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psnet.ahrq.gov/issue/potentially-harmful-medication-dispenses-after-fall-or-hip-fracture-mixed-methods-study
May 05, 2021 - Study
Potentially harmful medication dispenses after a fall or hip fracture: a mixed methods study of a commonly used quality measure.
Citation Text:
Fischer H, Hahn EE, Li BH, et al. Potentially harmful medication dispenses after a fall or hip fracture: a mixed methods study of a common…
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psnet.ahrq.gov/issue/stakeholder-perceptions-and-attitudes-towards-problematic-polypharmacy-and-prescribing
July 10, 2019 - Study
Stakeholder perceptions of and attitudes towards problematic polypharmacy and prescribing cascades: a qualitative study.
Citation Text:
Jennings AA, Doherty AS, Clyne B, et al. Stakeholder perceptions of and attitudes towards problematic polypharmacy and prescribing cascades: a qu…
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psnet.ahrq.gov/issue/does-learning-mistakes-have-be-painful-analysis-5-years-experience-leeds-radiology
April 05, 2013 - Study
Does learning from mistakes have to be painful? Analysis of 5 years' experience from the Leeds radiology educational cases meetings identifies common repetitive reporting errors and suggests acknowledging and celebrating excellence (ACE) as a more positive way of teaching the same lessons.
…
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psnet.ahrq.gov/issue/exposures-structural-racism-and-racial-discrimination-among-pregnant-and-early-post-partum
August 12, 2019 - Study
Exposures to structural racism and racial discrimination among pregnant and early post-partum Black women living in Oakland, California.
Citation Text:
Chambers BD, Arabia SE, Arega HA, et al. Exposures to structural racism and racial discrimination among pregnant and early post‐pa…
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psnet.ahrq.gov/issue/multifactorial-interventions-reduce-duration-and-variability-delays-identification-serious
July 20, 2022 - Study
Multifactorial interventions to reduce duration and variability in delays to identification of serious injury after falls in hospital inpatients.
Citation Text:
Saleem J, Sarma D, Wright H, et al. Multifactorial interventions to reduce duration and variability in delays to identifi…
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psnet.ahrq.gov/issue/barriers-emergency-departments-adherence-four-medication-safety-related-joint-commission
October 19, 2022 - Study
Barriers to emergency departments' adherence to four medication safety–related Joint Commission National Patient Safety Goals.
Citation Text:
Juarez A, Gacki-Smith J, Bauer MR, et al. Barriers to emergency departments' adherence to four medication safety-related Joint Commission …
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psnet.ahrq.gov/issue/nurse-bias-and-nursing-care-disparities-related-patient-characteristics-scoping-review
March 17, 2021 - Review
Nurse bias and nursing care disparities related to patient characteristics: a scoping review of the quantitative and qualitative evidence
Citation Text:
Groves PS, Bunch JL, Sabin JA. Nurse bias and nursing care disparities related to patient characteristics: a scoping review of t…
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psnet.ahrq.gov/issue/ed-overcrowding-associated-increased-frequency-medication-errors
August 20, 2018 - Study
ED overcrowding is associated with an increased frequency of medication errors.
Citation Text:
Kulstad EB, Sikka R, Sweis RT, et al. ED overcrowding is associated with an increased frequency of medication errors. Am J Emerg Med. 2010;28(3):304-309. doi:10.1016/j.ajem.2008.12.014. …
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psnet.ahrq.gov/issue/alternatives-opioid-education-and-prescription-drug-monitoring-program-cumulatively-decreased
April 06, 2022 - Study
Alternatives to opioid education and a prescription drug monitoring program cumulatively decreased outpatient opioid prescriptions.
Citation Text:
Sigal A, Shah A, Onderdonk A, et al. Alternatives to opioid education and a prescription drug monitoring program cumulatively decreased…
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psnet.ahrq.gov/issue/patient-feedback-safety-improvement-primary-care-results-feasibility-study
December 02, 2020 - Study
Patient feedback for safety improvement in primary care: results from a feasibility study.
Citation Text:
Hernan AL, Giles SJ, Beks H, et al. Patient feedback for safety improvement in primary care: results from a feasibility study. BMJ Open. 2020;10(6):e037887. doi:10.1136/bmjopen…
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psnet.ahrq.gov/issue/improving-patient-family-and-clinician-experience-after-harmful-events-when-things-go-wrong
July 01, 2020 - Study
Improving the patient, family, and clinician experience after harmful events: the "When Things Go Wrong" curriculum.
Citation Text:
Bell SK, Moorman D, Delbanco T. Improving the patient, family, and clinician experience after harmful events: the "when things go wrong" curriculum. A…
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psnet.ahrq.gov/issue/weight-and-size-descriptors-drug-dosing-too-many-options-and-too-many-errors
April 06, 2022 - Commentary
Weight and size descriptors for drug dosing: too many options and too many errors.
Citation Text:
Erstad BL, Romero AV, Barletta JF. Weight and size descriptors for drug dosing: Too many options and too many errors. Am J Health Syst Pharm. 2023;80(2):87-91. doi:10.1093/ajhp/zx…
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psnet.ahrq.gov/issue/engaging-ethnic-minority-consumers-improve-safety-cancer-services-national-stakeholder
September 15, 2021 - Study
Engaging with ethnic minority consumers to improve safety in cancer services: a national stakeholder analysis.
Citation Text:
Joseph K, Newman B, Manias E, et al. Engaging with ethnic minority consumers to improve safety in cancer services: a national stakeholder analysis. Patient …
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psnet.ahrq.gov/issue/impact-computerized-physician-order-entry-alerts-prescribing-older-patients
September 23, 2020 - Study
Impact of computerized physician order entry alerts on prescribing in older patients.
Citation Text:
Lester PE, Rios-Rojas L, Islam S, et al. Impact of computerized physician order entry alerts on prescribing in older patients. Drugs Aging. 2015;32(3):227-33. doi:10.1007/s40266-015…
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psnet.ahrq.gov/issue/why-do-healthcare-professionals-fail-escalate-early-warning-system-ews-protocol-qualitative
August 25, 2021 - Review
Emerging Classic
Why do healthcare professionals fail to escalate as per the early warning system (EWS) protocol? A qualitative evidence synthesis of the barriers and facilitators of escalation.
Citation Text:
O’Neill SM, Clyne B, Bell M, et al. Why do h…
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psnet.ahrq.gov/issue/supplemental-perioperative-oxygen-and-risk-surgical-wound-infection-randomized-controlled
March 09, 2022 - Study
Supplemental perioperative oxygen and the risk of surgical wound infection: a randomized controlled trial.
Citation Text:
Belda J, Aguilera L, de la Asunción JG, et al. Supplemental perioperative oxygen and the risk of surgical wound infection: a randomized controlled trial. JAMA…
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psnet.ahrq.gov/issue/do-telephone-call-interruptions-have-impact-radiology-resident-diagnostic-accuracy
July 19, 2023 - Study
Do telephone call interruptions have an impact on radiology resident diagnostic accuracy?
Citation Text:
Balint BJ, Steenburg SD, Lin H, et al. Do telephone call interruptions have an impact on radiology resident diagnostic accuracy? Acad Radiol. 2014;21(12):1623-8. doi:10.1016/j.a…
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psnet.ahrq.gov/issue/examination-relationship-between-management-and-clinician-perception-patient-safety-climate
November 07, 2018 - Study
Classic
Examination of the relationship between management and clinician perception of patient safety climate and patient satisfaction.
Citation Text:
Mazurenko O, Richter J, Kazley AS, et al. Examination of the relationship between management and clinicia…
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psnet.ahrq.gov/issue/physician-antipsychotic-overprescribing-letters-and-cognitive-behavioral-and-physical-health
March 05, 2025 - Study
Physician antipsychotic overprescribing letters and cognitive, behavioral, and physical health outcomes among people with dementia: a secondary analysis of a randomized clinical trial.
Citation Text:
Harnisch M, Barnett ML, Coussens S, et al. Physician antipsychotic overprescribing…
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psnet.ahrq.gov/issue/overrides-medication-related-clinical-decision-support-alerts-outpatients
September 01, 2016 - Study
Overrides of medication-related clinical decision support alerts in outpatients.
Citation Text:
Nanji KC, Slight SP, Seger DL, et al. Overrides of medication-related clinical decision support alerts in outpatients. J Am Med Inform Assoc. 2014;21(3):487-91. doi:10.1136/amiajnl-2013-…