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psnet.ahrq.gov/node/844798/psn-pdf
September 25, 2019 - Poetry and Medicine. Mistakes.
September 25, 2019
Kittleson M. JAMA. 2019;322(10):984.
https://psnet.ahrq.gov/issue/poetry-and-medicine-mistakes-0
Medical mistakes are a source of anxiety for both patients and clinicians. This poem articulates a
physician's perspective regarding the psychological impact of uncerta…
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psnet.ahrq.gov/node/34926/psn-pdf
February 03, 2010 - Strategies to improve the patient safety outcome
indicator: preventing or reducing falls.
February 3, 2010
Bright L. Strategies to improve the patient safety outcome indicator: preventing or reducing falls. Home
Healthc Nurse. 2005;23(1):29-36.
https://psnet.ahrq.gov/issue/strategies-improve-patient-safety-outcome…
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psnet.ahrq.gov/node/37951/psn-pdf
May 26, 2011 - The Leapfrog Group's CPOE standard and evaluation tool.
May 26, 2011
Metzger JB, Welebob E, Turisco F, et al. Patient Saf Qual Healthc. July/August
2008;5:22-25.
https://psnet.ahrq.gov/issue/leapfrog-groups-cpoe-standard-and-evaluation-tool
This article describes an evaluation tool designed for…
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psnet.ahrq.gov/node/37339/psn-pdf
January 02, 2017 - A check-up for safety culture in "my patient care area."
January 2, 2017
Sexton JB, Paine LA, Manfuso J, et al. A Check-up for Safety Culture in “My Patient Care Area”.
doi:10.1016/s1553-7250(07)33081-x.
https://psnet.ahrq.gov/issue/check-safety-culture-my-patient-care-area
This tool is designed to allow frontline…
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psnet.ahrq.gov/node/35761/psn-pdf
February 15, 2017 - SBAR: a shared mental model for improving
communication between clinicians.
February 15, 2017
Haig KM, Sutton S, Whittington J. SBAR: a shared mental model for improving communication between
clinicians. Jt Comm J Qual Patient Saf. 2006;32(3):167-75.
https://psnet.ahrq.gov/issue/sbar-shared-mental-model-improving-…
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psnet.ahrq.gov/node/41711/psn-pdf
September 26, 2012 - Beyond FMEA: the structured what-if technique (SWIFT).
September 26, 2012
Card AJ, Ward JR, Clarkson PJ. Beyond FMEA: The structured what-if technique (SWIFT). J Healthc Risk
Manag. 2012;31(4):23-29. doi:10.1002/jhrm.20101.
https://psnet.ahrq.gov/issue/swift-new-tool-identifying-prospective-hazards
This commentary…
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psnet.ahrq.gov/node/41442/psn-pdf
May 30, 2012 - Radiation Therapy Safety: The Critical Role of the
Radiation Therapist.
May 30, 2012
Odle TG, Rosier N. Albuquerque, NM: American Society of Radiologic Technologists Education and
Research Foundation; 2012.
https://psnet.ahrq.gov/issue/radiation-therapy-safety-critical-role-radiation-therapist
Summarizing the rol…
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psnet.ahrq.gov/node/43800/psn-pdf
August 02, 2016 - Patient Safety Culture: Theory, Methods and Application.
August 2, 2016
Waterson P, ed. London, UK: Ashgate; 2014. ISBN: 9781409448143.
https://psnet.ahrq.gov/issue/patient-safety-culture-theory-methods-and-application
This publication covers patient safety culture including its background in high-risk industries, …
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psnet.ahrq.gov/node/50633/psn-pdf
November 06, 2019 - Findings of Two Inaugural Leapfrog Surveys 2019.
November 6, 2019
Washington DC: Leapfrog Group; 2019.
https://psnet.ahrq.gov/issue/findings-two-inaugural-leapfrog-surveys-2019
Ambulatory surgery centers (ASC) are established venues for surgical care despite engagement in
assessment to ensure their safety. This re…
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psnet.ahrq.gov/node/35957/psn-pdf
August 02, 2010 - A practical approach to measure the quality of
handwritten medication orders: a tool for improvement.
August 2, 2010
Garbutt J, Milligan P, McNaughton C, et al. A Practical Approach to Measure the Quality of Handwritten
Medication Orders. J Patient Saf. 2008;1(4). doi:10.1097/01.jps.0000205738.45580.5a.
https://ps…
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psnet.ahrq.gov/node/865934/psn-pdf
May 01, 2023 - MHA Person- and Family-Centered Care.
May 1, 2023
MHA Keystone Center. Michigan Health and Hospital Association.
https://psnet.ahrq.gov/issue/mha-person-and-family-centered-care
Person- and family-centered (PFC) care puts the patient and their family at the center of decision making
and planning for their health a…
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psnet.ahrq.gov/node/44693/psn-pdf
June 15, 2016 - Safety.
June 15, 2016
Center for Health Design.
https://psnet.ahrq.gov/issue/safety-0
Elements of the health care work environment can affect the care delivery. This website highlights design
considerations for health care facilities that can help reduce noise, falls, and hospital-acquired infections.
The collect…
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psnet.ahrq.gov/node/41808/psn-pdf
October 08, 2024 - ISMP Medication Safety Intensive.
October 8, 2024
Institute for Safe Medication Practices. December 5-6 2024, 7:30 AM - 4:30 PM (eastern).
https://psnet.ahrq.gov/issue/ismp-medication-safety-intensive
This virtual workshop will explore tactics for community and specialty pharmacies to ensure medication
safety, inc…
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psnet.ahrq.gov/node/35034/psn-pdf
November 05, 2015 - Seven Leadership Leverage Points for Organization-Level
Improvement in Health Care. Second edition.
November 5, 2015
Reinertsen JL, Bisognano M, Pugh MD. Cambridge, MA: Institute for Healthcare Improvement; 2008.
https://psnet.ahrq.gov/issue/seven-leadership-leverage-points-organization-level-improvement-health-car…
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psnet.ahrq.gov/node/36816/psn-pdf
August 26, 2011 - Embedding quality improvement and patient safety - the
UCLA value analysis experience.
August 26, 2011
Gambone JC, Broder MS. Embedding quality improvement and patient safety: the UCLA value analysis
experience. Best Pract Res Clin Obstet Gynaecol. 2007;21(4):581-92.
https://psnet.ahrq.gov/issue/embedding-quality-…
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psnet.ahrq.gov/node/40812/psn-pdf
November 16, 2011 - Introducing the patient safety professional: why, what,
who, how, and where?
November 16, 2011
Saint S, Krein SL, Manojlovich M, et al. Introducing the patient safety professional: why, what, who, how,
and where? J Patient Saf. 2011;7(4):175-80. doi:10.1097/PTS.0b013e318230e585.
https://psnet.ahrq.gov/issue/introd…
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psnet.ahrq.gov/node/36942/psn-pdf
March 18, 2010 - Supplementary Advisory: Results of the PA-PSRS
Workgroup on Pharmacy Computer System Safety.
March 18, 2010
Patient Safety Advisory
https://psnet.ahrq.gov/issue/supplementary-advisory-results-pa-psrs-workgroup-pharmacy-computer-
system-safety
This article shares findings from a workgroup that assessed the efficac…
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psnet.ahrq.gov/node/856639/psn-pdf
November 29, 2023 - Impact Wellbeing.
November 29, 2023
National Institute for Occupational Safety and Health. Centers for Disease Control and Prevention.
https://psnet.ahrq.gov/issue/impact-wellbeing
Clinician burnout has become a major concern for both healthcare workforce and patient safety. This portal
provides access to too…
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psnet.ahrq.gov/node/50665/psn-pdf
November 13, 2019 - The SECOND Trial
November 13, 2019
Northwestern University Feinberg School of Medicine
https://psnet.ahrq.gov/issue/second-trial
Surgical resident well-being is paramount to ensuring safe surgical care and a healthy workforce. This
website shares information on the Surgical Education Culture Optimization through t…
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psnet.ahrq.gov/node/38192/psn-pdf
November 05, 2008 - Evaluation of critical incidents in general surgery.
November 5, 2008
Zingg U, Zala-Mezoe E, Kuenzle B, et al. Evaluation of critical incidents in general surgery. Br J Surg.
2008;95(11):1420-5. doi:10.1002/bjs.6296.
https://psnet.ahrq.gov/issue/evaluation-critical-incidents-general-surgery
This study developed an…