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  1. Misadministration of IV insulin associated with dose measurement and hyperkalemia treatment. | PSNet

    psnet.ahrq.gov/issue/misadministration-iv-insulin-associated-dose-measurement-and-hyperkalemia-treatment
    August 24, 2016 - Newspaper/Magazine Article Misadministration of IV insulin associated with dose measurement and hyperkalemia treatment. Citation Text: Misadministration of IV insulin associated with dose measurement and hyperkalemia treatment. ISMP Medication Safety Alert! Acute Care Edition. August 11,…

  2. Effective Health Care (pdf file)

    effectivehealthcare.ahrq.gov/sites/default/files/pdf/TND_0108_05-24-2009.pdf
    January 01, 2009 - Effective Health Care Topic Number(s): 0156 Document Completion Date: 1-12-10 1 Results of Topic Selection Process & Next Steps  Acute migraine treatment in emergency settings will go forward for refinement as a systematic review. The scope of this topic, including populations, interventions, c…

  3. Patient Safety Tool Kit. | PSNet

    psnet.ahrq.gov/issue/patient-safety-tool-kit
    February 14, 2024 - Toolkit Patient Safety Tool Kit. Citation Text: Patient Safety Tool Kit. WHO Regional Office for the Eastern Mediterranean. Cairo, Egypt: World Health Organization; 2015. ISBN: 9789290220596. Copy Citation Save Save to your library Print Download PDF …

  4. Patient Safety in the Home: Assessment of Issues, Challenges, and Opportunities. | PSNet

    psnet.ahrq.gov/issue/patient-safety-home-assessment-issues-challenges-and-opportunities
    August 09, 2017 - Book/Report Patient Safety in the Home: Assessment of Issues, Challenges, and Opportunities. Citation Text: Patient Safety in the Home: Assessment of Issues, Challenges, and Opportunities. Carpenter D, Famolaro T, Hassell S, et al. Cambridge, MA: Institute for Healthcare Improvement; 201…

  5. Wrong-site orthopedic operations on the extremities: the Pennsylvania experience. | PSNet

    psnet.ahrq.gov/issue/wrong-site-orthopedic-operations-extremities-pennsylvania-experience
    July 18, 2018 - Newspaper/Magazine Article Wrong-site orthopedic operations on the extremities: the Pennsylvania experience. Citation Text: Wrong-site orthopedic operations on the extremities: the Pennsylvania experience. Clarke JR. PA-PSRS Patient Saf Advis. 2015;12:19-27. Copy Citation …

  6. Eliminating racial and ethnic disparities causing mortality and morbidity in pregnant and postpartum patients. | PSNet

    psnet.ahrq.gov/issue/eliminating-racial-and-ethnic-disparities-causing-mortality-and-morbidity-pregnant-and
    December 23, 2016 - Sentinel Event Alerts Eliminating racial and ethnic disparities causing mortality and morbidity in pregnant and postpartum patients. Citation Text: Eliminating racial and ethnic disparities causing mortality and morbidity in pregnant and postpartum patients. Sentinel Event Alert. January…

  7. Error and Uncertainty in Diagnostic Radiology. | PSNet

    psnet.ahrq.gov/issue/error-and-uncertainty-diagnostic-radiology
    December 18, 2019 - Book/Report Error and Uncertainty in Diagnostic Radiology. Citation Text: Error and Uncertainty in Diagnostic Radiology. Bruno MA. New York, NY: Oxford University Press; 2019. ISBN: 9780190665395. Copy Citation Save Save to your library Print Download PD…

  8. Another tragic parenteral nutrition compounding error. | PSNet

    psnet.ahrq.gov/issue/another-tragic-parenteral-nutrition-compounding-error
    June 10, 2018 - Newspaper/Magazine Article Another tragic parenteral nutrition compounding error. Citation Text: Another tragic parenteral nutrition compounding error. ISMP Medication Safety Alert! Acute Care Edition. April 21, 2011;16:1-3. Copy Citation Save Save to your library…

  9. Improving Patient Safety Culture Through Teamwork and Communication: TeamSTEPPS. | PSNet

    psnet.ahrq.gov/issue/improving-patient-safety-culture-through-teamwork-and-communication-teamstepps
    November 21, 2016 - Book/Report Improving Patient Safety Culture Through Teamwork and Communication: TeamSTEPPS. Citation Text: Improving Patient Safety Culture Through Teamwork and Communication: TeamSTEPPS. Chicago, IL: Health Research & Educational Trust; June 2015. Copy Citation Save …

  10. COVID-19 Content. ISMP Medication Safety Alert! | PSNet

    psnet.ahrq.gov/issue/special-editions-covid-19-ismp-medication-safety-alert
    January 01, 2021 - Special or Theme Issue COVID-19 Content. ISMP Medication Safety Alert! Citation Text: COVID-19 Content. ISMP Medication Safety Alert! March 2020--January 2021. Copy Citation Save Save to your library Print Download PDF Share Facebook Tw…

  11. Disclosure of Adverse Events to Patients. | PSNet

    psnet.ahrq.gov/issue/disclosure-adverse-events-patients
    November 29, 2023 - Organizational Policy/Guidelines Disclosure of Adverse Events to Patients. Citation Text: Disclosure of Adverse Events to Patients. Department of Veterans Affairs, Washington DC: Veterans Health Administration; October 31, 2018. VHA Directive 1004.08. Copy Citation Sa…

  12. Safe Practices for Drug Allergies—Using CDS and Health IT. | PSNet

    psnet.ahrq.gov/issue/safe-practices-drug-allergies-using-cds-and-health-it
    March 10, 2021 - Book/Report Safe Practices for Drug Allergies—Using CDS and Health IT. Citation Text: Safe Practices for Drug Allergies—Using CDS and Health IT. Partnership for Health IT Patient Safety. Plymouth Meeting, PA: ECRI Institute; 2019. Copy Citation Save Save to your l…

  13. FactFinders. | PSNet

    psnet.ahrq.gov/issue/factfinders
    February 17, 2021 - Commentary FactFinders. Citation Text: FactFinders. SIS Patient Safety Committee. Spine Intervention Society. Copy Citation Save Save to your library Print Download PDF Share Facebook Twitter Linkedin Copy URL …

  14. Disrespectful behaviors—part 1 and part 2. | PSNet

    psnet.ahrq.gov/issue/disrespectful-behaviors-part-1-and-part-2
    June 10, 2018 - Newspaper/Magazine Article Disrespectful behaviors—part 1 and part 2. Citation Text: Disrespectful behaviors—part 1 and part 2. ISMP Medication Safety Alert! Acute care edition. October 3, 2013;18:1-4. April 24, 2014;19:1-4. Copy Citation Save Save to your library…

  15. FDA Advise-ERR: avoid using the error-prone abbreviation, TPA. | PSNet

    psnet.ahrq.gov/issue/fda-advise-err-avoid-using-error-prone-abbreviation-tpa
    April 29, 2015 - Newspaper/Magazine Article FDA Advise-ERR: avoid using the error-prone abbreviation, TPA. Citation Text: FDA Advise-ERR: avoid using the error-prone abbreviation, TPA. ISMP Medication Safety Alert! Acute Care Edition. September 24, 2015;20:1,4-5. Copy Citation Save …

  16. Safe Handling of Hazardous Drugs. | PSNet

    psnet.ahrq.gov/issue/safe-handling-hazardous-drugs
    January 02, 2011 - Clinical Guideline Safe Handling of Hazardous Drugs. Citation Text: Safe Handling of Hazardous Drugs. Polovich M; Blecher CS; Glynn-Tucker EM; McDiarmid M; Newton SA Copy Citation Save Save to your library Print Download PDF Share Facebook …

  17. Openness and Honesty When Things Go Wrong: the Professional Duty of Candour. | PSNet

    psnet.ahrq.gov/issue/openness-and-honesty-when-things-go-wrong-professional-duty-candour
    October 04, 2017 - Book/Report Openness and Honesty When Things Go Wrong: the Professional Duty of Candour. Citation Text: Openness and Honesty When Things Go Wrong: the Professional Duty of Candour. London, UK: General Medical Council and the Nursing and Midwifery Council; June 29, 2015. Copy Citation …

  18. The Report of the Short Life Working Group on Reducing Medication-related Harm. | PSNet

    psnet.ahrq.gov/issue/report-short-life-working-group-reducing-medication-related-harm
    September 09, 2015 - Book/Report The Report of the Short Life Working Group on Reducing Medication-related Harm. Citation Text: The Report of the Short Life Working Group on Reducing Medication-related Harm. Department of Health and Social Care. London, England: Crown Publishing; February 2018. Copy Citati…

  19. Cap 3 Decidexecut

    cds.ahrq.gov/sites/default/files/cds/artifact/396/cap_3_DecidExecut.html
    January 01, 1970 - recommendation; Reason: Logic:     Conditional: Direct admission to an ICU or high-level monitoring unit is recommended … Cost:             Recommendation Recommended diagnostic tests for etiology.

  20. CAMH_Template_Long_Instructions (pdf file)

    cds.ahrq.gov/sites/default/files/cds/artifact/711/Anthrax_Post_Exposure_Prophylaxis_CDS_Validation_Report.pdf
    October 17, 2018 - Logic encoded into the CDS determines the patient- specific recommended treatment and can also provide … Either there is an indication that the recommended dosing sequence was not followed (i.e., there is … OrderSet PlanDefinition (STU3) The order set containing the recommended treatment for Anthrax PEP … It references the ActionList and the ContainedResourcesList, which contain the recommended treatments … If treatment is not recommended, then this resource will be empty.
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