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4981. Implementing a Fall Prevention Program | PSNet
      psnet.ahrq.gov/perspective/implementing-fall-prevention-program
      November 29, 2023 - Implementing a Fall Prevention Program Frances Healey, RN, PhD | December 1, 2011  View more articles from the same authors. Citation Text: Healey F. Implementing a Fall Prevention Program. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Qualit…

4982. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/865411/psn-pdf
      March 27, 2024 - Uterine Artery Injury during Cesarean Delivery Leads to Cardiac Arrests and Emergency Hysterectomy March 27, 2024 Lopez C, Tache V. Uterine Artery Injury during Cesarean Delivery Leads to Cardiac Arrests and Emergency Hysterectomy. PSNet [internet]. 2024. https://psnet.ahrq.gov/web-mm/uterine-artery-injury-during-…

4983. Not-So-Therapeutic Tap | PSNet
      psnet.ahrq.gov/web-mm/not-so-therapeutic-tap
      December 01, 2014 - Video to Improve Patient Safety: Clinical and Educational Uses May 1, 2015 Assessing

4984. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/36016/psn-pdf
      September 27, 2016 - Strategies used by nurses to recover medical errors in an academic emergency department setting. September 27, 2016 Henneman EA, Blank FSJ, Gawlinski A, et al. Strategies used by nurses to recover medical errors in an academic emergency department setting. Appl Nurs Res. 2006;19(2):70-7. https://psnet.ahrq.gov/iss…

4985. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/38521/psn-pdf
      September 19, 2016 - Inpatient suicide: preventing a common sentinel event. September 19, 2016 Tishler CL, Reiss NS. Inpatient suicide: preventing a common sentinel event. Gen Hosp Psychiatry. 2009;31(2):103-9. doi:10.1016/j.genhosppsych.2008.09.007. https://psnet.ahrq.gov/issue/inpatient-suicide-preventing-common-sentinel-event Suici…

4986. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/60538/psn-pdf
      May 27, 2020 - Diagnostic Safety Toolkit. May 27, 2020 Child Health Patient Safety Organization. Diagnostic Safety Toolkit. Washington DC: Children's Hospital Association. May 2020. https://psnet.ahrq.gov/issue/diagnostic-safety-toolkit Effective communication is an important component of diagnostic accuracy. Shaped with data co…

4987. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/36935/psn-pdf
      September 01, 2011 - When should a multicampus hospital be considered a single entity for public reporting on patient safety issues? September 1, 2011 Naessens JM, Culbertson R, Lefante JJ, et al. When should a multicampus hospital be considered a single entity for public reporting on patient safety issues? Qual Manag Health Care. 2007…

4988. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/38813/psn-pdf
      June 16, 2010 - Medication reconciliation performed by pharmacy technicians at the time of preoperative screening. June 16, 2010 van den Bemt PM, van den Broek S, van Nunen AK, et al. Medication reconciliation performed by pharmacy technicians at the time of preoperative screening. Ann Pharmacother. 2009;43(5):868-74. doi:10.1345…

4989. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/38734/psn-pdf
      July 01, 2009 - Safety and efficiency considerations for the introduction of electronic ordering in a blood bank. July 1, 2009 Georgiou A, Greenfield T, Callen J, et al. Safety and efficiency considerations for the introduction of electronic ordering in a blood bank. Arch Pathol Lab Med. 2009;133(6):933-7. doi:10.1043/1543-2165- …

4990. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/36026/psn-pdf
      March 28, 2011 - Inter- and intra-rater reliability for classification of medication related events in paediatric inpatients. March 28, 2011 Kunac DL, Reith DM, Kennedy J, et al. Inter- and intra-rater reliability for classification of medication related events in paediatric inpatients. Qual Saf Health Care. 2006;15(3):196-201. ht…

4991. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/866869/psn-pdf
      October 02, 2024 - Core Elements of Hospital Diagnostic Excellence (DxEx). October 2, 2024 Core Elements of Hospital Diagnostic Excellence (DxEx). Centers for Disease Control and Prevention. https://psnet.ahrq.gov/issue/core-elements-hospital-diagnostic-excellence-dxex Diagnostic excellence is an expansion of the diagnostic error red…

4992. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/43985/psn-pdf
      December 06, 2017 - Development of a medication safety and quality survey for small rural hospitals. December 6, 2017 Winterstein AG, Johns TE, Campbell KN, et al. Development of a Medication Safety and Quality Survey for Small Rural Hospitals. J Patient Saf. 2017;13(4):249-254. doi:10.1097/PTS.0000000000000154. https://psnet.ahrq.go…

4993. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/60885/psn-pdf
      September 02, 2020 - Becoming a High Reliability Organization. September 2, 2020 VHA Forum. Summer 2020;1-12. https://psnet.ahrq.gov/issue/becoming-high-reliability-organization High reliability attainment is a stated goal for health care organizations. This special issue covers established initiatives at the United States Veterans He…

4994. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/37746/psn-pdf
      May 14, 2008 - Reducing preventable medication safety events by recognizing renal risk. May 14, 2008 Fields W, Tedeschi C, Foltz J, et al. Reducing preventable medication safety events by recognizing renal risk. Clin Nurse Spec. 2008;22(2):73-8; quiz 79-80. doi:10.1097/01.NUR.0000311795.69476.2f. https://psnet.ahrq.gov/issue/red…

4995. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/48128/psn-pdf
      August 28, 2019 - Burnout in healthcare: the case for organisational change. August 28, 2019 Montgomery A, Panagopoulou E, Esmail A, et al. Burnout in healthcare: the case for organisational change. BMJ. 2019;366:l4774. doi:10.1136/bmj.l4774. https://psnet.ahrq.gov/issue/burnout-healthcare-case-organisational-change Burnout has be…

4996. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/45659/psn-pdf
      November 16, 2016 - Misdiagnoses: a hidden risk of genetic testing. November 16, 2016 Howard J. CNN. October 31, 2016. https://psnet.ahrq.gov/issue/misdiagnoses-hidden-risk-genetic-testing Although genetic testing can provide proactive assessment for disease, it can also result in unnecessary care. This news article reports on the un…

4997. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/34816/psn-pdf
      February 28, 2018 - Blaming others for threatening events. February 28, 2018 Tennen H; Affleck G. https://psnet.ahrq.gov/issue/blaming-others-threatening-events This detailed review summarizes existing evidence on how people adapt to threatening events by blaming others. Discussion includes a synthesis of past work and explanations f…

4998. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/43020/psn-pdf
      May 29, 2014 - Handoff practices in undergraduate medical education. May 29, 2014 Liston BW, Tartaglia KM, Evans D, et al. Handoff practices in undergraduate medical education. J Gen Intern Med. 2014;29(5):765-9. doi:10.1007/s11606-014-2806-0. https://psnet.ahrq.gov/issue/handoff-practices-undergraduate-medical-education This su…

4999. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/45006/psn-pdf
      April 06, 2016 - Quality and Patient Safety. April 6, 2016 Agency for Healthcare Research and Quality. https://psnet.ahrq.gov/issue/quality-and-patient-safety The Agency for Healthcare Research and Quality has provided access to patient safety research, information, and tools for nearly two decades. This website offers a wide rang…

5000. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/73991/psn-pdf
      October 20, 2021 - Digital Clinical Safety Strategy October 20, 2021 NHSX, NHS Digital, NHS England, et al. London, England: Crown Copyright; September 2021. https://psnet.ahrq.gov/issue/digital-clinical-safety-strategy Digital clinical technologies hold promise for care improvement while contributing to potential failures due to th…