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psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.332_slideshow.ppt
September 01, 2014 - improve monitoring, The Joint Commission recommends serial assessments of respiration and depth of sedation
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psnet.ahrq.gov/node/49760/psn-pdf
May 01, 2016 - should only be reserved for treatment of alcohol
or benzodiazepine withdrawal; adverse effects include sedation
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psnet.ahrq.gov/node/60309/psn-pdf
May 06, 2020 - COVID-19 leads to increased need for dialysis machines.
May 6, 2020
Mosley T. Here & Now. Boston Public Radio. April 27, 2020.
https://psnet.ahrq.gov/issue/covid-19-leads-increased-need-dialysis-machines
Comorbidities can result in unexpected care complexities. This article discusses an emerging challenge for
…
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psnet.ahrq.gov/node/37139/psn-pdf
October 04, 2011 - Inappropriate drug use in the elderly: a nationwide
register-based study.
October 4, 2011
Johnell K, Fastbom J, Rosén M, et al. Inappropriate drug use in the elderly: a nationwide register-based
study. Ann Pharmacother. 2007;41(7):1243-8.
https://psnet.ahrq.gov/issue/inappropriate-drug-use-elderly-nationwide-regis…
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psnet.ahrq.gov/node/846171/psn-pdf
July 26, 2022 - spontaneous awakening trials
(SAT) and spontaneous breathing trials (SBT); Choice of analgesia and sedation
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psnet.ahrq.gov/web-mm/tale-two-falls
March 27, 2024 - Medications that cause dizziness or sedation or promote diuresis increase the risk of recurrent and injurious
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psnet.ahrq.gov/node/867035/psn-pdf
October 30, 2024 - #4
https://psnet.ahrq.gov//#5
https://psnet.ahrq.gov//#7
https://psnet.ahrq.gov//#10
dizziness or sedation
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psnet.ahrq.gov/web-mm/agitated-delirium-contributes-missed-testing-and-delayed-diagnosis-gastric-perforation
June 28, 2023 - spontaneous awakening trials (SAT) and spontaneous breathing trials (SBT); C hoice of analgesia and sedation
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psnet.ahrq.gov/node/47784/psn-pdf
February 13, 2019 - Patterns in outpatient benzodiazepine prescribing in the
United States.
February 13, 2019
Agarwal SD, Landon BE. Patterns in Outpatient Benzodiazepine Prescribing in the United States. JAMA
Netw Open. 2019;2(1):e187399. doi:10.1001/jamanetworkopen.2018.7399.
https://psnet.ahrq.gov/issue/patterns-outpatient-benzodi…
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psnet.ahrq.gov/node/46687/psn-pdf
February 21, 2018 - Oversedation of a patient with obstructive sleep apnea
prior to imaging.
February 21, 2018
Blay E, Barnard C, Bilimoria KY. Oversedation of a Patient With Obstructive Sleep Apnea Prior to Imaging.
JAMA. 2018;319(5):495-496. doi:10.1001/jama.2017.22004.
https://psnet.ahrq.gov/issue/oversedation-patient-obstructive-…
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psnet.ahrq.gov/node/50699/psn-pdf
November 26, 2019 - Patient Safety in Frail Older Patients
November 26, 2019
Wald HL, Hall KK, Fitall E. Patient Safety in Frail Older Patients. PSNet [internet]. 2019.
https://psnet.ahrq.gov/perspective/patient-safety-frail-older-patients
Background
Older patients are at a particular risk of experiencing a patient safety event. Stud…
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psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.251_slideshow.ppt
October 01, 2011 - Spotlight Case [MONTH] 2003
Spotlight Case
Mobility Lost in the ICU
*
*
Source and Credits
This presentation is based on the October 2011
AHRQ WebM&M Spotlight Case
See the full article at http://webmm.ahrq.gov
CME credit is available
Commentary by: Jim Smith, PT, DPT, MA; Associate Professor of Physical …
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psnet.ahrq.gov/node/33606/psn-pdf
December 15, 2024 - Opioid Safety
December 15, 2024
Opioid Safety. PSNet [internet]. 2019.
https://psnet.ahrq.gov/primer/opioid-safety
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/node/73153/psn-pdf
April 28, 2021 - Two Cases of Retained Vaginal Packing: When Writing an
Order is Not Enough
April 28, 2021
Gibbs VC. Two Cases of Retained Vaginal Packing: When Writing an Order is Not Enough. PSNet
[internet]. 2021.
https://psnet.ahrq.gov/web-mm/two-cases-retained-vaginal-packing-when-writing-order-not-enough
Disclosure of Relev…
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psnet.ahrq.gov/perspective/conversation-eric-thomas-about-zero-harm-striving-reduce-preventable-harms-point
September 24, 2024 - harm, but not direct attention to other preventable but more difficult to assess harms, such as over-sedation … result in focusing on reducing harms like bed sores, without addressing more complex harms like over-sedation
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psnet.ahrq.gov/web-mm/milliliters-vs-milligrams
September 01, 2004 - Hypoglycemic agents (insulin, oral agents)
Inotropic drugs (digoxin, milrinone)
Moderate sedation
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psnet.ahrq.gov/node/860049/psn-pdf
January 04, 2024 - stabilized in the ED but developed
hypoxic respiratory failure requiring endotracheal intubation, sedation
-
psnet.ahrq.gov/innovation/risk-mitigation-using-anesthesia-risk-alert-program-applying-proactive-approach-data
February 26, 2025 - Risk reduction in anesthesia and sedation-an analysis of process improvement towards zero adverse events
-
psnet.ahrq.gov/web-mm/double-dosing-rules
February 03, 2010 - Safety and Quality
April 26, 2023
Design and implementation of an analgesia, sedation
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psnet.ahrq.gov/web-mm/missing-ecg-and-missed-diagnosis-lead-dangerous-delay
March 01, 2015 - Project (NAP5) on accidental awareness during general anaesthesia: patient experiences, human factors, sedation