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  1. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/849336/psn-pdf
    May 24, 2023 - AI may be on its way to your doctor’s office, but it’s not ready to see patients. May 24, 2023 Tahir D. KFF Health News. May 12, 2023. https://psnet.ahrq.gov/issue/ai-may-be-its-way-your-doctors-office-its-not-ready-see-patients Real-time use of artificial intelligence (AI) in health care settings continues to cau…

  2. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/44825/psn-pdf
    January 01, 2019 - Does physician's training induce overconfidence that hampers disclosing errors? February 10, 2016 Brezis M, Orkin-Bedolach Y, Fink D, et al. Does Physician's Training Induce Overconfidence That Hampers Disclosing Errors? J Patient Saf. 2019;15(4):296-298. doi:10.1097/PTS.0000000000000255. https://psnet.ahrq.gov/is…

  3. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/37909/psn-pdf
    February 23, 2009 - Prevalence of adverse drug combinations in a large post- mortem toxicology database. February 23, 2009 Launiainen T, Vuori E, Ojanperä I. Prevalence of adverse drug combinations in a large post-mortem toxicology database. Int J Legal Med. 2009;123(2):109-15. doi:10.1007/s00414-008-0261-3. https://psnet.ahrq.gov/is…

  4. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/39731/psn-pdf
    August 04, 2010 - Comparing errors in ED computer-assisted vs conventional pediatric drug dosing and administration. August 4, 2010 Yamamoto LG, Kanemori J. Comparing errors in ED computer-assisted vs conventional pediatric drug dosing and administration. Am J Emerg Med. 2010;28(5):588-92. doi:10.1016/j.ajem.2009.02.009. https://ps…

  5. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/37156/psn-pdf
    October 06, 2011 - Preventable harm occurring to critically ill children. October 6, 2011 Larsen G, Donaldson AE, Parker HB, et al. Preventable harm occurring to critically ill children. Pediatr Crit Care Med. 2007;8(4):331-336. https://psnet.ahrq.gov/issue/preventable-harm-occurring-critically-ill-children This retrospective cohort…

  6. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/43861/psn-pdf
    July 01, 2016 - Misdiagnosis and missed diagnoses in foster and adopted children with prenatal alcohol exposure. July 1, 2016 Chasnoff IJ, Wells AM, King L. Misdiagnosis and missed diagnoses in foster and adopted children with prenatal alcohol exposure. Pediatrics. 2015;135(2):264-70. doi:10.1542/peds.2014-2171. https://psnet.ahr…

  7. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/37993/psn-pdf
    August 20, 2008 - Peer support: healthcare professionals supporting each other after adverse medical events. August 20, 2008 van Pelt F. Peer support: healthcare professionals supporting each other after adverse medical events. Qual Saf Health Care. 2008;17(4):249-52. doi:10.1136/qshc.2007.025536. https://psnet.ahrq.gov/issue/peer-…

  8. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/73500/psn-pdf
    July 14, 2021 - 'An ongoing nightmare': people with obesity face major obstacles when seeking medical care. July 14, 2021 Schapiro R. NBC News. June 27, 2021. https://psnet.ahrq.gov/issue/ongoing-nightmare-people-obesity-face-major-obstacles-when-seeking- medical-care System failures cause care delays in a wide range of pat…

  9. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/72673/psn-pdf
    January 27, 2021 - Implicit bias in stroke care: a recurring old problem in the rising incidence of young stroke. January 27, 2021 Bhat A, Mahajan V, Wolfe N. Implicit bias in stroke care: A recurring old problem in the rising incidence of young stroke. J Clin Neurosci. 2021;85(Mar):27-35. doi:10.1016/j.jocn.2020.12.017. https://psn…

  10. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/866443/psn-pdf
    August 07, 2024 - Cultivate discussions in a psychologically safe workplace: part 1 and part II. August 7, 2024 ISMP Medication Safety Alert! Acute Care. July 11, 2024;29;(14):1-3; July 25, 2024;29(15):1-5. https://psnet.ahrq.gov/issue/cultivate-discussions-psychologically-safe-workplace-part-1-and-part-ii Psychological safety is c…

  11. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/43578/psn-pdf
    October 01, 2014 - Some cancer experts see 'overdiagnosis,' question emphasis on early detection. October 1, 2014 Linos E, Schroeder SA, Chren M-M. Potential Overdiagnosis of Basal Cell Carcinoma in Older Patients With Limited Life Expectancy. JAMA. 2014;312(10). doi:10.1001/jama.2014.9655. https://psnet.ahrq.gov/issue/some-cancer-e…

  12. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/47583/psn-pdf
    December 05, 2018 - Interpersonal and organizational dynamics are key drivers of failure to rescue. December 5, 2018 Smith ME, Wells EE, Friese CR, et al. Interpersonal And Organizational Dynamics Are Key Drivers Of Failure To Rescue. Health Aff (Millwood). 2018;37(11):1870-1876. doi:10.1377/hlthaff.2018.0704. https://psnet.ahrq.gov/…

  13. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/852278/psn-pdf
    August 09, 2023 - Identifying failure modes in telemedicine: an instructional needs assessment. August 9, 2023 Monkman H, Kuziemsky C, Homco J, et al. Identifying failure modes in telemedicine: an instructional needs assessment. Stud Health Technol Inform. 2023;304:39-43. doi:10.3233/shti230365. https://psnet.ahrq.gov/issue/identif…

  14. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/46895/psn-pdf
    March 14, 2018 - Rapid response teams: what's the latest? March 14, 2018 Jackson SA. Rapid response teams: What's the latest? Nursing (Brux). 2017;47(12):34-41. doi:10.1097/01.NURSE.0000526885.10306.21. https://psnet.ahrq.gov/issue/rapid-response-teams-whats-latest Rapid response systems are an established strategy to prevent in-h…

  15. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/45409/psn-pdf
    May 17, 2021 - ISMP List of High-Alert Medications in Long-Term Care (LTC) Settings. May 17, 2021 Horsham, PA: Institute of Safe Medication Practices; 2021 https://psnet.ahrq.gov/issue/ismp-list-high-alert-medications-long-term-care-ltc-settings Long-term care patients often have concurrent conditions that increase their risk of…

  16. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/34676/psn-pdf
    December 23, 2008 - Driving improvement in patient care: lessons from Toyota. December 23, 2008 Thompson DN, Wolf GA, Spear SJ. Driving improvement in patient care: lessons from Toyota. J Nurs Adm. 2003;33(11):585-595. https://psnet.ahrq.gov/issue/driving-improvement-patient-care-lessons-toyota Representatives from University of Pit…

  17. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/73452/psn-pdf
    June 30, 2021 - Administration of concentrated potassium chloride for injection during a code: still deadly! June 30, 2021 ISMP Medication Safety Alert! Acute care edition. June 3, 2021; 26(11): 1-5. https://psnet.ahrq.gov/issue/administration-concentrated-potassium-chloride-injection-during-code-still- deadly Concentrated …

  18. Tool 3 Continued | Agency for Healthcare Research and Quality

    www.ahrq.gov/es/patient-safety/settings/hospital/red/toolkit/ahcp-components.html
    March 01, 2013 - Re-Engineered Discharge (RED) Toolkit Tool 3 Continued Previous Page Next Page Table of Contents Re-Engineered Discharge (RED) Toolkit Tool 1: Overview Tool 2: How To Begin the Re-engineered Discharge Implementation at Your Hospital How CMS Measures the "30-Day All Cause Rehospitalization Rate…

  19. Remove that Foley (doc file)

    www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/cauti-tools/impl-guide/implementation-guide-appendix-h.docx
    June 02, 2025 - Remove that Foley AHRQ Safety Program for Reducing CAUTI in Hospitals Appendix H. Urinary Catheter Pocket Card Front Front Back Remove that Urinary Catheter! Foley catheters can cause: · Infections · Length of Stay · Cost · Patient Discomfort · Antibiotic Use Urinary catheters confine patients to bed, …

  20. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/841200/psn-pdf
    December 07, 2022 - Preventing errors when preparing and administering medications via enteral feeding tubes. December 7, 2022 ISMP Medication Safety Alert! Acute care edition. November 17, 2022;27(23). https://psnet.ahrq.gov/issue/preventing-errors-when-preparing-and-administering-medications-enteral- feeding-tubes Enteral feeding …
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