-
psnet.ahrq.gov/node/42791/psn-pdf
December 04, 2013 - The effect of collaboration on obstetric patient safety in
three academic facilities.
December 4, 2013
Raab CA, Will SEB, Richards SL, et al. The Effect of Collaboration on Obstetric Patient Safety in Three
Academic Facilities. Journal of Obstetric, Gynecologic & Neonatal Nursing. 2013;42(5). doi:10.1111/1552-
690…
-
psnet.ahrq.gov/node/38117/psn-pdf
September 29, 2017 - Advances in Patient Safety: New Directions and
Alternative Approaches.
September 29, 2017
Rockville, MD: Agency for Healthcare Research and Quality; July 2008. AHRQ Publication Nos. 080034 (1-
4).
https://psnet.ahrq.gov/issue/advances-patient-safety-new-directions-and-alternative-approaches
The 115 articles freel…
-
psnet.ahrq.gov/node/73690/psn-pdf
September 08, 2021 - Medicine's Shadowside: Revisiting Clinical Iatrogenesis.
September 8, 2021
Varley E, Varma S, eds. Anthropol Med. 2021;28(2);141-278.
https://psnet.ahrq.gov/issue/medicines-shadowside-revisiting-clinical-iatrogenesis
Implicit biases are rooted in culture and context. This special issue examine…
-
psnet.ahrq.gov/node/37071/psn-pdf
September 30, 2011 - Improving patient safety in radiotherapy by learning from
near misses, incidents and errors.
September 30, 2011
Williams M. Improving patient safety in radiotherapy by learning from near misses, incidents and errors. Br
J Radiol. 2007;80(953):297-301.
https://psnet.ahrq.gov/issue/improving-patient-safety-radiother…
-
psnet.ahrq.gov/node/45338/psn-pdf
July 20, 2016 - Understanding models of error and how they apply in
clinical practice.
July 20, 2016
Garfield S, Franklin BD. Pharm J. June 14, 2016.
https://psnet.ahrq.gov/issue/understanding-models-error-and-how-they-apply-clinical-practice
Human error and fallibility are a part of health care delivery that can be exacerbated b…
-
www.ahrq.gov/teamstepps-program/evidence-base/index.html
July 01, 2023 - TeamSTEPPS: Research/Evidence Base
TeamSTEPPS ® has been used by healthcare professionals across the United States. The research cataloged here describes some of the approaches used to implement TeamSTEPPS 3.0 in specific settings of care, as well as evaluation efforts to quantify or qualify the impact of us…
-
psnet.ahrq.gov/node/43577/psn-pdf
October 01, 2014 - The State of VA Health Care.
October 1, 2014
Hearing Before the Committee on Veterans' Affairs United States Senate. 113th Cong (September 9,
2014).
https://psnet.ahrq.gov/issue/state-va-health-care
In this hearing Veterans Affairs leadership provide an update on the current investigation into data and
scheduling…
-
psnet.ahrq.gov/node/44503/psn-pdf
November 18, 2024 - Certified Professional in Patient Safety Review Course.
November 18, 2024
Institute for Healthcare Improvement. February 5-6, 2025, 12:00-4:00 PM (eastern).
https://psnet.ahrq.gov/issue/certified-professional-patient-safety-review-course
This online class prepares individuals to apply for the Institute for Healthca…
-
psnet.ahrq.gov/node/43560/psn-pdf
September 24, 2014 - Burnout in Healthcare.
September 24, 2014
Laschinger H, Montgomery A, eds. Burnout Res. 2014;1:57-102.
https://psnet.ahrq.gov/issue/burnout-healthcare
Burnout has been linked to depression, work dissatisfaction, and increased rates of adverse events.
Articles in this special issue explore health professionals' exp…
-
psnet.ahrq.gov/node/41277/psn-pdf
November 28, 2012 - AHRQ 2012 Annual Conference.
November 28, 2012
Agency for Healthcare Research and Quality. September 9–12, 2012; Bethesda North Marriott Hotel &
Conference Center, Bethesda, MD.
https://psnet.ahrq.gov/issue/ahrq-2012-annual-conference
The Agency for Healthcare Research and Quality's 2012 conference, "Moving Ahead:…
-
www.ahrq.gov/talkingquality/resources/writing/index.html
July 01, 2011 - Tips on Writing a Report on Health Care Quality for Consumers
Information on health care quality is complicated, so it’s crucial to present this information as simply and clearly as possible. This section suggests ways to make the language in your printed or Web-based quality report cards easier for your inten…
-
psnet.ahrq.gov/node/855439/psn-pdf
December 07, 2023 - Bringing a ‘Systemness’ Focus to Quality, Safety, and
Patient Experience.
November 15, 2023
American Hospital Association. December 7, 2023.
https://psnet.ahrq.gov/issue/bringing-systemness-focus-quality-safety-and-patient-experience
Health care organizations require a systems approach to address patient safety ch…
-
psnet.ahrq.gov/node/40885/psn-pdf
November 26, 2014 - Hospital do-not-resuscitate orders: why they have failed
and how to fix them.
November 26, 2014
Yuen JK, Reid C, Fetters MD. Hospital do-not-resuscitate orders: why they have failed and how to fix them.
J Gen Intern Med. 2011;26(7):791-7. doi:10.1007/s11606-011-1632-x.
https://psnet.ahrq.gov/issue/hospital-do-not-…
-
psnet.ahrq.gov/node/43921/psn-pdf
February 18, 2015 - Is incivility an underlying threat to safety in obstetrics?
February 18, 2015
Veltman L. Patient Saf Qual Healthc. January/February 2015;12:34-36.
https://psnet.ahrq.gov/issue/incivility-underlying-threat-safety-obstetrics
The Joint Commission and the American College of Obstetricians and Gynecologists have issued …
-
psnet.ahrq.gov/node/44932/psn-pdf
March 02, 2016 - Special Issue on Falls.
March 2, 2016
Alverzo JP. (ed). Rehabil Nurs. Jan-Feb 2016;41(1):1-59.
https://psnet.ahrq.gov/issue/special-issue-falls
Safety challenges in residential care facilities are well documented. Articles in this special issue explore
falls in rehabilitation settings, including nurses' role …
-
psnet.ahrq.gov/node/37379/psn-pdf
March 28, 2012 - Identifying modifiable barriers to medication error
reporting in the nursing home setting.
March 28, 2012
Handler S, Perera S, Olshansky EF, et al. Identifying modifiable barriers to medication error reporting in the
nursing home setting. J Am Med Dir Assoc. 2007;8(9):568-74.
https://psnet.ahrq.gov/issue/identifyi…
-
www.ahrq.gov/nursing-home/resources/trauma-informed.html
May 01, 2021 - Trauma-Informed Organizational Change Manual
Resource: Trauma-Informed Organizational Change Manual
This manual guides organizations and systems in planning for, implementing and sustaining a trauma-informed organizational change. This manual provides a step-by-step guide with tools intended for anyone inte…
-
www.ahrq.gov/nursing-home/resources/qapi-leadership-rounding.html
February 01, 2021 - QAPI Leadership Rounding Guide
Resource: QAPI Leadership Rounding Guide (PDF, 138.5 KB)
Leadership rounding is a process where leaders (e.g., administrator, department heads, and nurse managers) are out in the building with staff and residents, talking with them directly about care and services provided in…
-
psnet.ahrq.gov/node/38437/psn-pdf
February 25, 2009 - Beyond "see one, do one, teach one": toward a different
training paradigm.
February 25, 2009
Rodriguez-Paz JM, Kennedy M, Salas E, et al. Beyond "see one, do one, teach one": toward a different
training paradigm. Qual Saf Health Care. 2009;18(1):63-8. doi:10.1136/qshc.2007.023903.
https://psnet.ahrq.gov/issue/beyo…
-
psnet.ahrq.gov/node/38183/psn-pdf
December 14, 2016 - Building Bridges Between Radiology and Emergency
Medicine: Consensus Conference on Imaging Safety and
Quality for Children in the Emergency Setting.
December 14, 2016
Pediatr Radiol. 2008;38(suppl 4):625-734.
https://psnet.ahrq.gov/issue/building-bridges-between-radiology-and-emergency-medicine-consensus-
confere…