AHRQ Releases WebM&M

May 4, 2015    |   By: Calevir

The Agency for Healthcare Research and Quality (AHRQ) has released the May 2015 WebM&M, morbidity & mortality rounds on the web.  Cases and commentaries includes Errors in Sepsis Management, Transitions in Adolescent Medicine, and Departure From Central Line Ritual.

Perspectives on Safety include “Using Video to Assess Quality and Safety” includes an interview between Dr. Robert Wachter, Editor, AHRQ WebM&M, and Dr. John D Birkmeyer, a practicing general surgeon and internationally recognized health services researcher with expertise in performance management, hospital efficiency, and value-based purchasing.


PSO Case Law: Ungurian v. Beyzman, et al., 2020 PA Super 105:

A recent Pennsylvania case shows how courts narrowly interpret the PSQIA, ignoring the D & A pathway and the clear language of the Final Rule. (Ungurian v. Beyzman, et al., 2020 PA Super 105). The cour

Joint Commission New Sentinel Event Alert 61: Managing the Risks of Direct Oral Anticoagulants:

The Center for Patient Safety wants to share this important harm-prevention advice from The Joint Commission and its Sentinel Event Alert: Managing the Risks of Direct Oral Anticoagulants. The Joint Commis

CPS Safety Watch/Alert – Culture Can Improve the Control of Multi-Drug Resistant Organisms:

Issue: A number of events reported co CPS’ Patient Safety Organization (PSO) demonstrate poor handoff communication about the patients’ infectious disease status Examples include: Patient with

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