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psnet.ahrq.gov/node/49819/psn-pdf
February 01, 2018 - increasing complexity of hospitalized patients (3) and the introduction of trainee work hour reductions in
response
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psnet.ahrq.gov/web-mm/forgotten-drip
April 01, 2014 - The Forgotten Drip
Citation Text:
Josephson AS. The Forgotten Drip. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2008.
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Format:
Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged PubMedId R…
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psnet.ahrq.gov/node/49814/psn-pdf
December 01, 2017 - Miscommunication in the OR Leads to Anticoagulation
Mishap
December 1, 2017
Solsky I, Haynes AB. Miscommunication in the OR Leads to Anticoagulation Mishap. PSNet [internet].
2017.
https://psnet.ahrq.gov/web-mm/miscommunication-or-leads-anticoagulation-mishap
The Case
A 63-year-old man with a history of coronary…
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psnet.ahrq.gov/node/853773/psn-pdf
September 27, 2023 - Caring for our own: deploying a systemwide second victim
rapid response team.
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psnet.ahrq.gov/web-mm/complaints-safety-surveillance
May 05, 2021 - She immediately called the hospital's rapid response team, who administered naloxone (a medication that
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psnet.ahrq.gov/primer/simulation-training
September 15, 2024 - teach physical examination and other fundamental clinical skills, in addition to more complex clinical response … Rapid curricular innovations during COVID‐19 clinical suspension: maintaining student engagement with
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psnet.ahrq.gov/node/866992/psn-pdf
May 29, 2024 - Drug-checking is a newer harm reduction intervention that emerged in response to rising overdose rates … Perspectives on rapid fentanyl test strips as a harm
reduction practice among young adults who use drugs
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psnet.ahrq.gov/node/33586/psn-pdf
December 15, 2024 - Alert Fatigue
December 15, 2024
Alert Fatigue. PSNet [internet]. 2019.
https://psnet.ahrq.gov/primer/alert-fatigue
PSNet primers are regularly reviewed and updated by the UC Davis PSNet Editorial Team to ensure that
they reflect current research and practice in the patient safety field. Last reviewed in 2024.
Bac…
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psnet.ahrq.gov/primer/diagnostic-errors
June 15, 2024 - Blind obedience Placing undue reliance on test results or "expert" opinion A false-negative rapid test
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psnet.ahrq.gov/web-mm/preventable-transfer-hospital
March 31, 2022 - pneumonia-associated complications including acute-on-chronic hypoxic respiratory failure and atrial fibrillation with rapid
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psnet.ahrq.gov/periodic-issue/periodic-issue-470
December 31, 2024 - January 15, 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, report…
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psnet.ahrq.gov/sites/default/files/2023-04/april_2023_spotlight_the_dose_makes_the_poison.pdf
January 01, 2023 - in children.11,12
• Propofol is an effective sedative due to its many appealing characteristics: rapid … reported rates of hypoxia and hypotension.10
• Nitrous oxide, a commonly used inhalational agent with rapid … Right response
35
Approaches to Improving Patient Safety: Nine Rights of Medication
Administration … midazolam premedication in pediatric patients – a randomized placebo-controlled
trial of ketamine for rapid
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psnet.ahrq.gov/node/861760/psn-pdf
January 31, 2024 - Syringe Swap During Regional Block: A Case of
Medication Error and Recovery
January 31, 2024
Beres K, Gutierrez MC. Syringe Swap During Regional Block: A Case of Medication Error and Recovery.
PSNet [internet]. 2024.
https://psnet.ahrq.gov/web-mm/syringe-swap-during-regional-block-case-medication-error-and-recover…
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psnet.ahrq.gov/node/33783/psn-pdf
April 01, 2015 - In Conversation With… Lucian Leape, MD
April 1, 2015
In Conversation With… Lucian Leape, MD. PSNet [internet]. 2015.
https://psnet.ahrq.gov/perspective/conversation-lucian-leape-md
Editor's note: Dr. Lucian Leape is Adjunct Professor of Health Policy at the Harvard School of Public
Health, Chairman of the Lucian …
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psnet.ahrq.gov/web-mm/undiagnosed-vaginal-bleeding
July 06, 2022 - Psychosocial factors and the response to cancer symptoms. In: Yancik R, Yates JW, eds.
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psnet.ahrq.gov/node/848108/psn-pdf
April 26, 2023 - agitation in children.11,12 Propofol is an effective sedative due to its many appealing
characteristics: rapid … reported rates of hypoxia and
hypotension.10 Nitrous oxide, a commonly used inhalational agent with rapid … Right response
The right action requires providers who administer or prescribe medications to ensure … midazolam
premedication in pediatric patients – a randomized placebo-controlled trial of ketamine for rapid
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psnet.ahrq.gov/node/852807/psn-pdf
August 30, 2023 - The patient did not experience rapid onset of analgesia as expected and required a
6 ml bolus of 0.2% … emotionally charged atmosphere when
the parturient is crying or writhing in pain, combined with the need for rapid
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psnet.ahrq.gov/web-mm/sleep-deprivation-leads-medication-error-during-spinal-epidural-anesthesia
January 29, 2021 - The patient did not experience rapid onset of analgesia as expected and required a 6 ml bolus of 0.2% … emotionally charged atmosphere when the parturient is crying or writhing in pain, combined with the need for rapid
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psnet.ahrq.gov/node/837958/psn-pdf
December 01, 2021 - ED crowding has led to a dose-response increase in all-cause 30-day
mortality and one preventable death … are “held hostage” at hospitals waiting for the transition of their patients’
care to the ED.26 EMS response … patients are often unable to provide their own important medical
history and ED providers have to make rapid
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psnet.ahrq.gov/web-mm/fluidity-diagnostic-wet-reads
April 24, 2018 - Pulmonary Nodules Suspicious-appearing nodules (such as those with larger size, spiculated border, rapid … months.Consecutive CT images through left lower lobe obtained at same anatomic level after 6 months show rapid