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psnet.ahrq.gov/node/42625/psn-pdf
November 08, 2013 - Miscount incidents: a novel approach to exploring risk
factors for unintentionally retained surgical … Miscount incidents: a novel approach to exploring risk factors for
unintentionally retained surgical … https://psnet.ahrq.gov/issue/miscount-incidents-novel-approach-exploring-risk-factors-unintentionally … https://psnet.ahrq.gov/issue/miscount-incidents-novel-approach-exploring-risk-factors-unintentionally-retained-surgical … https://psnet.ahrq.gov/issue/miscount-incidents-novel-approach-exploring-risk-factors-unintentionally-retained-surgical
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psnet.ahrq.gov/node/38866/psn-pdf
August 19, 2009 - Patient misidentification in Papanicolaou tests: a
systems-based approach to reducing errors. … Patient misidentification in Papanicolaou tests: a systems-based
approach to reducing errors. … https://psnet.ahrq.gov/issue/patient-misidentification-papanicolaou-tests-systems-based-approach-
reducing-errors … https://psnet.ahrq.gov/issue/patient-misidentification-papanicolaou-tests-systems-based-approach-reducing-errors … https://psnet.ahrq.gov/issue/patient-misidentification-papanicolaou-tests-systems-based-approach-reducing-errors
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psnet.ahrq.gov/node/43430/psn-pdf
October 20, 2014 - Positive deviance: a different approach to achieving
patient safety. … Positive deviance: a different approach to achieving patient
safety. … https://psnet.ahrq.gov/issue/positive-deviance-different-approach-achieving-patient-safety
This commentary … advocates for organizations to adopt an approach that focuses on top performers and
team achievements … https://psnet.ahrq.gov/issue/positive-deviance-different-approach-achieving-patient-safety
https://psnet.ahrq.gov
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psnet.ahrq.gov/node/46650/psn-pdf
July 12, 2018 - Towards a more patient-centered approach to medication
safety. … Towards a More Patient-Centered Approach to Medication Safety. … https://psnet.ahrq.gov/issue/towards-more-patient-centered-approach-medication-safety
Patient perspectives … This commentary discusses the
value of seeking patient insights as an approach to measure medication … https://psnet.ahrq.gov/issue/towards-more-patient-centered-approach-medication-safety
https://psnet.ahrq.gov
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psnet.ahrq.gov/node/40166/psn-pdf
April 03, 2017 - A strategic approach for managing conflict in hospitals:
responding to The Joint Commission leadership … A strategic approach for managing conflict in hospitals: responding to the Joint
Commission leadership … https://psnet.ahrq.gov/issue/strategic-approach-managing-conflict-hospitals-responding-joint-commission … In part 1, the authors outline
an approach to conflict (moving from conflict avoidance to engagement … https://psnet.ahrq.gov/issue/strategic-approach-managing-conflict-hospitals-responding-joint-commission-leadership
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psnet.ahrq.gov/node/40239/psn-pdf
February 23, 2011 - Randomized trial of a warfarin communication protocol
for nursing homes: an SBAR-based approach. … Randomized trial of a warfarin communication protocol for nursing homes:
an SBAR-based approach. … ://psnet.ahrq.gov/issue/randomized-trial-warfarin-communication-protocol-nursing-homes-sbar-based-
approach … communication between nurses and physicians in 26 nursing homes, the patients randomized to
the SBAR approach … https://psnet.ahrq.gov/issue/randomized-trial-warfarin-communication-protocol-nursing-homes-sbar-based-approach
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psnet.ahrq.gov/node/40608/psn-pdf
November 27, 2012 - Developing a 'critical' approach to patient and public
involvement in patient safety in the NHS: learning … Developing a 'critical' approach to patient and public involvement in patient safety in
the NHS: learning … https://psnet.ahrq.gov/issue/developing-critical-approach-patient-and-public-involvement-patient-safety … https://psnet.ahrq.gov/issue/developing-critical-approach-patient-and-public-involvement-patient-safety-nhs-learning … https://psnet.ahrq.gov/issue/developing-critical-approach-patient-and-public-involvement-patient-safety-nhs-learning
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psnet.ahrq.gov/node/37336/psn-pdf
January 05, 2012 - 'My five moments for hand hygiene': a user-centred
design approach to understand, train, monitor and … 'My five moments for hand hygiene': a user-centred design approach to
understand, train, monitor and … https://psnet.ahrq.gov/issue/my-five-moments-hand-hygiene-user-centred-design-approach-understand-
train-monitor-and-report … https://psnet.ahrq.gov/issue/my-five-moments-hand-hygiene-user-centred-design-approach-understand-train-monitor-and-report … https://psnet.ahrq.gov/issue/my-five-moments-hand-hygiene-user-centred-design-approach-understand-train-monitor-and-report
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psnet.ahrq.gov/node/42657/psn-pdf
October 16, 2013 - Medication safety and knowledge-based functions: a
stepwise approach against information overload. … Medication safety and knowledge-based functions: a stepwise
approach against information overload. … https://psnet.ahrq.gov/issue/medication-safety-and-knowledge-based-functions-stepwise-approach-against … https://psnet.ahrq.gov/issue/medication-safety-and-knowledge-based-functions-stepwise-approach-against-information … https://psnet.ahrq.gov/issue/medication-safety-and-knowledge-based-functions-stepwise-approach-against-information
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psnet.ahrq.gov/node/34747/psn-pdf
August 04, 2009 - The Improvement Guide: A Practical Approach to
Enhancing Organizational Performance. 2nd ed. … https://psnet.ahrq.gov/issue/improvement-guide-practical-approach-enhancing-organizational-performance … improvement initiatives with
stories from business, law, and health care to illustrate the successes of this approach … https://psnet.ahrq.gov/issue/improvement-guide-practical-approach-enhancing-organizational-performance … -2nd-ed
https://psnet.ahrq.gov/issue/improvement-guide-practical-approach-enhancing-organizational-performance
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psnet.ahrq.gov/node/34779/psn-pdf
December 21, 2014 - The first, an
incidental approach, uses a multidisciplinary conference format to discuss cases in which … The second, a statistical approach, systematically captures annual death and
complication rates for … surgical death and complication rates, the authors suggest that greater value exists from the
incidental approach … They
conclude that both approaches should occur continuously, with the statistical approach used only … to
validate the effects of the incidental approach and respond to concerns of safety and quality.
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psnet.ahrq.gov/primer/strategies-and-approaches-investigating-patient-safety-events
March 15, 2025 - Using this approach, components of the process or product most in need of change are identified , and … This approach is ideally used as early as possible and continues throughout the operation of the product … September 24, 2024
Patient Safety Primers
Systems Approach
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psnet.ahrq.gov/node/41087/psn-pdf
November 26, 2014 - Use of an appreciative inquiry approach to improve
resident sign-out in an era of multiple shift changes … Use of an appreciative inquiry approach to improve resident sign-out in
an era of multiple shift changes … https://psnet.ahrq.gov/issue/use-appreciative-inquiry-approach-improve-resident-sign-out-era-multiple-shift … https://psnet.ahrq.gov/issue/use-appreciative-inquiry-approach-improve-resident-sign-out-era-multiple-shift-changes … https://psnet.ahrq.gov/issue/use-appreciative-inquiry-approach-improve-resident-sign-out-era-multiple-shift-changes
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psnet.ahrq.gov/node/41803/psn-pdf
December 16, 2013 - E-prescribing: a focused review and new approach to
addressing safety in pharmacies and primary care … E-prescribing: a focused review and new approach to addressing safety in
pharmacies and primary care … https://psnet.ahrq.gov/issue/e-prescribing-focused-review-and-new-approach-addressing-safety-
pharmacies-and-primary-care … https://psnet.ahrq.gov/issue/e-prescribing-focused-review-and-new-approach-addressing-safety-pharmacies-and-primary-care … https://psnet.ahrq.gov/issue/e-prescribing-focused-review-and-new-approach-addressing-safety-pharmacies-and-primary-care
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psnet.ahrq.gov/node/43797/psn-pdf
January 07, 2015 - Building a community engagement approach for patient
safety improvement. … Building a community engagement approach for patient safety
improvement. … https://psnet.ahrq.gov/issue/building-community-engagement-approach-patient-safety-improvement
This … commentary provides information about an approach to augment patient safety through public health
engagement … https://psnet.ahrq.gov/issue/building-community-engagement-approach-patient-safety-improvement
https:
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psnet.ahrq.gov/node/45143/psn-pdf
October 20, 2016 - Medical improv: a novel approach to teaching
communication and professionalism skills. … Medical Improv: A Novel Approach to Teaching Communication and Professionalism
Skills. … https://psnet.ahrq.gov/issue/medical-improv-novel-approach-teaching-communication-and-professionalism … https://psnet.ahrq.gov/issue/medical-improv-novel-approach-teaching-communication-and-professionalism-skills … https://psnet.ahrq.gov/issue/medical-improv-novel-approach-teaching-communication-and-professionalism-skills
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psnet.ahrq.gov/node/39732/psn-pdf
August 04, 2010 - A comparative resident site visit project: a novel
approach for implementing programmatic change in … A comparative resident site visit project: a novel approach
for implementing programmatic change in … https://psnet.ahrq.gov/issue/comparative-resident-site-visit-project-novel-approach-implementing-
programmatic-change-duty … https://psnet.ahrq.gov/issue/comparative-resident-site-visit-project-novel-approach-implementing-programmatic-change-duty … https://psnet.ahrq.gov/issue/comparative-resident-site-visit-project-novel-approach-implementing-programmatic-change-duty
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psnet.ahrq.gov/node/38782/psn-pdf
August 01, 2009 - A multidisciplinary approach to adverse drug events in
pediatric trauma patients in an adult trauma … A multidisciplinary approach to adverse drug events in pediatric
trauma patients in an adult trauma … https://psnet.ahrq.gov/issue/multidisciplinary-approach-adverse-drug-events-pediatric-trauma-patients … https://psnet.ahrq.gov/issue/multidisciplinary-approach-adverse-drug-events-pediatric-trauma-patients-adult-trauma-center … https://psnet.ahrq.gov/issue/multidisciplinary-approach-adverse-drug-events-pediatric-trauma-patients-adult-trauma-center
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psnet.ahrq.gov/node/45716/psn-pdf
September 29, 2017 - Microanalysis of video from the operating room: an
underused approach to patient safety research. … Microanalysis of video from the operating room: an underused
approach to patient safety research. … https://psnet.ahrq.gov/issue/microanalysis-video-operating-room-underused-approach-patient-safety-
research … https://psnet.ahrq.gov/issue/microanalysis-video-operating-room-underused-approach-patient-safety-research … https://psnet.ahrq.gov/issue/microanalysis-video-operating-room-underused-approach-patient-safety-research
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psnet.ahrq.gov/node/47023/psn-pdf
January 16, 2019 - Usability testing of a mobile app to report medication
errors anonymously: mixed-methods approach. … Usability Testing of a Mobile App to Report Medication Errors
Anonymously: Mixed-Methods Approach. … psnet.ahrq.gov/issue/usability-testing-mobile-app-report-medication-errors-anonymously-mixed-
methods-approach … psnet.ahrq.gov/issue/usability-testing-mobile-app-report-medication-errors-anonymously-mixed-methods-approach … psnet.ahrq.gov/issue/usability-testing-mobile-app-report-medication-errors-anonymously-mixed-methods-approach