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psnet.ahrq.gov/issue/counting-matters-lessons-root-cause-analysis-retained-surgical-item
January 02, 2017 - 2012
WebM&M Cases
Home Medications Contribute to a Unique
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psnet.ahrq.gov/issue/perioperative-medication-errors-uncovering-risk-behind-drapes
March 27, 2018 - January 20, 2016
Medication errors affecting pediatric patients: unique challenges for
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psnet.ahrq.gov/issue/assessment-ahrq-patient-safety-initiative-focus-implementation-and-dissemination-evaluation
May 21, 2014 - December 15, 2010
Identity Crisis: An Examination of the Costs and Benefits of a Unique
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psnet.ahrq.gov/node/36678/psn-pdf
August 27, 2007 - Excusable neglect in malpractice suits against
radiologists: a proposed jury instruction to recognize the
human condition.
August 27, 2007
Caldwell C; Seamone ER.
https://psnet.ahrq.gov/issue/excusable-neglect-malpractice-suits-against-radiologists-proposed-jury-
instruction-recognize
The authors discuss the uni…
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psnet.ahrq.gov/node/33872/psn-pdf
January 01, 2018 - Patients as Reporters of Unique Safety Events
Studies published this year corroborate earlier work demonstrating … While this
intervention did not reduce safety incidents like pressure ulcers or falls, it did identify unique
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psnet.ahrq.gov/perspective/update-patient-engagement-safety
January 01, 2017 - Patients as Reporters of Unique Safety Events
Studies published this year corroborate earlier work … this intervention did not reduce safety incidents like pressure ulcers or falls , it did identify unique
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psnet.ahrq.gov/issue/measured-response-identified-suicide-risk-and-violence-what-you-need-know-about-psychiatric
January 30, 2019 - October 14, 2020
Wrong-patient ordering errors in peripartum mother-newborn pairs: a unique
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psnet.ahrq.gov/issue/reducing-hospital-cardiac-arrests-and-hospital-mortality-introducing-medical-emergency-team
March 11, 2013 - March 11, 2013
Nosocomial SARS-CoV-2 infections and mortality during unique COVID-19
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psnet.ahrq.gov/issue/comparison-medication-safety-systems-critical-access-hospitals-combined-analysis-two-studies
September 28, 2016 - Resources
WebM&M Cases
Home Medications Contribute to a Unique
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psnet.ahrq.gov/node/49592/psn-pdf
October 01, 2009 - I wish this case were unique. … in silos in their own disciplines, graduates have little knowledge of
each other's competencies and unique
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psnet.ahrq.gov/node/866436/psn-pdf
August 07, 2024 - Using name overlap analysis to understand medication
name search safety.
August 7, 2024
Flynn AJ, Mieure KD, Myers C. Using name overlap analysis to understand medication name search
safety. Am J Health Syst Pharm. 2024;81(14):622-633. doi:10.1093/ajhp/zxae048.
https://psnet.ahrq.gov/issue/using-name-overlap-analy…
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psnet.ahrq.gov/node/49584/psn-pdf
April 01, 2009 - Unique patient identification. … Because the United States prohibits a unique medical ID, as EMRs and interoperability grow,
identity … Privacy advocates offer good arguments about the dangers of a unique medical ID.
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psnet.ahrq.gov/node/60201/psn-pdf
April 08, 2020 - Misdiagnosis, mistreatment, and harm - when medical
care ignores social forces.
April 8, 2020
Holmes SM, Hansen H, Jenks A, et al. Misdiagnosis, mistreatment, and harm - when medical care ignores
social forces. N Engl J Med. 2020;382(12). doi:10.1056/nejmp1916269.
https://psnet.ahrq.gov/issue/misdiagnosis-mistreat…
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psnet.ahrq.gov/web-mm/danger-disruption
July 29, 2020 - I wish this case were unique. … in silos in their own disciplines, graduates have little knowledge of each other's competencies and unique
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psnet.ahrq.gov/node/852447/psn-pdf
August 16, 2023 - Patient safety in palliative care at the end of life from the
perspective of complex thinking.
August 16, 2023
Bittencourt NCC de M, Duarte S da CM, Marcon SS, et al. Patient safety in palliative care at the end of life
from the perspective of complex thinking. Healthcare (Basel). 2023;11(14):2030.
doi:10.3390/hea…
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psnet.ahrq.gov/node/838074/psn-pdf
January 01, 2023 - Online patient feedback as a safety valve: an automated
language analysis of unnoticed and unresolved safety
incidents.
September 14, 2022
Gillespie A, Reader TW. Online patient feedback as a safety valve: an automated language analysis of
unnoticed and unresolved safety incidents. Risk Anal. 2023;43(7):1463-1477.…
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psnet.ahrq.gov/node/33865/psn-pdf
September 01, 2018 - RW: Is there something unique about health care that we do this even less well than other organizations … Patients have a unique perspective on the care environment and provide feedback on that, which can be … Although patients have a unique insight, they don't see their care in siloes in the way that
perhaps
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psnet.ahrq.gov/node/33704/psn-pdf
December 01, 2010 - There needs to be an understanding of the unique things that a risk manager brings to the table, such … We have taken
"disclosure" and turned it into a unique animal. … have it or fault when we don't have it—if
we can learn that human skill, disclosure is not a totally unique
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psnet.ahrq.gov/node/73998/psn-pdf
October 27, 2021 - complications include evidence of
dislodgment, redness, swelling, infiltration, induration, and drainage.10
Unique
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psnet.ahrq.gov/node/46738/psn-pdf
February 28, 2018 - Safe care for pediatric patients: a scoping review across
multiple health care settings.
February 28, 2018
Stang A, Thomson D, Hartling L, et al. Safe Care for Pediatric Patients: A Scoping Review Across Multiple
Health Care Settings. Clin Pediatr (Phila). 2018;57(1):62-75. doi:10.1177/0009922817691820.
https://ps…