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- Bedside Procedures
- Noncognitive Errors ("Slips & Lapses")
- Nonsurgical Procedural Complications
- Practice Guidelines
PA-PSRS Patient Saf Advis. June 2005;2:19-21.
This advisory from the Pennsylvania Patient Safety Reporting System discusses 125 reports of tourniquets being inappropriately left on patients and provides strategies to reduce these occurrences.
Cases & Commentaries
- Spotlight Case
- Web M&M
Margaret C. Fang, MD, MPH; December 2013
Two days after knee replacement surgery, a woman with a history of deep venous thrombosis receiving pain control via epidural catheter was restarted on her outpatient dose of rivaroxaban (a newer oral anticoagulant). Although the pain service fellow scanned the medication list for traditional anticoagulants, he did not notice the patient was taking rivaroxaban before removing the epidural catheter, placing the patient at very high risk for bleeding.