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psnet.ahrq.gov/issue/improving-transfusion-safety-operating-room-barcode-scanning-system-designed-specifically
February 01, 2023 - Study
Improving transfusion safety in the operating room with a barcode scanning system designed specifically for the surgical environment and existing electronic medical record systems: an interrupted time series analysis.
Citation Text:
Vanneman MW, Balakrishna A, Lang AL, et al. Impro…
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psnet.ahrq.gov/issue/costs-associated-adverse-drug-events-among-older-adults-ambulatory-setting
May 20, 2020 - Study
The costs associated with adverse drug events among older adults in the ambulatory setting.
Citation Text:
Field T, Gilman BH, Subramanian S, et al. The costs associated with adverse drug events among older adults in the ambulatory setting. Med Care. 2005;43(12):1171-1176.
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psnet.ahrq.gov/issue/computerized-order-entry-limited-decision-support-prevent-prescription-errors-picu
January 31, 2018 - Study
Computerized order entry with limited decision support to prevent prescription errors in a PICU.
Citation Text:
Kadmon G, Bron-Harlev E, Nahum E, et al. Computerized order entry with limited decision support to prevent prescription errors in a PICU. Pediatrics. 2009;124(3):935-94…
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psnet.ahrq.gov/issue/co-design-implementation-and-evaluation-serious-board-game-playdecide-patient-safety-educate
September 12, 2018 - Journal Article
The co-design, implementation and evaluation of a serious board game 'PlayDecide patient safety' to educate junior doctors about patient safety and the importance of reporting safety concerns
Citation Text:
Ward M, Shé ÉN, De Brún A, et al. The co-design, implementation a…
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psnet.ahrq.gov/issue/overrides-medication-related-clinical-decision-support-alerts-outpatients
September 01, 2016 - Study
Overrides of medication-related clinical decision support alerts in outpatients.
Citation Text:
Nanji KC, Slight SP, Seger DL, et al. Overrides of medication-related clinical decision support alerts in outpatients. J Am Med Inform Assoc. 2014;21(3):487-91. doi:10.1136/amiajnl-2013-…
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psnet.ahrq.gov/issue/relationship-between-patient-safety-and-hospital-surgical-volume
May 04, 2012 - Study
Relationship between patient safety and hospital surgical volume.
Citation Text:
Hernandez-Boussard T, Downey JR, McDonald KM, et al. Relationship between Patient Safety and Hospital Surgical Volume. Health Serv Res. 2011;47(2). doi:10.1111/j.1475-6773.2011.01310.x.
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psnet.ahrq.gov/issue/frequency-and-nature-prescribing-problems-general-practitioners-training-revisit
December 16, 2020 - Study
The frequency and nature of prescribing problems by general practitioners in training (REVISiT).
Citation Text:
Salema N-E, Bell BG, Marsden K, et al. The frequency and nature of prescribing problems by general practitioners in training (REVISiT). BJGP Open. 2022;6(3):BJGPO.2021.02…
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psnet.ahrq.gov/issue/developing-learning-health-system-insights-qualitative-process-evaluation-pharmacist-led
February 17, 2021 - Study
Developing a learning health system: insights from a qualitative process evaluation of a pharmacist-led electronic audit and feedback intervention to improve medication safety in primary care.
Citation Text:
Jeffries M, Keers RN, Phipps D, et al. Developing a learning health system…
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psnet.ahrq.gov/issue/resident-and-family-engagement-medication-management-aged-care-facilities-systematic-review
August 11, 2021 - Review
Resident and family engagement in medication management in aged care facilities: a systematic review.
Citation Text:
Manias E, Bucknall T, Hutchinson AM, et al. Resident and family engagement in medication management in aged care facilities: a systematic review. Expert Opin Drug S…
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psnet.ahrq.gov/issue/high-reliability-safety-net-hospital-leading-operational-excellence
March 01, 2011 - Study
High reliability in a safety net hospital leading to operational excellence.
Citation Text:
Didion L, Whitfield C, Bishop P, et al. High reliability in a safety net hospital leading to operational excellence. J Patient Saf. 2024;20(5):375-380. doi:10.1097/pts.0000000000001236.
Co…
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psnet.ahrq.gov/issue/adverse-events-italian-nursing-homes-during-covid-19-epidemic-national-survey
December 16, 2020 - Study
Adverse events in Italian nursing homes during the COVID-19 epidemic: a national survey.
Citation Text:
Lombardo FL, Salvi E, Lacorte E, et al. Adverse events in Italian nursing homes during the COVID-19 epidemic: a national survey. Front Psychiatry. 2020;11:578465.
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psnet.ahrq.gov/issue/surveying-care-teams-after-hospital-deaths-identify-preventable-harm-and-opportunities
April 17, 2024 - Study
Surveying care teams after in-hospital deaths to identify preventable harm and opportunities to improve advance care planning.
Citation Text:
Lucier D, Folcarelli P, Totte C, et al. Surveying Care Teams after in-Hospital Deaths to Identify Preventable Harm and Opportunities to Impr…
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psnet.ahrq.gov/issue/linking-patient-safety-climate-missed-nursing-care-labor-and-delivery-units-findings-laborrns
January 19, 2022 - Study
Linking patient safety climate with missed nursing care in labor and delivery units: findings from the LaborRNs survey.
Citation Text:
Zhong J, Simpson KR, Spetz J, et al. Linking patient safety climate with missed nursing care in labor and delivery units: findings from the LaborRN…
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psnet.ahrq.gov/issue/25-year-summary-us-malpractice-claims-diagnostic-errors-1986-2010-analysis-national
July 17, 2019 - Study
25-Year summary of US malpractice claims for diagnostic errors 1986–2010: an analysis from the National Practitioner Data Bank.
Citation Text:
Tehrani ASS, Lee HW, Mathews SC, et al. 25-Year summary of US malpractice claims for diagnostic errors 1986-2010: an analysis from the N…
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psnet.ahrq.gov/issue/team-based-approach-improving-medication-reconciliation-rates-family-medicine-residency
June 15, 2022 - Study
Team-based approach to improving medication reconciliation rates in family medicine residency clinics.
Citation Text:
Harper PG, Schafer KM, Van Riper K, et al. Team-based approach to improving medication reconciliation rates in family medicine residency clinics. J Am Pharm Assoc (…
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psnet.ahrq.gov/issue/improved-safety-culture-and-teamwork-climate-are-associated-decreases-patient-harm-and
January 15, 2014 - Study
Classic
Improved safety culture and teamwork climate are associated with decreases in patient harm and hospital mortality across a hospital system.
Citation Text:
Berry JC, Davis JT, Bartman T, et al. Improved Safety Culture and Teamwork Climate Are Associ…
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psnet.ahrq.gov/issue/surveys-patient-safety-culture-sops-hospital-survey-20-user-database-report
December 18, 2024 - Book/Report
Surveys on Patient Safety Culture (SOPS) Hospital Survey 2.0: User Database Report.
Citation Text:
Tyler ER, Yalden O, Fan L, et al. Surveys On Patient Safety Culture (Sops) Hospital Survey 2.0: User Database Report. Rockville, MD: Agency for Healthcare Research and Quality; …
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psnet.ahrq.gov/issue/computerised-physician-order-entry-related-medication-errors-analysis-reported-errors-and
May 08, 2017 - Study
Classic
Computerised physician order entry-related medication errors: analysis of reported errors and vulnerability testing of current systems.
Citation Text:
Schiff GD, Amato MG, Eguale T, et al. Computerised physician order entry-related medication error…
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psnet.ahrq.gov/issue/patient-safety-reporting-systems-sustained-quality-improvement-using-multidisciplinary-team
February 12, 2020 - Study
Patient safety reporting systems: sustained quality improvement using a multidisciplinary team and "Good Catch" awards.
Citation Text:
Herzer KR, Mirrer M, Xie Y, et al. Patient Safety Reporting Systems: Sustained Quality Improvement Using a Multidisciplinary Team and “Good Catch” …
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psnet.ahrq.gov/issue/types-unintended-consequences-related-computerized-provider-order-entry
February 18, 2011 - Study
Classic
Types of unintended consequences related to computerized provider order entry.
Citation Text:
Campbell EM, Sittig DF, Ash JS, et al. Types of unintended consequences related to computerized provider order entry. J Am Med Inform Assoc. 2006;13(5):…