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  1. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/47645/psn-pdf
    April 17, 2019 - When a nurse is prosecuted for a fatal medical mistake, does it make medicine safer? April 17, 2019 Gordon M. Health Shots. National Public Radio. April 10, 2019. https://psnet.ahrq.gov/issue/when-nurse-prosecuted-fatal-medical-mistake-does-it-make-medicine-safer Punitive responses to medical errors persist despit…
  2. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/41022/psn-pdf
    December 21, 2011 - Key performance outcomes of patient safety curricula: root cause analysis, failure mode and effects analysis, and structured communications skills. December 21, 2011 Fassett WE. Key performance outcomes of patient safety curricula: root cause analysis, failure mode and effects analysis, and structured communicatio…
  3. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/44408/psn-pdf
    April 12, 2017 - Enhancing Surgical Performance: A Primer in Non- technical Skills. April 12, 2017 Flin R, Youngson GG, Yule S. Boca Raton, FL: CRC Press; 2015. ISBN: 9781482246322. https://psnet.ahrq.gov/issue/enhancing-surgical-performance-primer-non-technical-skills Non-technical skill development is gaining attention as a way …
  4. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/41306/psn-pdf
    May 04, 2012 - Identifying nontechnical skills associated with safety in the emergency department: a scoping review of the literature. May 4, 2012 Flowerdew L, Brown R, Vincent CA, et al. Identifying nontechnical skills associated with safety in the emergency department: a scoping review of the literature. Ann Emerg Med. 2012;59…
  5. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/41648/psn-pdf
    September 30, 2012 - Using an objective structured clinical examination to test adherence to Joint Commission National Patient Safety Goal–associated behaviors. September 30, 2012 Pernar LIM, Shaw T, Pozner CN, et al. Using an Objective Structured Clinical Examination to test adherence to Joint Commission National Patient Safety Goal-…
  6. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/47389/psn-pdf
    November 02, 2018 - What 'just culture' doesn't understand about just punishment. November 2, 2018 Reis-Dennis S. What 'Just Culture' doesn't understand about just punishment. J Med Ethics. 2018;44(11):739-742. doi:10.1136/medethics-2018-104911. https://psnet.ahrq.gov/issue/what-just-culture-doesnt-understand-about-just-punishment T…
  7. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/46023/psn-pdf
    May 03, 2017 - Patient safety and leadership: do you walk the walk? May 3, 2017 Jarrett MP. Patient Safety and Leadership: Do You Walk the Walk? J Healthc Manag. 2017;62(2):88-92. doi:10.1097/JHM-D-17-00005. https://psnet.ahrq.gov/issue/patient-safety-and-leadership-do-you-walk-walk Hospital leaders are increasingly encouraged t…
  8. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/34750/psn-pdf
    May 21, 2019 - The Basics of FMEA. 2nd ed. May 21, 2019 McDermott RE, Mikulak RJ, Beauregard MR. New York, NY: CRC Press; 2009. ISBN: 9781563273773. https://psnet.ahrq.gov/issue/basics-fmea-2nd-edition The authors provide a handbook that serves as the core tool for understanding and implementing the failure mode and effect analy…
  9. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/43820/psn-pdf
    February 18, 2015 - Care of the clinician after an adverse event. February 18, 2015 Pratt SD, Jachna BR. Care of the clinician after an adverse event. Int J Obstet Anesth. 2014;24(1):54-63. doi:10.1016/j.ijoa.2014.10.001. https://psnet.ahrq.gov/issue/care-clinician-after-adverse-event Spotlighting the emotional impact adverse events …
  10. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/46213/psn-pdf
    June 28, 2017 - The second victim: a review. June 28, 2017 Coughlan B, Powell D, Higgins MF. The Second Victim: a Review. Eur J Obstet Gynecol Reprod Biol. 2017;213:11-16. doi:10.1016/j.ejogrb.2017.04.002. https://psnet.ahrq.gov/issue/second-victim-review Maternity care is a high-risk environment. This review discusses second vic…
  11. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/60065/psn-pdf
    March 18, 2020 - Safety in Numbers: Hospital Performance on Leapfrog’s Surgical Volume Standard Based on Results of the 2019 Leapfrog Hospital Survey. March 18, 2020 Washington DC: Leapfrog Group; 2020. https://psnet.ahrq.gov/issue/safety-numbers-hospital-performance-leapfrogs-surgical-volume-standard- based-results-2019 Surgica…
  12. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/47081/psn-pdf
    September 02, 2018 - Beyond Dr. Google: the evidence on consumer-facing digital tools for diagnosis. September 2, 2018 Millenson ML, Baldwin JL, Zipperer L, et al. Beyond Dr. Google: the evidence on consumer-facing digital tools for diagnosis. Diagnosis (Berl). 2018;5(3):95-105. doi:10.1515/dx-2018-0009. https://psnet.ahrq.gov/issue/b…
  13. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/43515/psn-pdf
    July 03, 2016 - Targeting improvements in patient safety at a large academic center: an institutional handoff curriculum for graduate medical education. July 3, 2016 Allen S, Caton C, Cluver J, et al. Targeting improvements in patient safety at a large academic center: an institutional handoff curriculum for graduate medical educ…
  14. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/836789/psn-pdf
    March 23, 2022 - COVID-19 Focused Inspection Initiative in Healthcare. March 23, 2022 Occupational Safety and Health Administration. March 2, 2022. https://psnet.ahrq.gov/issue/covid-19-focused-inspection-initiative-healthcare The impact of nursing home inspections to ensure the quality and safety of the service environment is…
  15. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/46208/psn-pdf
    July 12, 2017 - Improving patient safety by practicing in a just culture. July 12, 2017 Duffy W. Improving Patient Safety by Practicing in a Just Culture. AORN J. 2017;106(1):66-68. doi:10.1016/j.aorn.2017.05.005. https://psnet.ahrq.gov/issue/improving-patient-safety-practicing-just-culture The importance of just culture is widel…
  16. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/862999/psn-pdf
    February 21, 2024 - Health tech hazards: at-home medical devices, AI governance on ECRI's new list. February 21, 2024 Miliard M. Healthcare IT News. February 1, 2024. https://psnet.ahrq.gov/issue/health-tech-hazards-home-medical-devices-ai-governance-ecris-new-list Technologies provide improvements and introduce unique problems to ca…
  17. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/44300/psn-pdf
    July 29, 2015 - Learning From Serious Failings in Care: Main Report. July 29, 2015 Short-Life Working Group on Hospital Reports. Edinburgh, Scotland: Academy of Medical Royal Colleges and Faculties in Scotland; May 2015. https://psnet.ahrq.gov/issue/learning-serious-failings-care-main-report Substantive reports of failures have t…
  18. psnet.ahrq.gov/issue/post-operative-mortality-missed-care-and-nurse-staffing-nine-countries-cross-sectional-study
    December 12, 2014 - June 22, 2022 Factors associated with missed nursing care and nurse-assessed quality
  19. psnet.ahrq.gov/issue/safety-attitudes-questionnaire-psychometric-properties-benchmarking-data-and-emerging
    June 16, 2011 - nursing homes: variance of six patient safety climate factor scores across nursing homes and wards—assessed
  20. psnet.ahrq.gov/issue/why-patient-summaries-electronic-health-records-do-not-provide-cognitive-support-necessary
    January 18, 2013 - January 18, 2013 The effect of hospital electronic health record adoption on nurse-assessed

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