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psnet.ahrq.gov/node/72507/psn-pdf
November 25, 2020 - In situ simulation: an essential tool for safe preparedness
for the COVID-19 pandemic.
November 25, 2020
Sharara-Chami R, Sabouneh R, Zeineddine R, et al. In situ simulation: an essential tool for safe
preparedness for the COVID-19 pandemic. Simul Healthc. 2020;15(5):303-309.
doi:10.1097/sih.0000000000000504.
htt…
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www.ahrq.gov/research/shuttered/toolkitchecklist/facadvcare.html
July 01, 2018 - Facilities/Advanced Patient Care
Layout and potential use of former advanced care areas for general surge. Aspects being evaluated for general surge capacity, not for original purposes.
Date: ____________ Location: _______________________ Team member: __________________________
Operating Rooms
Observati…
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psnet.ahrq.gov/node/74065/psn-pdf
November 10, 2021 - AHRQ announces interest in research on digital
healthcare safety.
November 10, 2021
Rockville, MD: Agency for Healthcare Research and Quality. Special Emphasis Notice. October 28, 2021
Publication No. NOT-HS-22-004.
https://psnet.ahrq.gov/issue/ahrq-announces-interest-research-digital-healthcare-safety
Digital in…
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psnet.ahrq.gov/node/38831/psn-pdf
August 05, 2009 - Rural hospital information technology implementation for
safety and quality improvement: lessons learned.
August 5, 2009
Tietze MF, Williams J, Galimbertti M. Rural hospital information technology implementation for safety and
quality improvement: lessons learned. Comput Inform Nurs. 2009;27(4):206-14.
doi:10.1097…
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psnet.ahrq.gov/node/40884/psn-pdf
October 26, 2011 - Get a clue: it can be all too easy to make assessment
errors in the field; here's some tips to prevent you from
making mistakes.
October 26, 2011
Rubin M. Get a clue: It can be all too easy to make assessment errors in the field; here's some tips to
prevent you from making mistakes. EMS world. 2011;40(9):57-64.
h…
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psnet.ahrq.gov/node/34706/psn-pdf
December 23, 2012 - Analysing potential harm in Australian general practice:
an incident-monitoring study.
December 23, 2012
Bhasale AL, Miller GC, Reid SE, et al. Analysing potential harm in Australian general practice: an incident-
monitoring study. Med J Aust. 1998;169(2):73-6.
https://psnet.ahrq.gov/issue/analysing-potential-harm…
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psnet.ahrq.gov/node/41241/psn-pdf
June 15, 2012 - Using root cause analysis to reduce falls with injury in the
psychiatric unit.
June 15, 2012
Lee A, Mills PD, Watts B. Using root cause analysis to reduce falls with injury in the psychiatric unit. Gen
Hosp Psychiatry. 2012;34(3):304-11. doi:10.1016/j.genhosppsych.2011.12.007.
https://psnet.ahrq.gov/issue/using-ro…
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digital.ahrq.gov/location/usa-ut-murray
January 01, 2023 - USA, UT, Murray
Development of SMART on FHIR Interoperable Clinical Decision Support for Emergency Department Patients with Pneumonia and Pilot Deployment into Novel Epic Electronic Health Record Environments
Description
This research will develop a SMART on FHIR version of an…
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www.uspreventiveservicestaskforce.org/apps/
The Prevention TaskForce (formerly ePSS) application assists primary care clinicians to identify the screening, counseling, and preventive medication services that are appropriate for their patients.
The Prevention TaskForce data is based on the current recommendations of the U.S. Preventive Services Task Force (USPS…
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psnet.ahrq.gov/node/42915/psn-pdf
January 01, 2016 - Reducing Avoidable Readmissions Effectively campaign:
a statewide collaborative.
February 5, 2014
McCoy KA, Bear-Pfaffendorf K, Foreman JK, et al. Reducing Avoidable Hospital Readmissions Effectively:
A Statewide Campaign. Joint Comm J Qual Patient Saf. 2016;40(5):198-204, AP2. doi:10.1016/s1553-
7250(14)40026-6.
…
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psnet.ahrq.gov/node/44901/psn-pdf
March 30, 2016 - Medication safety pharmacy technician in a large, tertiary
care, community hospital.
March 30, 2016
Brown KN, Bergsbaken J, Reichard JS. Medication safety pharmacy technician in a large, tertiary care,
community hospital. Am J Health Syst Pharm. 2016;73(4):188-191. doi:10.2146/ajhp150098.
https://psnet.ahrq.gov/is…
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psnet.ahrq.gov/node/47945/psn-pdf
August 28, 2019 - Individual and team-based medical error disclosure:
dialectical tensions among health care providers.
August 28, 2019
Jones M, Scarduzio J, Mathews E, et al. Individual and Team-Based Medical Error Disclosure: Dialectical
Tensions Among Health Care Providers. Qual Health Res. 2019;29(8):1096-1108.
doi:10.1177/1049…
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psnet.ahrq.gov/node/43294/psn-pdf
April 25, 2016 - The right and wrong way to talk to patients about adverse
events.
April 25, 2016
Beaulieu-Volk D. The right and wrong way to talk to patients about adverse events. Medical economics.
2014;91(11):52-5.
https://psnet.ahrq.gov/issue/right-and-wrong-way-talk-patients-about-adverse-events
Apology laws have been explor…
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psnet.ahrq.gov/node/46216/psn-pdf
July 12, 2017 - Physician satisfaction with transition from CPOE to
paper-based prescription.
July 12, 2017
Griffon N, Schuers M, Joulakian M, et al. Physician satisfaction with transition from CPOE to paper-based
prescription. Int J Med Inform. 2017;103:42-48. doi:10.1016/j.ijmedinf.2017.04.007.
https://psnet.ahrq.gov/issue/phys…
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psnet.ahrq.gov/node/47850/psn-pdf
March 27, 2019 - Medicines-related harm in the elderly post-hospital
discharge.
March 27, 2019
Cheong V-L, Tomlinson J, Khan S, et al. Prescriber. 2019;30:29-34.
https://psnet.ahrq.gov/issue/medicines-related-harm-elderly-post-hospital-discharge
Geriatric patients are particularly vulnerable to medication-related harm. This articl…
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psnet.ahrq.gov/node/43320/psn-pdf
September 26, 2016 - Identification and interference of intraoperative
distractions and interruptions in operating rooms.
September 26, 2016
Antoniadis S, Passauer-Baierl S, Baschnegger H, et al. Identification and interference of intraoperative
distractions and interruptions in operating rooms. J Surg Res. 2014;188(1):21-29.
doi:10.1…
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psnet.ahrq.gov/node/44675/psn-pdf
July 05, 2016 - Why July matters.
July 5, 2016
Petrilli CM, Del Valle J, Chopra V. Why July Matters. Acad Med. 2016;91(7):910-912.
doi:10.1097/ACM.0000000000001196.
https://psnet.ahrq.gov/issue/why-july-matters
Studies have reached conflicting conclusions about whether the "July Effect"—the belief that inpatient
mortality increa…
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psnet.ahrq.gov/node/866809/psn-pdf
September 25, 2024 - Stop the line: interventions to prevent retained surgical
items.
September 25, 2024
Angelilli S. Stop the line: interventions to prevent retained surgical items. AORN J. 2024;120(2):71-81.
doi:10.1002/aorn.14190.
https://psnet.ahrq.gov/issue/stop-line-interventions-prevent-retained-surgical-items
Retained surgica…
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psnet.ahrq.gov/node/44650/psn-pdf
November 11, 2015 - 'Providing good and comfortable care by building a bond
of trust': nurses views regarding their role in patients'
perception of safety in the intensive care unit.
November 11, 2015
Wassenaar A, van den Boogaard M, van der Hooft T, et al. 'Providing good and comfortable care by
building a bond of trust': nurses vie…
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psnet.ahrq.gov/node/43931/psn-pdf
March 04, 2015 - Design of endoscopic retrograde
cholangiopancreatography (ERCP) duodenoscopes may
impede effective cleaning.
March 4, 2015
FDA Safety Communication. Silver Spring, MD: US Food and Drug Administration; February 23, 2015.
https://psnet.ahrq.gov/issue/design-endoscopic-retrograde-cholangiopancreatography-ercp-
duode…