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psnet.ahrq.gov/node/41591/psn-pdf
November 26, 2014 - "Did I do as best as the system would let me?" Healthcare
professional views on hospital to home care transitions.
November 26, 2014
Davis MM, Devoe M, Kansagara D, et al. "Did I do as best as the system would let me?" Healthcare
professional views on hospital to home care transitions. J Gen Intern Med. 2012;27(12)…
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psnet.ahrq.gov/node/853068/psn-pdf
August 30, 2023 - Healthcare fragmentation, multimorbidity, potentially
inappropriate medication, and mortality: a Danish
nationwide cohort study.
August 30, 2023
Prior A, Vestergaard CH, Vedsted P, et al. Healthcare fragmentation, multimorbidity, potentially
inappropriate medication, and mortality: a Danish nationwide cohort study…
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psnet.ahrq.gov/node/44216/psn-pdf
April 25, 2016 - Improving medication safety during hospital-based
transitions of care.
April 25, 2016
Sponsler KC, Neal EB, Kripalani S. Improving medication safety during hospital-based transitions of care.
Cleve Clin J Med. 2015;82(6):351-360. doi:10.3949/ccjm.82a.14025.
https://psnet.ahrq.gov/issue/improving-medication-safety-…
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psnet.ahrq.gov/node/37454/psn-pdf
January 09, 2008 - Quantifying nursing workflow in medication
administration.
January 9, 2008
Keohane CA, Bane AD, Featherstone E, et al. Quantifying nursing workflow in medication administration. J
Nurs Adm. 2007;38(1):19-26. doi:10.1097/01.nna.0000295628.87968.bc.
https://psnet.ahrq.gov/issue/quantifying-nursing-workflow-medicatio…
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psnet.ahrq.gov/node/852285/psn-pdf
August 09, 2023 - Risk Evaluation and Mitigation Strategy (REMS) Programs
and Medication Safety: Parts I and II.
August 9, 2023
ISMP Medication Safety Alert! Acute care edition. July 13, 2023;(4):1-3;July 27, 2023;(5):1-5.
https://psnet.ahrq.gov/issue/risk-evaluation-and-mitigation-strategy-rems-programs-and-medication-safety-
part…
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psnet.ahrq.gov/node/73587/psn-pdf
August 11, 2021 - Effects of a brief team training program on surgical
teams' nontechnical skills: an interrupted time-series
study.
August 11, 2021
Gillespie BM, Harbeck EL, Kang E, et al. Effects of a brief team training program on surgical teams'
nontechnical skills: an interrupted time-series study. J Patient Saf. 2021;17(5):e4…
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psnet.ahrq.gov/node/41132/psn-pdf
March 13, 2012 - Spreading a medication administration intervention
organizationwide in six hospitals.
March 13, 2012
Kliger J, Singer SJ, Hoffman F, et al. Spreading a medication administration intervention organizationwide
in six hospitals. Jt Comm J Qual Patient Saf. 2012;38(2):51-60.
https://psnet.ahrq.gov/issue/spreading-medi…
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psnet.ahrq.gov/node/864857/psn-pdf
March 20, 2024 - Safety on the ground: using critical incident technique to
explore the factors influencing medical registrars'
provision of safe care.
March 20, 2024
Ralston K, Smith SE, Kerins J, et al. Safety on the ground: using critical incident technique to explore the
factors influencing medical registrars’ provision of saf…
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psnet.ahrq.gov/node/856588/psn-pdf
November 29, 2023 - It depends who you ask: divergences in staff and external
stakeholder narratives about the causes of a healthcare
failure.
November 29, 2023
Hald EJ, Gillespie A, Reader TW. It depends who you ask: divergences in staff and external stakeholder
narratives about the causes of a healthcare failure. J Contingencies Cr…
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psnet.ahrq.gov/node/50627/psn-pdf
November 06, 2019 - Change?of?shift nursing handoff interruptions:
implications for evidence?based practice.
November 6, 2019
Rhudy LM, Johnson MR, Krecke CA, et al. Change-of-Shift Nursing Handoff Interruptions: Implications for
Evidence-Based Practice. Worldviews Evid Based Nurs. 2019;16(5):362-370. doi:10.1111/wvn.12390.
https://p…
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psnet.ahrq.gov/node/866313/psn-pdf
July 17, 2024 - Towards understanding and improving medication safety
for patients with mental illness in primary care: a
multimethod study.
July 17, 2024
Ayre MJ, Lewis PJ, Phipps DL, et al. Towards understanding and improving medication safety for patients
with mental illness in primary care: a multimethod study. Health Expect.…
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psnet.ahrq.gov/node/35229/psn-pdf
January 02, 2017 - Patient Safety Leadership WalkRounds™ at Partners
HealthCare: learning from implementation.
January 2, 2017
Frankel A, Grillo SP, Baker EG, et al. Patient Safety Leadership WalkRounds at Partners Healthcare:
learning from implementation. Jt Comm J Qual Patient Saf. 2005;31(8):423-37.
https://psnet.ahrq.gov/issue/p…
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psnet.ahrq.gov/node/35451/psn-pdf
January 05, 2017 - Closing the loop: follow-up and feedback in a patient
safety program.
January 5, 2017
Gandhi TK, Graydon-Baker E, Huber CN, et al. Closing the loop: follow-up and feedback in a patient safety
program. Jt Comm J Qual Patient Saf. 2005;31(11):614-21.
https://psnet.ahrq.gov/issue/closing-loop-follow-and-feedback-pati…
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psnet.ahrq.gov/node/861765/psn-pdf
January 31, 2024 - Observational study of conformity in yet another medical
learning environment: conformity to preceptors during
high-fidelity simulation.
January 31, 2024
Beran T, Altabbaa G, Oddone Paolucci E. Observational study of conformity in yet another medical
learning environment: conformity to preceptors during high-fidel…
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psnet.ahrq.gov/node/47896/psn-pdf
July 10, 2019 - Engaging patients and informal caregivers to improve
safety and facilitate person- and family-centered care
during transitions from hospital to home: a qualitative
descriptive study.
July 10, 2019
Backman C, Cho-Young D. Engaging patients and informal caregivers to improve safety and facilitate
person- and family…
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psnet.ahrq.gov/node/849325/psn-pdf
January 01, 2024 - Medication safety event reporting: factors that contribute
to safety events during times of organizational stress.
May 24, 2023
Cohen TN, Berdahl CT, Coleman BL, et al. Medication safety event reporting: factors that contribute to
safety events during times of organizational stress. J Nurs Care Qual. 2024;39(1):51-…
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psnet.ahrq.gov/node/837731/psn-pdf
July 27, 2022 - Predictors and outcomes of patient safety culture: a
cross-sectional comparative study.
July 27, 2022
Mrayyan MT. Predictors and outcomes of patient safety culture: a cross-sectional comparative study. BMJ
Open Qual. 2022;11(3):e001889. doi:10.1136/bmjoq-2022-001889.
https://psnet.ahrq.gov/issue/predictors-and-out…
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psnet.ahrq.gov/node/60536/psn-pdf
May 27, 2020 - Nursing home workers warned government about safety
violations before COVID-19 outbreaks and deaths.
May 27, 2020
Ellis B, Hicken M. CNN. May 14, 2020.
https://psnet.ahrq.gov/issue/nursing-home-workers-warned-government-about-safety-violations-covid-19-
outbreaks-and-deaths
Long-term care and skilled nursing faci…
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psnet.ahrq.gov/node/46603/psn-pdf
April 12, 2019 - Comparison of internal medicine and general surgery
residents' assessments of risk of postsurgical
complications in surgically complex patients.
April 12, 2019
Healy JM, Davis KA, Pei KY. Comparison of Internal Medicine and General Surgery Residents'
Assessments of Risk of Postsurgical Complications in Surgically …
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psnet.ahrq.gov/node/50917/psn-pdf
February 19, 2020 - "Thank You for Listening": An exploratory study
regarding the lived experience and perception of medical
errors among those who receive care.
February 19, 2020
Terry D, Kim J-ah, Gilbert J, et al. “Thank You for Listening”: An Exploratory Study Regarding the Lived
Experience and Perception of Medical Errors Among …