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psnet.ahrq.gov/node/42660/psn-pdf
October 16, 2013 - Practice indicators of suboptimal care and avoidable
adverse events: a content analysis of a national qualifying
examination.
October 16, 2013
Bordage G, Meguerditchian A-N, Tamblyn R. Practice indicators of suboptimal care and avoidable adverse
events: a content analysis of a national qualifying examination. Acad…
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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…
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psnet.ahrq.gov/node/44511/psn-pdf
October 14, 2015 - Multimorbidity and patient safety incidents in primary
care: a systematic review and meta-analysis.
October 14, 2015
Panagioti M, Stokes J, Esmail A, et al. Multimorbidity and Patient Safety Incidents in Primary Care: A
Systematic Review and Meta-Analysis. PLoS One. 2015;10(8):e0135947.
doi:10.1371/journal.pone.01…
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psnet.ahrq.gov/node/46831/psn-pdf
April 18, 2018 - Guideline Summary: Medication Safety.
April 18, 2018
Guideline Summary: Medication Safety. AORN J. 2018;107(4):489-494. doi:10.1002/aorn.12096.
https://psnet.ahrq.gov/issue/guideline-summary-medication-safety
Perioperative medication errors can result in patient harm as well as emotional distress among clinical
te…
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psnet.ahrq.gov/node/47951/psn-pdf
April 24, 2019 - Safe medication management at ambulatory surgery
centers.
April 24, 2019
Ubaldi K. Safe Medication Management at Ambulatory Surgery Centers. AORN J. 2019;109(4):435-442.
doi:10.1002/aorn.12635.
https://psnet.ahrq.gov/issue/safe-medication-management-ambulatory-surgery-centers
Safe medication use can be challengin…
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psnet.ahrq.gov/node/50867/psn-pdf
February 05, 2020 - Cognitive testing of older clinicians prior to
recredentialing.
February 5, 2020
Cooney L, Balcezak T. Cognitive Testing of Older Clinicians Prior to Recredentialing. JAMA.
2020;323(2):179-180. doi:10.1001/jama.2019.18665.
https://psnet.ahrq.gov/issue/cognitive-testing-older-clinicians-prior-recredentialing
In an…
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psnet.ahrq.gov/node/42248/psn-pdf
June 12, 2013 - Measuring handoff quality in labor and delivery:
development, validation, and application of the
Coordination of Handoff Effectiveness Questionnaire
(CHEQ).
June 12, 2013
Block M, Ehrenworth JF, Cuce VM, et al. Measuring handoff quality in labor and delivery: development,
validation, and application of the Coordi…
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psnet.ahrq.gov/node/44389/psn-pdf
August 19, 2015 - A method of addressing proprietary name similarity for
US prescription drugs.
August 19, 2015
Stockbridge MD, Taylor K. A Method of Addressing Proprietary Name Similarity for US Prescription Drugs.
Ther Innov Regul Sci. 2015;49(4). doi:10.1177/2168479015570331.
https://psnet.ahrq.gov/issue/method-addressing-propri…
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psnet.ahrq.gov/node/45921/psn-pdf
March 08, 2017 - Do hospital boards matter for better, safer, patient care?
March 8, 2017
Mannion R, Davies HTO, Jacobs R, et al. Do Hospital Boards matter for better, safer, patient care? Soc Sci
Med. 2017;177:278-287. doi:10.1016/j.socscimed.2017.01.045.
https://psnet.ahrq.gov/issue/do-hospital-boards-matter-better-safer-patient-…
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psnet.ahrq.gov/node/73249/psn-pdf
May 12, 2021 - I-PASS handover system: a decade of evidence demands
action.
May 12, 2021
Shahian DM. I-PASS handover system: a decade of evidence demands action. BMJ Qual Saf.
2021;30(10):769-774. doi:10.1136/bmjqs-2021-013314.
https://psnet.ahrq.gov/issue/i-pass-handover-system-decade-evidence-demands-action
The I-PASS structu…
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psnet.ahrq.gov/node/45531/psn-pdf
December 14, 2016 - The role of safety culture in influencing provider
perceptions of patient safety.
December 14, 2016
Bishop A, Boyle TA. The Role of Safety Culture in Influencing Provider Perceptions of Patient Safety. J
Patient Saf. 2016;12(4):204-209.
https://psnet.ahrq.gov/issue/role-safety-culture-influencing-provider-percepti…
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psnet.ahrq.gov/node/38059/psn-pdf
September 17, 2008 - Characteristics and outcomes of patients receiving a
medical emergency team review for respiratory distress
or hypotension.
September 17, 2008
Quach J, Downey A, Haase M, et al. Characteristics and outcomes of patients receiving a medical
emergency team review for respiratory distress or hypotension. J Crit Care. …
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psnet.ahrq.gov/node/60815/psn-pdf
August 19, 2020 - Clinical reasoning in the wild: premature closure during
the COVID-19 pandemic.
August 19, 2020
Boyle JG, Walters MR, Jamieson S, et al. Clinical reasoning in the wild: premature closure during the
COVID-19 pandemic. Diagnosis (Berl). 2020;7(3):177-179. doi:10.1515/dx-2020-0061.
https://psnet.ahrq.gov/issue/clinic…
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psnet.ahrq.gov/node/73668/psn-pdf
September 01, 2021 - Leadership: an effective human factor during COVID-19.
September 1, 2021
Dhahri AA, Refson J. Leadership: an effective human factor during COVID-19. BMJ Leader. 2021;5:203-
205. doi:10.1136/leader-2020-000384.
https://psnet.ahrq.gov/issue/leadership-effective-human-factor-during-covid-19
Hierarchy and professional…
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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…
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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 …
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psnet.ahrq.gov/node/39798/psn-pdf
January 19, 2011 - Clinical handover in the trauma setting: a qualitative
study of paramedics and trauma team members.
January 19, 2011
Evans S, Murray A, Patrick I, et al. Clinical handover in the trauma setting: a qualitative study of
paramedics and trauma team members. Qual Saf Health Care. 2010;19(6):e57.
doi:10.1136/qshc.2009.0…
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psnet.ahrq.gov/node/42839/psn-pdf
January 09, 2014 - Teaching medical error disclosure to residents using
patient-centered simulation training.
January 9, 2014
Sukalich S, Elliott JO, Ruffner G. Teaching medical error disclosure to residents using patient-centered
simulation training. Acad Med. 2014;89(1):136-43. doi:10.1097/ACM.0000000000000046.
https://psnet.ahrq.…
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psnet.ahrq.gov/node/44333/psn-pdf
July 15, 2015 - One hospital's initiatives to encourage safe opioid use.
July 15, 2015
Surprise JK, Simpson MH. One Hospital's Initiatives to Encourage Safe Opioid Use. J Infus Nurs.
2015;38(4):278-83. doi:10.1097/NAN.0000000000000110.
https://psnet.ahrq.gov/issue/one-hospitals-initiatives-encourage-safe-opioid-use
This commentar…
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psnet.ahrq.gov/node/47906/psn-pdf
August 21, 2019 - Creating a just culture: the Ottawa Hospital's experience.
August 21, 2019
Forster AJ, Hamilton S, Hayes T, et al. Creating a Just Culture: The Ottawa Hospital's experience. Healthc
Manage Forum. 2019;32(5):266-271. doi:10.1177/0840470419853303.
https://psnet.ahrq.gov/issue/creating-just-culture-ottawa-hospitals-ex…