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Showing results for "reviews".

  1. Error rate greatest in hospital radiology. | PSNet

    psnet.ahrq.gov/issue/error-rate-greatest-hospital-radiology
    December 24, 2008 - Newspaper/Magazine Article Error rate greatest in hospital radiology. Citation Text: Error rate greatest in hospital radiology. Stein R; USP; United States Pharmacopeia Copy Citation Save Save to your library Print Download PDF Share Face…

  2. Preventing wrong-site surgery in Minnesota: a 5-year journey. | PSNet

    psnet.ahrq.gov/issue/preventing-wrong-site-surgery-minnesota-5-year-journey
    December 19, 2007 - Newspaper/Magazine Article Preventing wrong-site surgery in Minnesota: a 5-year journey. Citation Text: Preventing wrong-site surgery in Minnesota: a 5-year journey. Rydrych D, Apold J, Harder K. Patient Saf Qual Healthc. November/December 2012;9:24-27,30-32,34. Copy Citation …

  3. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/60328/psn-pdf
    May 27, 2020 - Fatal Patient-Controlled Analgesia (PCA) Opioid-Induced Respiratory Depression May 27, 2020 Fazio S, Firestone R. Fatal Patient-Controlled Analgesia (PCA) Opioid-Induced Respiratory Depression. PSNet [internet]. 2020. https://psnet.ahrq.gov/web-mm/fatal-patient-controlled-analgesia-pca-opioid-induced-respiratory- …

  4. Missed Opportunities for Suicide Risk Assessment | PSNet

    psnet.ahrq.gov/web-mm/missed-opportunities-suicide-risk-assessment
    September 27, 2023 - SPOTLIGHT CASE Missed Opportunities for Suicide Risk Assessment Citation Text: Xiong G, Kahn D. Missed Opportunities for Suicide Risk Assessment. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2019. Copy Citation For…

  5. Missed Nursing Care: A Key Measure for Patient Safety | PSNet

    psnet.ahrq.gov/perspective/missed-nursing-care-key-measure-patient-safety
    March 01, 2018 - Missed Nursing Care: A Key Measure for Patient Safety Jane Ball, PhD, and Peter Griffiths, PhD | March 1, 2018  Also Read a Conversation View more articles from the same authors. Citation Text: Ball JE, Griffiths P. Missed Nursing Care: A Key Measure for Patient…

  6. May I Have Another?—Medication Error | PSNet

    psnet.ahrq.gov/web-mm/may-i-have-another-medication-error
    March 01, 2009 - May I Have Another?—Medication Error Citation Text: Wolf MS. May I Have Another?—Medication Error. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2014. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNote …

  7. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/866055/psn-pdf
    May 29, 2024 - Reducing Preventable Patient Harm Due to Retained Surgical Items: The RSI Bundle May 29, 2024 https://psnet.ahrq.gov/innovation/reducing-preventable-patient-harm-due-retained-surgical-items-rsi-bundle Summary Retained surgical items (RSIs) cause severe yet preventable patient harm. RSIs are the most common catego…

  8. Duplicate Insulin Order | PSNet

    psnet.ahrq.gov/web-mm/duplicate-insulin-order
    May 04, 2012 - Duplicate Insulin Order Citation Text: Acquisto NM, Cobaugh DJ. Duplicate Insulin Order. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2019. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endn…

  9. Transfer Troubles | PSNet

    psnet.ahrq.gov/web-mm/transfer-troubles
    December 29, 2014 - SPOTLIGHT CASE Transfer Troubles Citation Text: Hains IM. Transfer Troubles. 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 EndNote 7 XML Endno…

  10. A Double “Never Event”: Wrong Patient and Wrong Side. | PSNet

    psnet.ahrq.gov/web-mm/double-never-event-wrong-patient-and-wrong-side
    August 20, 2018 - A Double “Never Event”: Wrong Patient and Wrong Side. Citation Text: Bellini A, Salcedo ES. A Double “Never Event”: Wrong Patient and Wrong Side.. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2023. Copy Citation Format: …

  11. Death by PCA | PSNet

    psnet.ahrq.gov/web-mm/death-pca
    January 06, 2017 - Death by PCA Citation Text: Hicks RW. Death by PCA. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2013. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged PubMedId RIS Dow…

  12. Verification Screen That Includes Prominent Patient Photograph Significantly Reduces Errors Caused by Orders Placed in Wrong Chart | PSNet

    psnet.ahrq.gov/innovation/verification-screen-includes-prominent-patient-photograph-significantly-reduces-errors
    October 30, 2024 - Verification Screen That Includes Prominent Patient Photograph Significantly Reduces Errors Caused by Orders Placed in Wrong Chart Save Save to your library Print Download PDF Share Facebook Twitter Linkedin Copy URL June 12, 2020 …

  13. Delayed Diagnosis and Treatment of an Occult Hemothorax Following Complicated Central Line Insertion Leads to Cardiac Arrest | PSNet

    psnet.ahrq.gov/web-mm/delayed-diagnosis-and-treatment-occult-hemothorax-following-complicated-central-line
    April 01, 2008 - Delayed Diagnosis and Treatment of an Occult Hemothorax Following Complicated Central Line Insertion Leads to Cardiac Arrest Citation Text: Raff G, Goudy B. Delayed Diagnosis and Treatment of an Occult Hemothorax Following Complicated Central Line Insertion Leads to Cardiac Arrest. PSNet [internet]. Rockvil…

  14. Liposuction Gone Awry | PSNet

    psnet.ahrq.gov/web-mm/liposuction-gone-awry
    July 01, 2003 - Liposuction Gone Awry Citation Text: Yates JA. Liposuction Gone Awry. 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…

  15. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/33645/psn-pdf
    February 01, 2007 - Diagnostic Errors in Medicine: What Do Doctors and Umpires Have in Common? February 1, 2007 Graber ML. Diagnostic Errors in Medicine: What Do Doctors and Umpires Have in Common? PSNet [internet]. 2007. https://psnet.ahrq.gov/perspective/diagnostic-errors-medicine-what-do-doctors-and-umpires-have-common Perspectiv…

  16. Spotlight (pdf file)

    psnet.ahrq.gov/sites/default/files/2022-10/spotlight_case_missed_pneumothorax_10.09.2022_-_final.pdf
    January 01, 2022 - Spotlight Spotlight False Assumptions Result in a Missed Pneumothorax after Bronchoscopy with Transbronchial Biopsy Source and Credits • This presentation is based on the September 2022 AHRQ WebM&M Spotlight Case o See the full article at https://psnet.ahrq.gov/webmm o CME credit is available o Commentary by:…

  17. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/846770/psn-pdf
    March 29, 2023 - Procedure Complications – Who is Responsible for Follow up? March 29, 2023 Chalupsky M, Wei H, Marquet E. Procedure Complications – Who is Responsible for Follow up? PSNet [internet]. 2023. https://psnet.ahrq.gov/web-mm/procedure-complications-who-responsible-follow The Case A 74-year-old man with newly diagnose…

  18. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49795/psn-pdf
    June 01, 2017 - The Perils of Contrast Media June 1, 2017 Sadat U, Solomon R. The Perils of Contrast Media. PSNet [internet]. 2017. https://psnet.ahrq.gov/web-mm/perils-contrast-media Case Objectives Recognize that contrast media are potentially nephrotoxic. Identify key risk factors for the development of contrast-induced kidne…

  19. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/33614/psn-pdf
    June 01, 2005 - Interpreting the Patient Safety Literature June 1, 2005 Shojania KG. Interpreting the Patient Safety Literature. PSNet [internet]. 2005. https://psnet.ahrq.gov/perspective/interpreting-patient-safety-literature Perspective Five years ago, a widely publicized randomized trial reported a 90% reduction in the inciden…

  20. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49783/psn-pdf
    February 01, 2017 - The Hazards of Distraction: Ticking All the EHR Boxes February 1, 2017 Easty AC. The Hazards of Distraction: Ticking All the EHR Boxes. PSNet [internet]. 2017. https://psnet.ahrq.gov/web-mm/hazards-distraction-ticking-all-ehr-boxes Case Objectives List the goals of having order sets in the electronic health record…
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