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psnet.ahrq.gov/primers-0
March 15, 2025 - Complications
(10)
Nosocomial Infections
(6)
Patient Falls
(3)
Pressure … Ulcers
(1)
Medication Safety
(12)
Medication Errors/Preventable Adverse
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psnet.ahrq.gov/perspective/update-safety-culture
January 22, 2020 - because they are able to do the basics every time, like turning patients every 60 minutes to avoid pressure … ulcers, using a central line checklist, or washing their hands frequently.
-
psnet.ahrq.gov/node/49737/psn-pdf
June 01, 2015 - because like restraints, catheters
can cause functional impairment leading to emboli, discomfort, and pressure … ulcers.
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psnet.ahrq.gov/web-mm/unseen-perils-urinary-catheters
January 31, 2024 - because like restraints, catheters can cause functional impairment leading to emboli, discomfort, and pressure … ulcers.
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psnet.ahrq.gov/node/841567/psn-pdf
December 14, 2022 - increased with a 40% rise in healthcare-acquired infections and an increase in inpatient falls and
pressure … ulcers.14 Healthcare leaders recognize the need to do better.
-
psnet.ahrq.gov/perspective/conversation-christine-cassel-md
February 26, 2025 - Or a patient falls or gets what might be a preventable pressure ulcer, or a mistake occurs in a surgical
-
psnet.ahrq.gov/node/33788/psn-pdf
June 01, 2015 - Or a patient falls or gets what might be a preventable pressure ulcer, or a mistake occurs in a
surgical
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psnet.ahrq.gov/web-mm/hidden-mystery
December 01, 2011 - oximetry monitoring, wound care, blood draws, intravenous catheter placement, skin care and prevention of pressure … ulcers, respiratory and ventilator support, and correct administration of medications can all be challenging
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psnet.ahrq.gov/node/49474/psn-pdf
March 01, 2005 - oximetry monitoring, wound care, blood draws, intravenous catheter placement,
skin care and prevention of pressure … ulcers, respiratory and ventilator support, and correct administration of
medications can all be challenging
-
psnet.ahrq.gov/node/49744/psn-pdf
October 01, 2015 - He was diagnosed, again, with sepsis secondary to sacral decubitus ulcers.
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psnet.ahrq.gov/node/49522/psn-pdf
November 01, 2006 - Intramuscular injection site injuries masquerading as pressure ulcers. Wounds.
2003;15:302-312.
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psnet.ahrq.gov/perspective/conversation-charles-crecelius-md-phd-cmd-and-lori-l-popejoy-phd-rn-faan
October 28, 2020 - individuals can gain from social interaction and enhanced mobility, such as reduced risk of falls and pressure … ulcers. … mitigate safety risks associated with usual care needs for this patient population, such as falls and pressure … ulcers.
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psnet.ahrq.gov/perspective/long-term-care-and-response-covid-19
October 28, 2020 - individuals can gain from social interaction and enhanced mobility, such as reduced risk of falls and pressure … ulcers. … mitigate safety risks associated with usual care needs for this patient population, such as falls and pressure … ulcers.
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psnet.ahrq.gov/webmm-case-studies
March 25, 2025 - Delirium
(6)
Nosocomial Infections
(16)
Patient Falls
(8)
Pressure … Ulcers
(1)
Venous Thrombosis and Thromboembolism
(10)
Medication Safety
-
psnet.ahrq.gov/perspective/conversation-withsanjay-saint-md-mph
November 01, 2008 - On the one hand, we're trying to get patients up out of bed to prevent deconditioning, decubitus ulcers … , and pressure sores, but the urinary catheter is tethering them to the bed, preventing them from getting
-
psnet.ahrq.gov/web-mm/risks-absent-interoperability-medication-induced-hemolysis-patient-known-allergy
April 08, 2019 - He was diagnosed, again, with sepsis secondary to sacral decubitus ulcers.
-
psnet.ahrq.gov/web-mm/getting-good-report-card-unintended-consequences-public-reporting-hospital-quality
October 01, 2004 - Intramuscular injection site injuries masquerading as pressure ulcers. Wounds. 2003;15:302-312.
-
psnet.ahrq.gov/node/865540/psn-pdf
April 11, 2024 - Misplaced Nasogastric Tube Resulting in Aspiration
April 11, 2024
Singh A, Huang C. Misplaced Nasogastric Tube Resulting in Aspiration. PSNet [internet]. 2024.
https://psnet.ahrq.gov/web-mm/misplaced-nasogastric-tube-resulting-aspiration
The Case
An 82-year-old woman presented to the Emergency Department (ED) for …
-
psnet.ahrq.gov/node/33849/psn-pdf
January 01, 2018 - Maybe she has a pressure ulcer
that's red, inflamed. But trainees don't prioritize those things.
-
psnet.ahrq.gov/perspective/health-care-acquired-urinary-tract-infection-problem-and-solutions
November 01, 2008 - On the one hand, we're trying to get patients up out of bed to prevent deconditioning, decubitus ulcers … , and pressure sores, but the urinary catheter is tethering them to the bed, preventing them from getting