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  1. Prevention of a wrong-location misadministration through the use of an intradepartmental incident learning system. | PSNet

    psnet.ahrq.gov/issue/prevention-wrong-location-misadministration-through-use-intradepartmental-incident-learning
    January 22, 2017 - Study Prevention of a wrong-location misadministration through the use of an intradepartmental incident learning system. Citation Text: Ford E, Smith K, Harris K, et al. Prevention of a wrong-location misadministration through the use of an intradepartmental incident learning system. M…

  2. Improving radiology report quality by rapidly notifying radiologist of report errors. | PSNet

    psnet.ahrq.gov/issue/improving-radiology-report-quality-rapidly-notifying-radiologist-report-errors
    May 29, 2019 - Study Improving radiology report quality by rapidly notifying radiologist of report errors. Citation Text: Minn MJ, Zandieh AR, Filice RW. Improving Radiology Report Quality by Rapidly Notifying Radiologist of Report Errors. J Digit Imaging. 2015;28(4):492-8. doi:10.1007/s10278-015-9781-…

  3. Intensive care unit safety culture and outcomes: a US multicenter study. | PSNet

    psnet.ahrq.gov/issue/intensive-care-unit-safety-culture-and-outcomes-us-multicenter-study
    June 16, 2011 - Study Intensive care unit safety culture and outcomes: a US multicenter study. Citation Text: Huang DT, Clermont G, Kong L, et al. Intensive care unit safety culture and outcomes: a US multicenter study. Int J Qual Health Care. 2010;22(3):151-61. doi:10.1093/intqhc/mzq017. Copy Citat…

  4. Frequency and severity of parenteral nutrition medication errors at a large children's hospital after implementation of electronic ordering and compounding. | PSNet

    psnet.ahrq.gov/issue/frequency-and-severity-parenteral-nutrition-medication-errors-large-childrens-hospital-after
    April 11, 2011 - Study Frequency and severity of parenteral nutrition medication errors at a large children's hospital after implementation of electronic ordering and compounding. Citation Text: MacKay M, Anderson C, Boehme S, et al. Frequency and Severity of Parenteral Nutrition Medication Errors at a L…

  5. Provider and pharmacist responses to warfarin drug–drug interaction alerts: a study of healthcare downstream of CPOE alerts. | PSNet

    psnet.ahrq.gov/issue/provider-and-pharmacist-responses-warfarin-drug-drug-interaction-alerts-study-healthcare
    July 29, 2020 - Study Provider and pharmacist responses to warfarin drug–drug interaction alerts: a study of healthcare downstream of CPOE alerts. Citation Text: Miller AM, Boro MS, Korman NE, et al. Provider and pharmacist responses to warfarin drug-drug interaction alerts: a study of healthcare downst…

  6. Understanding national coverage policies. Navigating the maze of HACs, serious reportable events, and wrong surgical sites. | PSNet

    psnet.ahrq.gov/issue/understanding-national-coverage-policies-navigating-maze-hacs-serious-reportable-events-and
    June 28, 2017 - Commentary Understanding national coverage policies. Navigating the maze of HACs, serious reportable events, and wrong surgical sites. Citation Text: Cook J, D'Amato C, Garrett G, et al. Understanding national coverage policies. Navigating the maze of HACs, serious reportable events, a…

  7. A new perspective on blame culture: an experimental study. | PSNet

    psnet.ahrq.gov/issue/new-perspective-blame-culture-experimental-study
    July 10, 2013 - Study A new perspective on blame culture: an experimental study. Citation Text: Gorini A, Miglioretti M, Pravettoni G. A new perspective on blame culture: an experimental study. J Eval Clin Pract. 2012;18(3):671-5. doi:10.1111/j.1365-2753.2012.01831.x. Copy Citation Format: …

  8. A comparative analysis of incident reporting lag times in academic medical centres in Japan and the USA. | PSNet

    psnet.ahrq.gov/issue/comparative-analysis-incident-reporting-lag-times-academic-medical-centres-japan-and-usa
    March 23, 2011 - Study A comparative analysis of incident reporting lag times in academic medical centres in Japan and the USA. Citation Text: Regenbogen SE, Hirose M, Imanaka Y, et al. A comparative analysis of incident reporting lag times in academic medical centres in Japan and the USA. Qual Saf Hea…

  9. Retained foreign bodies: risk and outcomes at the national level. | PSNet

    psnet.ahrq.gov/issue/retained-foreign-bodies-risk-and-outcomes-national-level
    May 29, 2019 - Study Retained foreign bodies: risk and outcomes at the national level. Citation Text: Al-Qurayshi ZH, Hauch AT, Slakey DP, et al. Retained foreign bodies: risk and outcomes at the national level. J Am Coll Surg. 2015;220(4):749-759. doi:10.1016/j.jamcollsurg.2014.12.015. Copy Citation…

  10. Medical errors in orthopaedics. Results of an AAOS member survey. | PSNet

    psnet.ahrq.gov/issue/medical-errors-orthopaedics-results-aaos-member-survey
    August 04, 2021 - Study Medical errors in orthopaedics. Results of an AAOS member survey. Citation Text: Wong DA, Herndon JH, Canale T, et al. Medical errors in orthopaedics. Results of an AAOS member survey. J Bone Joint Surg Am. 2009;91(3):547-57. doi:10.2106/JBJS.G.01439. Copy Citation Format: …

  11. Safe chemotherapy administration: using failure mode and effects analysis in computerized prescriber order entry. | PSNet

    psnet.ahrq.gov/issue/safe-chemotherapy-administration-using-failure-mode-and-effects-analysis-computerized
    October 19, 2022 - Commentary Safe chemotherapy administration: using failure mode and effects analysis in computerized prescriber order entry. Citation Text: Kozakiewicz JM, Benis LJ, Fisher SM, et al. Safe chemotherapy administration: Using failure mode and effects analysis in computerized prescriber o…

  12. Augmenting health care failure modes and effects analysis with simulation. | PSNet

    psnet.ahrq.gov/issue/augmenting-health-care-failure-modes-and-effects-analysis-simulation
    December 18, 2024 - Study Augmenting health care failure modes and effects analysis with simulation. Citation Text: Nielsen DS, Dieckmann P, Mohr M, et al. Augmenting health care failure modes and effects analysis with simulation. Simul Healthc. 2014;9(1):48-55. doi:10.1097/SIH.0b013e3182a3defd. Copy Cit…

  13. Retrieval medicine: a review and guide for UK practitioners. Part 2: safety in patient retrieval systems. | PSNet

    psnet.ahrq.gov/issue/retrieval-medicine-review-and-guide-uk-practitioners-part-2-safety-patient-retrieval-systems
    March 09, 2016 - Commentary Retrieval medicine: a review and guide for UK practitioners. Part 2: safety in patient retrieval systems. Citation Text: Hearns S, Shirley PJ. Retrieval medicine: a review and guide for UK practitioners. Part 2: safety in patient retrieval systems. Emerg Med J. 2006;23(12):9…

  14. Antibiotic shortages in pediatrics. | PSNet

    psnet.ahrq.gov/issue/antibiotic-shortages-pediatrics
    September 13, 2017 - Commentary Antibiotic shortages in pediatrics. Citation Text: Banerjee R, Thurm CW, Fox ER, et al. Antibiotic Shortages in Pediatrics. Pediatrics. 2018;142(5). doi:10.1542/peds.2018-0858. Copy Citation Format: DOI Google Scholar PubMed BibTeX EndNote X3 XML EndNote 7 XML En…

  15. Ten years after the IOM report: engaging residents in quality and patient safety by creating a house staff quality council. | PSNet

    psnet.ahrq.gov/issue/ten-years-after-iom-report-engaging-residents-quality-and-patient-safety-creating-house-staff
    December 27, 2014 - Commentary Ten years after the IOM report: engaging residents in quality and patient safety by creating a house staff quality council. Citation Text: Fleischut PM, Evans AS, Nugent WC, et al. Ten years after the IOM report: Engaging residents in quality and patient safety by creating a …

  16. Measuring safety culture in the ambulatory setting: The Safety Attitudes Questionnaire—Ambulatory Version. | PSNet

    psnet.ahrq.gov/issue/measuring-safety-culture-ambulatory-setting-safety-attitudes-questionnaire-ambulatory-version
    June 16, 2011 - Study Classic Measuring safety culture in the ambulatory setting: The Safety Attitudes Questionnaire—Ambulatory Version. Citation Text: Modak I, Sexton B, Lux TR, et al. Measuring safety culture in the ambulatory setting: the safety attitudes questionnaire--am…

  17. Race differences in a malpractice event database in a large healthcare system. | PSNet

    psnet.ahrq.gov/issue/race-differences-malpractice-event-database-large-healthcare-system
    December 15, 2021 - Study Race differences in a malpractice event database in a large healthcare system. Citation Text: Thomas AD, Pandit C, Krevat S. Race differences in a malpractice event database in a large healthcare system. J Patient Saf. 2023;19(2):67-70. doi:10.1097/pts.0000000000001090. Copy Cita…

  18. Review of patient safety incidents reported from critical care units in North-West England in 2009 and 2010. | PSNet

    psnet.ahrq.gov/issue/review-patient-safety-incidents-reported-critical-care-units-north-west-england-2009-and-2010
    December 02, 2009 - Study Review of patient safety incidents reported from critical care units in North-West England in 2009 and 2010. Citation Text: Thomas AN, Taylor RJ. Review of patient safety incidents reported from critical care units in North-West England in 2009 and 2010. Anaesthesia. 2012;67(7):7…

  19. Dynamics of dignity and safety: a discussion. | PSNet

    psnet.ahrq.gov/issue/dynamics-dignity-and-safety-discussion
    September 07, 2022 - Commentary Dynamics of dignity and safety: a discussion. Citation Text: Goodwin D, Mesman J, Verkerk M, et al. Dynamics of dignity and safety: a discussion. BMJ Qual Saf. 2018;27(6):488-491. doi:10.1136/bmjqs-2017-007159. Copy Citation Format: DOI Google Scholar PubMed BibT…

  20. Can surveillance systems identify and avert adverse drug events? A prospective evaluation of a commercial application. | PSNet

    psnet.ahrq.gov/issue/can-surveillance-systems-identify-and-avert-adverse-drug-events-prospective-evaluation
    February 10, 2015 - Study Can surveillance systems identify and avert adverse drug events? A prospective evaluation of a commercial application. Citation Text: Jha AK, Laguette J, Seger AC, et al. Can surveillance systems identify and avert adverse drug events? A prospective evaluation of a commercial app…
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