to Anticoagulation Mishap Citation Text: Solsky I, Haynes AB. Miscommunication in the OR Leads to Anticoagulation Mishap. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2017. Copy Citation Forma…
  10. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49818/psn-pdf
    January 01, 2018 - A Costly Colonoscopy Leads to a Delay in Diagnosis January 1, 2018 Moriates C. A Costly Colonoscopy Leads to a Delay in Diagnosis. PSNet [internet]. 2018. https://psnet.ahrq.gov/web-mm/costly-colonoscopy-leads-delay-diagnosis The Case A 50-year-old man presented to a primary care clinic to establish care, as he ha…
  11. psnet.ahrq.gov/web-mm/specimen-almost-lost
    September 21, 2022 - Specimen Almost Lost Citation Text: Hehe YK. Specimen Almost Lost. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2017. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged PubMedId RI…
  12. psnet.ahrq.gov/web-mm/hospital-admission-due-high-dose-methotrexate-drug-interaction
    October 01, 2003 - Hospital Admission Due to High-Dose Methotrexate Drug Interaction Citation Text: Siegel LC, Gandhi TK. Hospital Admission Due to High-Dose Methotrexate Drug Interaction. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2009. Copy Cit…
  13. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49452/psn-pdf
    July 01, 2004 - Allergy to Holter July 1, 2004 Williams M. Allergy to Holter. PSNet [internet]. 2004. https://psnet.ahrq.gov/web-mm/allergy-holter The Case A 52-year-old man was admitted for palpitations and chest pain. As part of the evaluation, on hospital day 4 the patient was sent to the cardiac clinic to start a continuous …
  14. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49434/psn-pdf
    February 01, 2004 - Undiagnosed Vaginal Bleeding February 1, 2004 Mandelblatt J. Undiagnosed Vaginal Bleeding . PSNet [internet]. 2004. https://psnet.ahrq.gov/web-mm/undiagnosed-vaginal-bleeding The Case The patient is a 34-year-old gravida 3, para 3 woman with a 2-year history of increasingly profuse vaginal bleeding. Over the past…
  15. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49492/psn-pdf
    November 01, 2005 - Reconciling Doses November 1, 2005 Federico F. Reconciling Doses. PSNet [internet]. 2005. https://psnet.ahrq.gov/web-mm/reconciling-doses Case Objectives List the steps involved in medication reconciliation. Describe the role of each of the stakeholders in medication reconciliation. Discuss how medication reconc…
  16. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/33739/psn-pdf
    October 01, 2012 - The Physical Environment: An Often Unconsidered Patient Safety Tool October 1, 2012 Joseph A, Malone EB. The Physical Environment: An Often Unconsidered Patient Safety Tool. PSNet [internet]. 2012. https://psnet.ahrq.gov/perspective/physical-environment-often-unconsidered-patient-safety-tool Perspective Now that…
  17. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49731/psn-pdf
    April 01, 2015 - Fire in the Hole!—An OR Fire April 1, 2015 Mehta SP, Domino KM. Fire in the Hole!—An OR Fire. PSNet [internet]. 2015. https://psnet.ahrq.gov/web-mm/fire-hole-or-fire The Case A patient was taken to the operating room (OR) to undergo a planned laparoscopic subtotal colon resection for a biopsy-proven adenocarcinom…
  18. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49592/psn-pdf
    October 01, 2009 - Danger in Disruption October 1, 2009 Fontaine DK. Danger in Disruption. PSNet [internet]. 2009. https://psnet.ahrq.gov/web-mm/danger-disruption The Case A 23-month-old toddler was severely dehydrated after vomiting due to gastric outlet obstruction. She had metabolic alkalosis (pH = 7.58), and her last peripheral…
  19. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49707/psn-pdf
    April 01, 2014 - CYP450 Drugs: Expect the Unexpected April 1, 2014 Gonzalez CJ. CYP450 Drugs: Expect the Unexpected. PSNet [internet]. 2014. https://psnet.ahrq.gov/web-mm/cyp450-drugs-expect-unexpected The Case A 42-year-old man with acquired immunodeficiency syndrome (AIDS) (CD4 count 198), hip dystocia, and generalized anxiety …
  20. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49670/psn-pdf
    November 01, 2012 - Missed Pneumonia November 1, 2012 Rohde JM, Flanders S. Missed Pneumonia. PSNet [internet]. 2012. https://psnet.ahrq.gov/web-mm/missed-pneumonia The Case A 32-year-old man presented to the emergency department (ED) with 3 days of fever and right pleuritic chest pain. Review of systems was negative for cough or dy…

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