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psnet.ahrq.gov/node/866281/psn-pdf
July 10, 2024 - Updating Eindhoven: clarifying the features of a patient
safety near miss.
July 10, 2024
Woodier N, Burnett C, Sampson P, et al. Updating Eindhoven: clarifying the features of a patient safety
near miss. J Patient Saf Risk Manag. 2024;29(4):195-201. doi:10.1177/25160435241247096.
https://psnet.ahrq.gov/issue/updat…
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psnet.ahrq.gov/node/43142/psn-pdf
June 15, 2014 - Development and sustainability of an inpatient-to-
outpatient discharge handoff tool: a quality improvement
project.
June 15, 2014
Moy NY, Lee SJ, Chan T, et al. Development and sustainability of an inpatient-to-outpatient discharge
handoff tool: a quality improvement project. Jt Comm J Qual Patient Saf. 2014;40(5…
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psnet.ahrq.gov/node/851657/psn-pdf
July 26, 2023 - Weight stigma and barriers to effective obesity care.
July 26, 2023
Puhl RM. Weight stigma and barriers to effective obesity care. Gastroenterol Clin North Am.
2023;52(2):417-428. doi:10.1016/j.gtc.2023.02.002.
https://psnet.ahrq.gov/issue/weight-stigma-and-barriers-effective-obesity-care
Implicit biases and stigm…
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psnet.ahrq.gov/node/44740/psn-pdf
April 15, 2016 - Interhospital transfer patients discharged by academic
hospitalists and general internists: characteristics and
outcomes.
April 15, 2016
Sokol-Hessner L, White AA, Davis KF, et al. Interhospital transfer patients discharged by academic
hospitalists and general internists: Characteristics and outcomes. J Hosp Med. …
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psnet.ahrq.gov/node/49746/psn-pdf
October 01, 2015 - The previous night, soon after eating dinner, he developed severe mid-
abdominal pain that did not radiate … from intra-abdominal metastases,
active inflammatory bowel disease, or when the patient had acute, severe … medical conditions requiring
stabilization (such as acute myocardial infarction and severe chronic
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psnet.ahrq.gov/node/49655/psn-pdf
June 01, 2012 - dialysis patients; approximately 50% experience chronic pain, with 82%
reporting this pain as moderate or severe … Points
All dialysis patients should be routinely screened for chronic pain, which is common and often
severe … A systematic review of the use of opioid
medication for those with moderate to severe cancer pain and
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psnet.ahrq.gov/node/49601/psn-pdf
April 01, 2010 - However, as this case demonstrates, epistaxis can be severe, requiring transfusion,
angiographic or … Most severe nose bleeds of this nature
occur in individuals older than 50 years.(1)
https://psnet.ahrq.gov … If the
bleeding has been prolonged, recurrent, or severe, a high index of suspicion for anemia and volume
-
psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.317_slideshow.ppt
March 01, 2014 - acute kidney injury with an elevated creatinine of 2.2 mg/dL (up from a baseline of 0.8 mg/dL), and a severe … The patient was treated for severe sepsis and given intravenous fluids and antibiotics.
4
4
Case … of proportion to the degree of illness, which should have prompted exploration for other causes of severe
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psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.182_slideshow.ppt
September 01, 2008 - Effects of systemic steroids in patients with severe community-acquired pneumonia. … Even though diagnosis was not clear, most causes of infection had been ruled out
Severe multi-system … Infection—all forms
Exception to rule is when high doses of glucocorticoids are indicated to diminish severe
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psnet.ahrq.gov/issue/emergency-nursing-and-medical-error-survey-two-states
January 25, 2010 - December 1, 2011
Are temporary staff associated with more severe emergency department
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psnet.ahrq.gov/issue/ismp-quarterwatch-reports
June 07, 2017 - June 13, 2018
Severe hyperglycemia in patients incorrectly using insulin pens at home
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psnet.ahrq.gov/issue/2017-ismp-medication-safety-self-assessment-communityambulatory-pharmacy
June 07, 2017 - May 11, 2017
Severe hyperglycemia in patients incorrectly using insulin pens at home.
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psnet.ahrq.gov/issue/patient-safety-24
December 01, 2011 - July 8, 2013
Are temporary staff associated with more severe emergency department medication
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psnet.ahrq.gov/issue/nursing-care-quality-nqf
September 06, 2011 - July 8, 2009
Antecedents of severe and nonsevere medication errors.
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psnet.ahrq.gov/node/49811/psn-pdf
November 01, 2017 - worsening respiratory status, liver abnormalities, and colonic pseudo-obstruction were all
consistent with severe … These are rare but life-threatening conditions that result from either decompensated
thyrotoxicosis or severe … Effects Score
Absent 0
Mild (agitation) 10
Moderate (delirium, psychosis, extreme lethargy) 20
Severe … 25
Congestive Heart Failure Score
Absent 0
Mild (pedal edema) 5
Moderate (bibasilar rales) 10
Severe
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psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.25_slideshow.ppt
July 01, 2003 - advanced care discussions
Case: Code Status Confusion
A 60-year-old woman with a history of severe … preferences in scenarios with uncertain outcomes
i.e., successful cardiac resuscitation with resultant severe
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psnet.ahrq.gov/issue/10-medication-safety-tips-hospitalized-patients
February 06, 2019 - June 13, 2018
Severe hyperglycemia in patients incorrectly using insulin pens at home
-
psnet.ahrq.gov/issue/ismp-long-term-care-advise-err
June 07, 2017 - June 13, 2018
Severe hyperglycemia in patients incorrectly using insulin pens at home
-
psnet.ahrq.gov/issue/clinical-issues-series
July 05, 2006 - 2006
National Partnership for Maternal Safety: consensus bundle on support after a severe
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psnet.ahrq.gov/issue/fatal-gas-line-mix-how-avoid-making-gastly-mistake
April 29, 2018 - September 12, 2016
ALERT: reports of severe harm after intravenous administration of