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6361. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49695/psn-pdf
      October 01, 2013 - Finding Fault With the Default Alert October 1, 2013 Baysari M. Finding Fault With the Default Alert. PSNet [internet]. 2013. https://psnet.ahrq.gov/web-mm/finding-fault-default-alert The Case A 33-year-old man with known refractory epilepsy and developmental delay was admitted to the hospital after experiencing …

6362. Amended Lab Results: Communication Slip | PSNet
      psnet.ahrq.gov/web-mm/amended-lab-results-communication-slip
      September 26, 2012 - Amended Lab Results: Communication Slip Citation Text: Mohta V. Amended Lab Results: Communication Slip. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2012. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML En…

6363. Insert Omission | PSNet
      psnet.ahrq.gov/web-mm/insert-omission
      May 09, 2014 - Insert Omission Citation Text: Darney P. Insert Omission. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2006. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged PubMedId RIS …

6364. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/33821/psn-pdf
      December 01, 2016 - Errors and Near Misses: What Health Care Could Learn From Aviation December 1, 2016 Macrae C. Errors and Near Misses: What Health Care Could Learn From Aviation. PSNet [internet]. 2016. https://psnet.ahrq.gov/perspective/errors-and-near-misses-what-health-care-could-learn-aviation Perspective Some of the most urg…

6365. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49405/psn-pdf
      June 01, 2003 - XL or Smaller? June 1, 2003 Kozer E. XL or Smaller? PSNet [internet]. 2003. https://psnet.ahrq.gov/web-mm/xl-or-smaller The Case With a history of hypertension and chronic renal failure secondary to hemolytic uremia syndrome at age 3, a 14-year-old boy presented to the emergency department with dehydration second…

6366. Spotlight Case (ppt file)
      psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.127_slideshow.ppt
      May 01, 2006 - Spotlight Case Spotlight Case May 2006 Right? Left? Neither! Source and Credits This presentation is based on the May 2006 AHRQ WebM&M Spotlight Case See the full article at http://webmm.ahrq.gov CME credit is available through the Web site Commentary by: Elizabeth A. Howell, MD, MPP; Mark R. Chassin, MD…

6367. Secured But Not Always Safe | PSNet
      psnet.ahrq.gov/web-mm/secured-not-always-safe
      October 01, 2015 - Secured But Not Always Safe Citation Text: Jahr JS, Hosseini P. Secured But Not Always Safe. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2006. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNote 7 XML …

6368. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/33808/psn-pdf
      May 01, 2016 - Reducing the Safety Hazards of Monitor Alert and Alarm Fatigue May 1, 2016 Jacques S, Williams E. Reducing the Safety Hazards of Monitor Alert and Alarm Fatigue. PSNet [internet]. 2016. https://psnet.ahrq.gov/perspective/reducing-safety-hazards-monitor-alert-and-alarm-fatigue Perspective Alarm fatigue occurs whe…

6369. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49740/psn-pdf
      August 21, 2015 - Baffled by Botulinum Toxin August 21, 2015 Sivaraman-Nair KP. Baffled by Botulinum Toxin. PSNet [internet]. 2015. https://psnet.ahrq.gov/web-mm/baffled-botulinum-toxin The Case A 5-year-old boy with a history of transverse myelitis with resultant spasticity of both lower extremities, gait abnormalities, neurogeni…

6370. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/33797/psn-pdf
      January 01, 2016 - Diagnostic Errors: A New Chapter in Patient Safety Science, Policy, and Practice January 1, 2016 Singh H. Diagnostic Errors: A New Chapter in Patient Safety Science, Policy, and Practice. PSNet [internet]. 2016. https://psnet.ahrq.gov/perspective/diagnostic-errors-new-chapter-patient-safety-science-policy-and-prac…

6371. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/836942/psn-pdf
      April 27, 2022 - Saline Flush Leads to Acute Paralysis of an Awake Patient: Risks of Improper Medication Labeling in an Operating Room April 27, 2022 Kriss RS. Saline Flush Leads to Acute Paralysis of an Awake Patient: Risks of Improper Medication Labeling in an Operating Room. PSNet [internet]. 2022. https://psnet.ahrq.gov/web-m…

6372. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49532/psn-pdf
      March 15, 2007 - Back to Basics March 1, 2007 Hellman R. Back to Basics. PSNet [internet]. 2007. https://psnet.ahrq.gov/web-mm/back-basics The Case A 48-year-old woman with insulin-dependent diabetes mellitus presents to the emergency department with right upper quadrant pain, fever, and leukocytosis, prompting admission for pres…

6373. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/33840/psn-pdf
      August 01, 2017 - ACGME's 2017 Revision of Common Program Requirements August 1, 2017 Malloy K, Brigham TP, Nasca TJ. ACGME's 2017 Revision of Common Program Requirements. PSNet [internet]. 2017. https://psnet.ahrq.gov/perspective/acgmes-2017-revision-common-program-requirements Perspective The Accreditation Council for Graduate …

6374. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/73643/psn-pdf
      August 01, 2022 - ECHO-Care Transitions Successfully Reduces Patient Readmissions from Skilled Nursing Facilities, Reduces Length of Stay August 25, 2021 https://psnet.ahrq.gov/innovation/echo-care-transitions-successfully-reduces-patient-readmissions-skilled- nursing Summary ECHO-Care Transitions (ECHO-CT) intends to ensure cont…

6375. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49395/psn-pdf
      April 01, 2003 - Medication Overdose April 1, 2003 Kaushal R. Medication Overdose. PSNet [internet]. 2003. https://psnet.ahrq.gov/web-mm/medication-overdose The Case A 15-year-old boy with end-stage AIDS was admitted to the pediatric ICU with mental status changes. He was diagnosed with status epilepticus and started on a loading…

6376. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49821/psn-pdf
      February 01, 2018 - Right Place, Right Drug, Wrong Strength February 1, 2018 Jelincic V, Greenall J. Right Place, Right Drug, Wrong Strength. PSNet [internet]. 2018. https://psnet.ahrq.gov/web-mm/right-place-right-drug-wrong-strength The Case A 2-year-old girl was admitted to a hospital burn unit for a 10% total body surface area bur…

6377. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49838/psn-pdf
      August 01, 2018 - An Untimely End Despite End-of-Life Care Planning August 1, 2018 Elia G, Barbour S, Anderson WG. An Untimely End Despite End-of-Life Care Planning. PSNet [internet]. 2018. https://psnet.ahrq.gov/web-mm/untimely-end-despite-end-life-care-planning The Case A 76-year-old man was admitted to the intensive care unit (…

6378. Patient Safety and Opioid Medications | PSNet
      psnet.ahrq.gov/perspective/patient-safety-and-opioid-medications
      January 01, 2015 - Annual Perspective Patient Safety and Opioid Medications Urmimala Sarkar, MD, and Kaveh Shojania, MD | January 1, 2016  View more articles from the same authors. Citation Text: Sarkar U, Shojania KG. Patient Safety and Opioid Medications. PSNet [internet]. Ro…

6379. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49556/psn-pdf
      March 01, 2008 - Hold That Order March 1, 2008 Grissinger M. Hold That Order. PSNet [internet]. 2008. https://psnet.ahrq.gov/web-mm/hold-order The Case A 25-year-old woman with a history of a pituitary tumor was admitted with hypernatremia. Because of her previous pituitary resection and radiation, the patient had a long history …

6380. Digital Health Literacy | PSNet
      psnet.ahrq.gov/primer/digital-health-literacy
      August 30, 2023 - Digital Health Literacy Citation Text: Seidel E, Cortes T, Chong C. Digital Health Literacy. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2023. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNote 7 XML …