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  1. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/849660/psn-pdf
    May 31, 2023 - Strategies to Improve Organizational Health Literacy. May 31, 2023 Seidel E, Cortes T, Chong C. Strategies to Improve Organizational Health Literacy. PSNet [internet]. 2023. https://psnet.ahrq.gov/primer/strategies-improve-organizational-health-literacy Background Health literacy is important at both the personal …

  2. Strategies to improve the patient safety outcome indicator: preventing or reducing falls. | PSNet

    psnet.ahrq.gov/issue/strategies-improve-patient-safety-outcome-indicator-preventing-or-reducing-falls
    March 24, 2021 - Commentary Strategies to improve the patient safety outcome indicator: preventing or reducing falls. Citation Text: Bright L. Strategies to improve the patient safety outcome indicator: preventing or reducing falls. Home Healthc Nurse. 2005;23(1):29-36. Copy Citation Format: …

  3. Evidence-based red cell transfusion in the critically ill: quality improvement using computerized physician order entry. | PSNet

    psnet.ahrq.gov/issue/evidence-based-red-cell-transfusion-critically-ill-quality-improvement-using-computerized
    February 15, 2017 - Study Evidence-based red cell transfusion in the critically ill: quality improvement using computerized physician order entry. Citation Text: Rana R, Afessa B, Keegan MT, et al. Evidence-based red cell transfusion in the critically ill: quality improvement using computerized physician …

  4. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/33681/psn-pdf
    March 01, 2009 - The Role of Health Literacy in Patient Safety March 1, 2009 Wolf MS, Bailey SC. The Role of Health Literacy in Patient Safety. PSNet [internet]. 2009. https://psnet.ahrq.gov/perspective/role-health-literacy-patient-safety Perspective Clear health communication is increasingly recognized as essential for promoting …

  5. The devil is in the detail: how a closed-loop documentation system for IV infusion administration contributes to and compromises patient safety. | PSNet

    psnet.ahrq.gov/issue/devil-detail-how-closed-loop-documentation-system-iv-infusion-administration-contributes-and
    February 12, 2020 - Study The devil is in the detail: how a closed-loop documentation system for IV infusion administration contributes to and compromises patient safety. Citation Text: Furniss D, Dean Franklin B, Blandford A. The devil is in the detail: how a closed-loop documentation system for IV infusi…

  6. Worldwide incidence of surgical site infections in general surgical patients: a systematic review and meta-analysis of 488,594 patients. | PSNet

    psnet.ahrq.gov/issue/worldwide-incidence-surgical-site-infections-general-surgical-patients-systematic-review-and
    August 11, 2021 - Review Worldwide incidence of surgical site infections in general surgical patients: a systematic review and meta-analysis of 488,594 patients. Citation Text: Gillespie BM, Harbeck EL, Rattray M, et al. Worldwide incidence of surgical site infections in general surgical patients: a syste…

  7. Facilitated self-reported anaesthetic medication errors before and after implementation of a safety bundle and barcode-based safety system. | PSNet

    psnet.ahrq.gov/issue/facilitated-self-reported-anaesthetic-medication-errors-and-after-implementation-safety
    February 09, 2011 - Study Facilitated self-reported anaesthetic medication errors before and after implementation of a safety bundle and barcode-based safety system. Citation Text: Bowdle TA, Jelacic S, Nair B, et al. Facilitated self-reported anaesthetic medication errors before and after implementation of…

  8. 'My five moments for hand hygiene': a user-centred design approach to understand, train, monitor and report hand hygiene. | PSNet

    psnet.ahrq.gov/issue/my-five-moments-hand-hygiene-user-centred-design-approach-understand-train-monitor-and-report
    September 09, 2020 - Commentary 'My five moments for hand hygiene': a user-centred design approach to understand, train, monitor and report hand hygiene. Citation Text: Sax H, Allegranzi B, Uçkay I, et al. 'My five moments for hand hygiene': a user-centred design approach to understand, train, monitor and …

  9. Improving team information sharing with a structured call-out in anaesthetic emergencies: a randomized controlled trial. | PSNet

    psnet.ahrq.gov/issue/improving-team-information-sharing-structured-call-out-anaesthetic-emergencies-randomized
    November 17, 2014 - Study Improving team information sharing with a structured call-out in anaesthetic emergencies: a randomized controlled trial. Citation Text: Weller JM, Torrie J, Boyd M, et al. Improving team information sharing with a structured call-out in anaesthetic emergencies: a randomized control…

  10. Crew resource management improved perception of patient safety in the operating room. | PSNet

    psnet.ahrq.gov/issue/crew-resource-management-improved-perception-patient-safety-operating-room
    April 27, 2010 - Study Crew resource management improved perception of patient safety in the operating room. Citation Text: Gore DC, Powell JM, Baer JG, et al. Crew resource management improved perception of patient safety in the operating room. Am J Med Qual. 2010;25(1):60-3. doi:10.1177/1062860609351…

  11. The wolf is crying in the operating room: patient monitor and anesthesia workstation alarming patterns during cardiac surgery. | PSNet

    psnet.ahrq.gov/issue/wolf-crying-operating-room-patient-monitor-and-anesthesia-workstation-alarming-patterns
    April 17, 2013 - Study The wolf is crying in the operating room: patient monitor and anesthesia workstation alarming patterns during cardiac surgery. Citation Text: Schmid F, Goepfert MS, Kuhnt D, et al. The wolf is crying in the operating room: patient monitor and anesthesia workstation alarming patte…

  12. What is driving hospitals' patient-safety efforts? | PSNet

    psnet.ahrq.gov/issue/what-driving-hospitals-patient-safety-efforts
    February 10, 2015 - Commentary What is driving hospitals' patient-safety efforts? Citation Text: Devers KJ, Pham HH, Liu G. What is driving hospitals' patient-safety efforts? Health Aff (Millwood). 2004;23(2):103-15. Copy Citation Format: Google Scholar PubMed BibTeX EndNote X3 XML EndNote 7…

  13. What happens to the medication regimens of older adults during and after an acute hospitalization? | PSNet

    psnet.ahrq.gov/issue/what-happens-medication-regimens-older-adults-during-and-after-acute-hospitalization
    May 19, 2021 - Study What happens to the medication regimens of older adults during and after an acute hospitalization? Citation Text: Harris CM, Sridharan A, Landis R, et al. What happens to the medication regimens of older adults during and after an acute hospitalization? J Patient Saf. 2013;9(3):15…

  14. Don't Push | PSNet

    psnet.ahrq.gov/web-mm/dont-push
    March 02, 2011 - Don't Push Citation Text: Meltzer HY. Don't Push. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2003. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged PubMedId RIS Downl…

  15. False Assumptions Result in a Missed Pneumothorax after Bronchoscopy with Transbronchial Biopsy. | PSNet

    psnet.ahrq.gov/web-mm/false-assumptions-result-missed-pneumothorax-after-bronchoscopy-transbronchial-biopsy
    March 15, 2023 - August 5, 2020 Pediatric adverse drug events in the outpatient setting: an 11-year national … April 8, 2011 Adverse drug events in the outpatient setting: an 11-year national analysis

  16. Hospital-Acquired Diabetic Ketoacidosis. | PSNet

    psnet.ahrq.gov/web-mm/hospital-acquired-diabetic-ketoacidosis
    October 28, 2020 - Hospital-Acquired Diabetic Ketoacidosis. Citation Text: Zuidema D, Bagley B, Tan CL. Hospital-Acquired Diabetic Ketoacidosis.. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2023. Copy Citation Format: Google Scholar Bi…

  17. Quality and Safety Education for Nurses. | PSNet

    psnet.ahrq.gov/issue/quality-and-safety-education-nurses
    November 26, 2014 - Special or Theme Issue Quality and Safety Education for Nurses. Citation Text: Quality and Safety Education for Nurses. Cronenwett L, ed. Nurs Outlook. 2007;55(3):117-162. Copy Citation Save Save to your library Print Download PDF Share …

  18. Why doctors should own up to their medical mistakes. | PSNet

    psnet.ahrq.gov/issue/why-doctors-should-own-their-medical-mistakes
    August 26, 2009 - Audiovisual Why doctors should own up to their medical mistakes. Citation Text: Why doctors should own up to their medical mistakes. Miller K; Goldman B; Goldhill D. Copy Citation Save Save to your library Print Download PDF Share Faceboo…

  19. Sterile water should not be given "freely." | PSNet

    psnet.ahrq.gov/issue/sterile-water-should-not-be-given-freely
    March 18, 2010 - Newspaper/Magazine Article Sterile water should not be given "freely." Citation Text: Sterile water should not be given "freely." PA-PSRS Patient Saf Advis. June 2008;5:53-56. Copy Citation Save Save to your library Print Download PDF Share…

  20. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49702/psn-pdf
    March 01, 2014 - Tough Call: Addressing Errors From Previous Providers March 1, 2014 Martinez W, Hickson GB. Tough Call: Addressing Errors From Previous Providers. PSNet [internet]. 2014. https://psnet.ahrq.gov/web-mm/tough-call-addressing-errors-previous-providers Case Objectives Define what it means to be a professional. Identi…
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