-
psnet.ahrq.gov/node/34043/psn-pdf
March 11, 2011 - Some unintended consequences of information
technology in health care: the nature of patient care
information system-related errors.
March 11, 2011
Ash JS, Berg M, Coiera E. Some unintended consequences of information technology in health care: the
nature of patient care information system-related errors. J Am Med…
-
psnet.ahrq.gov/node/74162/psn-pdf
December 08, 2021 - Impact of state nurse practitioner regulations on
potentially inappropriate medication prescribing between
physicians and nurse practitioners: a national study in
the United States.
December 8, 2021
Tzeng H-M, Raji MA, Chou L-N, et al. Impact of state nurse practitioner regulations on potentially
inappropriate me…
-
psnet.ahrq.gov/node/867338/psn-pdf
December 11, 2024 - Using patient experience surveys to identify potential
diagnostic safety breakdowns: a mixed methods study.
December 11, 2024
Baker KM, Brahier M, Penne M, et al. Using patient experience surveys to identify potential diagnostic
safety breakdowns: a mixed methods study. J Patient Saf. 2024;20(8):556-563.
doi:10.10…
-
psnet.ahrq.gov/node/36833/psn-pdf
March 03, 2011 - Achieving the National Quality Forum's "Never Events":
prevention of wrong site, wrong procedure, and wrong
patient operations.
March 3, 2011
Michaels RK, Makary MA, Dahab Y, et al. Achieving the National Quality Forum's "Never Events":
prevention of wrong site, wrong procedure, and wrong patient operations. Ann S…
-
psnet.ahrq.gov/node/43626/psn-pdf
November 05, 2014 - Effects of skilled nursing facility structure and process
factors on medication errors during nursing home
admission.
November 5, 2014
Lane SJ, Troyer JL, Dienemann JA, et al. Effects of skilled nursing facility structure and process factors on
medication errors during nursing home admission. Health Care Manag Rev…
-
psnet.ahrq.gov/node/867594/psn-pdf
January 22, 2025 - A systematic review on the evidence of misdiagnosis in
dementia and its impact on accessing dementia care.
January 22, 2025
Giebel C, Silva?Ribeiro W, Watson J, et al. A systematic review on the evidence of misdiagnosis in
dementia and its impact on accessing dementia care. Int J Geriat Psychiatry. 2024;39(10):e615…
-
psnet.ahrq.gov/node/837427/psn-pdf
June 15, 2022 - Cost of adverse drug events related to potentially
inappropriate medication use: a systematic review.
June 15, 2022
Schiavo G, Forgerini M, Lucchetta RC, et al. Cost of adverse drug events related to potentially
inappropriate medication use: a systematic review. J Am Pharm Assoc (2003). 2022;62(5):1463-1476.e14.
d…
-
psnet.ahrq.gov/node/847532/psn-pdf
April 12, 2023 - The impact of an intervention to improve intrapartum
maternal vital sign monitoring and reduce alarm fatigue.
April 12, 2023
Kern-Goldberger AR, Nicholls EM, Plastino N, et al. The impact of an intervention to improve intrapartum
maternal vital sign monitoring and reduce alarm fatigue. Am J Obstet Gynecol MFM. 2023…
-
psnet.ahrq.gov/node/764390/psn-pdf
March 02, 2022 - Does root cause analysis improve patient safety? A
systematic review at the Department of Veterans Affairs.
March 2, 2022
Shah F, Falconer EA, Cimiotti JP. Does root cause analysis improve patient safety? A systematic review at
the Department of Veterans Affairs. Qual Manag Health Care. 2022;31(4):231-241.
doi:10.…
-
psnet.ahrq.gov/node/42696/psn-pdf
March 21, 2017 - Evaluation of a problem-specific SBAR tool to improve
after-hours nurse-physician phone communication: a
randomized trial.
March 21, 2017
Joffe E, Turley JP, Hwang KO, et al. Evaluation of a problem-specific SBAR tool to improve after-hours
nurse-physician phone communication: a randomized trial. Jt Comm J Qual Pa…
-
psnet.ahrq.gov/node/36889/psn-pdf
May 28, 2024 - Surveys on Patient Safety Culture.
May 28, 2024
Rockville MD: Agency for Healthcare Research and Quality
https://psnet.ahrq.gov/issue/surveys-patient-safety-culture
Safety culture has been described as a key to establishing high reliability organizations. The National
Quality Forum's Safe Practices for Healthcare …
-
psnet.ahrq.gov/node/35856/psn-pdf
June 16, 2011 - The Safety Attitudes Questionnaire: psychometric
properties, benchmarking data, and emerging research.
June 16, 2011
Sexton JB, Helmreich RL, Neilands TB, et al. The Safety Attitudes Questionnaire: psychometric properties,
benchmarking data, and emerging research. BMC Health Serv Res. 2006;6(1):44. doi:10.1186/1472…
-
psnet.ahrq.gov/node/867441/psn-pdf
January 08, 2025 - Consumer involvement in the design and development of
medication safety interventions or services in primary
care: a scoping review.
January 8, 2025
DelDot M, Lau E, Rayner N, et al. Consumer involvement in the design and development of medication
safety interventions or services in primary care: a scoping review.…
-
psnet.ahrq.gov/node/867437/psn-pdf
January 08, 2025 - Handoff mnemonics used in perioperative handoff
intervention studies: a systematic review.
January 8, 2025
Patel SM, Fuller S, Michael MM, et al. Handoff mnemonics used in perioperative handoff intervention
studies: a systematic review. Anesth Analg. 2024;Epub Nov 26. doi:10.1213/ane.0000000000007261.
https://psne…
-
psnet.ahrq.gov/node/60319/psn-pdf
May 13, 2020 - Predictors of nursing home nurses' willingness to report
medication near-misses.
May 13, 2020
Farag A, Vogelsmeier A, Knox K, et al. Predictors of nursing home nurses' willingness to report medication
near-misses. J Gerontol Nurs. 2020;46(4):21-30. doi:10.3928/00989134-20200303-03.
https://psnet.ahrq.gov/issue/pre…
-
psnet.ahrq.gov/node/60224/psn-pdf
April 15, 2020 - Information transfer at hospital discharge: a systematic
review.
April 15, 2020
Kattel S, Manning DM, Erwin PJ, et al. Information transfer at hospital discharge: a systematic review. J
Patient Saf. 2020;16(1):e25-e33. doi:10.1097/pts.0000000000000248.
https://psnet.ahrq.gov/issue/information-transfer-hospital-dis…
-
psnet.ahrq.gov/node/837507/psn-pdf
June 22, 2022 - Missed nursing care in the critical care unit, before and
during the COVID-19 pandemic: a comparative cross-
sectional study.
June 22, 2022
Falk A-C, Nymark C, Göransson KE, et al. Missed nursing care in the critical care unit, before and during
the COVID-19 pandemic: A comparative cross-sectional study. Intensive…
-
psnet.ahrq.gov/node/837640/psn-pdf
July 06, 2022 - Identifying and reconciling patients' allergy information
within the electronic health record.
July 6, 2022
Vallamkonda S, Ortega CA, Lo YC, et al. Identifying and reconciling patients' allergy information within the
electronic health record. Stud Health Technol Inform. 2022;290:120-124. doi:10.3233/shti220044.
ht…
-
psnet.ahrq.gov/node/72682/psn-pdf
January 27, 2021 - Healthcare failure mode and effect analysis (HFMEA) as
an effective mechanism in preventing infection caused by
accompanying caregivers during COVID-19-experience of
a city medical center in Taiwan.
January 27, 2021
Tiao C-H, Tsai L-C, Chen L-C, et al. Healthcare Failure Mode and Effect Analysis (HFMEA) as an Effe…
-
psnet.ahrq.gov/node/46034/psn-pdf
April 05, 2017 - Design and reliability of a specific instrument to evaluate
patient safety for patients with acute myocardial
infarction treated in a predefined care track: a
retrospective patient record review study in a single
tertiary hospital in the Netherlands.
April 5, 2017
Eindhoven DC, Borleffs JW, Dietz MF, et al. Desig…