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psnet.ahrq.gov/perspective/identifying-adverse-events-not-present-admission-can-we-do-it
October 01, 2008 - If you take the old situation and look at it, I think you'll realize that it's a little bit odd. … October 10, 2017
Association of hospital participation in a surgical outcomes monitoring
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psnet.ahrq.gov/perspective/what-have-we-learned-about-safe-inpatient-handovers
March 01, 2011 - They define these "vigilance tasks," things that require a lot of attention and vigilance like monitoring … ACGME duty hour recommendations, it does say that programs should all implement handoff education and monitoring
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psnet.ahrq.gov/perspective/conversation-robert-hirschtick-md
January 01, 2018 - Are there technological solutions that we should be thinking about to try to improve the situation? … Susan McGrath, PhD and George Blike, MD about Surveillance Monitoring
April 26, 2023
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psnet.ahrq.gov/perspective/conversation-michael-cohen-rph-ms-scd-hon-0
October 24, 2021 - That's concerning because you know what speed does in a situation like that, and the time pressures that … June 29, 2011
Monitoring adverse drug reactions in children using community pharmacies
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psnet.ahrq.gov/web-mm/life-threatening-infant-overdose-sodium-chloride
December 23, 2020 - trained personnel who regularly perform this task...usually during daytime hours.” 13 However, in this situation … and allergies), catch errors in prescribing, suggest medication changes, and ensure adequate patient monitoring
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psnet.ahrq.gov/perspective/ensuring-patient-and-workforce-safety-culture-healthcare
March 27, 2024 - same clinical environment with the same equipment and with the same team members as a real clinical situation … November 27, 2023
Perspective
Surveillance Monitoring
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psnet.ahrq.gov/perspective/conversation-withallan-frankel-md
July 01, 2006 - Susan McGrath, PhD and George Blike, MD about Surveillance Monitoring
April 26, 2023
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psnet.ahrq.gov/perspective/rapid-response-teams-lessons-early-experience
November 01, 2005 - However, developments in technology, such as the availability of remote critical care physician monitoring
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psnet.ahrq.gov/periodic-issue/periodic-issue-300
July 28, 2021 - July 14, 2021 Weekly Issue
PSNet highlights the latest patient safety literature, news, and expert commentary, including Weekly
Updates, WebM&M, and Perspectives on Safety. The current issue highlights what's new this week in patient
safety literature, news, conferences, reports, …
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psnet.ahrq.gov/periodic-issue/periodic-issue-278
February 10, 2021 - emergence from anesthesia and an unnecessary transfer to the intensive care unit for ventilation and monitoring
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psnet.ahrq.gov/periodic-issue/periodic-issue-405
August 30, 2023 - the patient suffered slower onset of analgesia and significant pruritis, and required more prolonged monitoring
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psnet.ahrq.gov/periodic-issue/periodic-issue-404
August 30, 2023 - the patient suffered slower onset of analgesia and significant pruritis, and required more prolonged monitoring
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psnet.ahrq.gov/innovation/project-boost-increases-patient-understanding-treatment-and-follow-care
February 26, 2025 - Project BOOST Increases Patient Understanding of Treatment and Follow-up Care
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May 26, 2021
Innovation
Contact
…
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psnet.ahrq.gov/node/49735/psn-pdf
June 01, 2015 - Anchoring Bias With Critical Implications
June 1, 2015
Etchells E. Anchoring Bias With Critical Implications. PSNet [internet]. 2015.
https://psnet.ahrq.gov/web-mm/anchoring-bias-critical-implications
Case Objectives
Appreciate that diagnostic errors are common in primary and ambulatory care.
Define premature clo…
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psnet.ahrq.gov/node/846170/psn-pdf
March 15, 2023 - Duplicate Therapies in Retail Pharmacy
March 15, 2023
Punatar N, Molla M, Lee S. Duplicate Therapies in Retail Pharmacy. PSNet [internet]. 2023.
https://psnet.ahrq.gov/web-mm/duplicate-therapies-retail-pharmacy
The Cases
Case 1: A middle-aged man with a past medical history of heart failure with reduced ejection f…
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psnet.ahrq.gov/perspective/conversation-john-g-reiling-phd
February 26, 2025 - In Conversation With... John G. Reiling, PhD
December 1, 2012
Citation Text:
In Conversation With.. John G. Reiling, PhD. PSNet [internet]. 2012.In Conversation With... John G. Reiling, PhD. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Qualit…
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psnet.ahrq.gov/node/73300/psn-pdf
July 01, 2022 - Project BOOST Increases Patient Understanding of
Treatment and Follow-up Care
May 26, 2021
https://psnet.ahrq.gov/innovation/project-boost-increases-patient-understanding-treatment-and-follow-care
Summary
The Patient Safe-D(ischarge) program used standardized tools to educate patients about their discharge
needs,…
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psnet.ahrq.gov/node/49822/psn-pdf
March 01, 2018 - Unlike warfarin, DOACs do not require routine dose adjustment or monitoring.
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psnet.ahrq.gov/node/33770/psn-pdf
August 01, 2014 - focused on
ambulatory patient safety, including missed and delayed diagnosis, adverse drug events, and monitoring
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psnet.ahrq.gov/web-mm/order-interrupted-text-multitasking-mishap
August 21, 2015 - electromagnetic radiation, which may interfere with other hospital devices (e.g., remote telemetry monitoring