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psnet.ahrq.gov/issue/effect-prescriber-education-medication-related-patient-harm-hospital-systematic-review
January 07, 2015 - Review
The effect of prescriber education on medication-related patient harm in the hospital: a systematic review.
Citation Text:
Bos JM, van den Bemt PMLA, de Smet PAGM, et al. The effect of prescriber education on medication-related patient harm in the hospital: a systematic review. Br…
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psnet.ahrq.gov/issue/defining-health-information-technology-related-errors-new-developments-err-human
December 06, 2023 - Commentary
Classic
Defining health information technology–related errors: new developments since To Err Is Human.
Citation Text:
Sittig DF, Singh H. Defining health information technology-related errors: new developments since to err is human. Arch Intern Med.…
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psnet.ahrq.gov/issue/utilization-role-based-head-covering-system-decrease-misidentification-operating-room
September 23, 2020 - Study
Utilization of a role-based head covering system to decrease misidentification in the operating room.
Citation Text:
Rosen DA, Criser AL, Petrone AB, et al. Utilization of a Role-Based Head Covering System to Decrease Misidentification in the Operating Room. J Patient Saf. 2019;15(…
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psnet.ahrq.gov/issue/accidents-and-incidents-related-intravenous-drug-administration-pre-post-study-following
September 24, 2016 - Study
Accidents and incidents related to intravenous drug administration: a pre-post study following implementation of smart pumps in a teaching hospital.
Citation Text:
Guérin A, Tourel J, Delage E, et al. Accidents and Incidents Related to Intravenous Drug Administration: A Pre-Post St…
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psnet.ahrq.gov/issue/medication-errors-how-reliable-are-severity-ratings-reported-national-reporting-and-learning
September 09, 2015 - Study
Medication errors: how reliable are the severity ratings reported to the National Reporting and Learning System?
Citation Text:
Williams SD, Ashcroft DM. Medication errors: how reliable are the severity ratings reported to the national reporting and learning system? Int J Qual He…
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psnet.ahrq.gov/issue/action-patient-safety-can-reduce-health-inequalities
February 05, 2020 - Commentary
Action on patient safety can reduce health inequalities.
Citation Text:
Wade C, Malhotra AM, McGuire P, et al. Action on patient safety can reduce health inequalities. BMJ. 2022;376:e067090. doi:10.1136/bmj-2021-067090.
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psnet.ahrq.gov/issue/extent-diagnostic-agreement-among-medical-referrals
October 31, 2011 - Study
Extent of diagnostic agreement among medical referrals.
Citation Text:
Van Such M, Lohr R, Beckman T, et al. Extent of diagnostic agreement among medical referrals. J Eval Clin Pract. 2017;23(4):870-874. doi:10.1111/jep.12747.
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psnet.ahrq.gov/issue/characteristics-pediatric-chemotherapy-medication-errors-national-error-reporting-database
September 21, 2008 - Study
Characteristics of pediatric chemotherapy medication errors in a national error reporting database.
Citation Text:
Rinke ML, Shore AD, Morlock L, et al. Characteristics of pediatric chemotherapy medication errors in a national error reporting database. Cancer. 2007;110(1):186-95.…
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psnet.ahrq.gov/issue/using-rapid-response-system-provide-better-oversight-patient-care-processes
January 07, 2015 - Commentary
Using the rapid response system to provide better oversight of patient care processes.
Citation Text:
Moore MS, Howard SK, Lighthall GK. Using the rapid response system to provide better oversight of patient care processes. Jt Comm J Qual Patient Saf. 2007;33(11):695-8, 645.
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psnet.ahrq.gov/issue/graduating-pediatrics-residents-reports-impact-fatigue-over-past-decade-duty-hour-changes
July 21, 2010 - Study
Graduating pediatrics residents' reports on the impact of fatigue over the past decade of duty hour changes.
Citation Text:
Schumacher DJ, Frintner MP, Winn A, et al. Graduating Pediatrics Residents' Reports on the Impact of Fatigue Over the Past Decade of Duty Hour Changes. Acad P…
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psnet.ahrq.gov/issue/relationship-staff-information-sharing-and-advice-networks-patient-safety-outcomes
June 22, 2011 - Study
Relationship of staff information sharing and advice networks to patient safety outcomes.
Citation Text:
Brewer BB, Carley KM, Benham-Hutchins MM, et al. Relationship of Staff Information Sharing and Advice Networks to Patient Safety Outcomes. J Nurs Adm. 2018;48(9):437-444. doi:10…
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psnet.ahrq.gov/issue/development-trigger-tool-identify-adverse-drug-events-elderly-patients-multimorbidity
December 02, 2020 - Study
Development of a trigger tool to identify adverse drug events in elderly patients with multimorbidity.
Citation Text:
Guzmán MDT, Banqueri MG, Otero MJ, et al. Development of a Trigger Tool to Identify Adverse Drug Events in Elderly Patients With Multimorbidity. J Patient Saf. 2021…
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psnet.ahrq.gov/issue/failures-care-coordination-and-reviewing-patients-death-va-salt-lake-city-healthcare-system
April 19, 2023 - Book/Report
Failures in Care Coordination and Reviewing a Patient's Death at the VA Salt Lake City Healthcare System in Utah.
Citation Text:
Failures in Care Coordination and Reviewing a Patient's Death at the VA Salt Lake City Healthcare System in Utah. Washington, DC: Department of Vet…
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psnet.ahrq.gov/issue/review-incidents-related-health-information-technology-swedish-healthcare-characterise-system
December 20, 2023 - Study
A review of incidents related to health information technology in Swedish healthcare to characterise system issues as a basis for improvement in clinical practice.
Citation Text:
Pan D, Nilsson E, Rahman Jabin MS. A review of incidents related to health information technology in Sw…
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psnet.ahrq.gov/issue/impact-post-fall-huddles-repeat-fall-rates-and-perceptions-safety-culture-quasi-experimental
December 30, 2014 - Journal Article
The impact of post-fall huddles on repeat fall rates and perceptions of safety culture: a quasi-experimental evaluation of a patient safety demonstration project
Citation Text:
Jones KJ, Crowe J, Allen JA, et al. The impact of post-fall huddles on repeat fall rates and pe…
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psnet.ahrq.gov/issue/errors-laboratory-medicine-practical-lessons-improve-patient-safety
February 14, 2024 - Commentary
Classic
Errors in laboratory medicine: practical lessons to improve patient safety.
Citation Text:
Howanitz PJ. Errors in laboratory medicine: practical lessons to improve patient safety. Arch Pathol Lab Med. 2005;129(10):1252-1261.
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psnet.ahrq.gov/issue/early-cost-and-safety-benefits-inpatient-electronic-health-record
August 04, 2021 - Study
Early cost and safety benefits of an inpatient electronic health record.
Citation Text:
Zlabek JA, Wickus JW, Mathiason MA. Early cost and safety benefits of an inpatient electronic health record. Journal of the American Medical Informatics Association. 2011;18(2). doi:10.1136/ja…
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psnet.ahrq.gov/issue/rapidly-increasing-rapid-response-team-activation-rates
February 18, 2015 - Study
Rapidly increasing rapid response team activation rates.
Citation Text:
Braaten JS, deGunst G, Bilys K. Rapidly Increasing Rapid Response Team Activation Rates. Jt Comm J Qual Patient Saf. 2015;41(9):421-427.
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psnet.ahrq.gov/issue/getting-it-right-patient-safety-specimen-collection-process-improvement-operating-room
July 16, 2013 - Commentary
Getting it right for patient safety: specimen collection process improvement from operating room to pathology.
Citation Text:
D'Angelo R, Mejabi O. Getting It Right for Patient Safety: Specimen Collection Process Improvement From Operating Room to Pathology. Am J Clin Pathol.…
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psnet.ahrq.gov/issue/child-health-pso-10-years-emerging-learning-network
July 28, 2021 - Commentary
The Child Health PSO at 10 years: an emerging learning network.
Citation Text:
Levy FH, Conrad KA, Kemper C, et al. The Child Health PSO at 10 Years: an emerging learning network. Pediatr Qual Saf. 2021;6(4):e449. doi:10.1097/pq9.0000000000000449.
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