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psnet.ahrq.gov/node/74729/psn-pdf
February 02, 2022 - Healing our own: a randomized trial to assess benefits of
peer support.
February 2, 2022
Rivera-Chiauzzi EY, Smith HA, Moore-Murray T, et al. Healing our own: a randomized trial to assess
benefits of peer support. J Patient Saf. 2022;18(1):e308-e314. doi:10.1097/pts.0000000000000771.
https://psnet.ahrq.gov/issue/h…
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psnet.ahrq.gov/node/47786/psn-pdf
June 26, 2019 - Creating a Safe Space: Psychological Health and Safety
of Healthcare Workers.
June 26, 2019
Canadian Patient Safety Institute: 2019.
https://psnet.ahrq.gov/issue/creating-safe-space-psychological-health-and-safety-healthcare-workers
Structured approaches to managing negative psychological consequences of medical e…
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psnet.ahrq.gov/node/845649/psn-pdf
March 08, 2023 - Medication rounds: a tool to promote medication safety
for children with medical complexity.
March 8, 2023
Rojas CR, Moore A, Coffin A, et al. Medication rounds: a tool to promote medication safety for children with
medical complexity. Jt Comm J Qual Patient Saf. 2023;49(4):226-234. doi:10.1016/j.jcjq.2023.01.003.
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psnet.ahrq.gov/node/864860/psn-pdf
March 20, 2024 - Designing human-centered AI to prevent medication
dispensing errors: focus group study with pharmacists.
March 20, 2024
Zheng Y, Rowell B, Chen Q, et al. Designing human-centered AI to prevent medication dispensing errors:
focus group study with pharmacists. JMIR Form Res. 2023;7:e51921. doi:10.2196/51921.
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psnet.ahrq.gov/node/48134/psn-pdf
August 14, 2019 - Root cause analysis for hospital-acquired pressure injury.
August 14, 2019
Black JM. Root cause analysis for hospital-acquired pressure injury. J Wound Ostomy Continence Nurs.
2019;46(4):298-304. doi:10.1097/WON.0000000000000546.
https://psnet.ahrq.gov/issue/root-cause-analysis-hospital-acquired-pressure-injury
Pr…
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psnet.ahrq.gov/node/73468/psn-pdf
July 07, 2021 - The implementation of communication didactics for
OB/GYN residents on the disclosure of adverse
perioperative events.
July 7, 2021
Chung EH, Truong T, Jooste KR, et al. The implementation of communication didactics for OB/GYN
residents on the disclosure of adverse perioperative events. J Surg Educ. 2021;78(3):942-…
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psnet.ahrq.gov/node/60913/psn-pdf
September 16, 2020 - Triggers contributing to health care clinicians' disruptive
behaviors.
September 16, 2020
Bae S-H, Dang D, Karlowicz KA, et al. Triggers contributing to health care clinicians' disruptive behaviors. J
Patient Saf. 2020;16(3):e148-e155. doi:10.1097/pts.0000000000000288.
https://psnet.ahrq.gov/issue/triggers-contrib…
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psnet.ahrq.gov/node/46955/psn-pdf
May 30, 2018 - Governing the quality and safety of healthcare: a
conceptual framework.
May 30, 2018
Brown A, Dickinson H, Kelaher M. Governing the quality and safety of healthcare: A conceptual framework.
Soc Sci Med. 2018;202:99-107. doi:10.1016/j.socscimed.2018.02.020.
https://psnet.ahrq.gov/issue/governing-quality-and-safety-…
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psnet.ahrq.gov/node/837511/psn-pdf
June 22, 2022 - Striving for high reliability in healthcare: a qualitative
study of the implementation of a hospital safety
programme.
June 22, 2022
Rotteau L, Goldman J, Shojania KG, et al. Striving for high reliability in healthcare: a qualitative study of the
implementation of a hospital safety programme. BMJ Qual Saf. 2022;31…
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psnet.ahrq.gov/node/843094/psn-pdf
January 25, 2023 - Getting Started with a Communication and Resolution
Program (CRP) Policy or Commitment Statement to CR.
January 25, 2023
Collaborative for Accountability and Improvement Policy Committee. Seattle, WA: University of
Washington; 2022
https://psnet.ahrq.gov/issue/getting-started-communication-and-resolution-program-c…
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psnet.ahrq.gov/node/849131/psn-pdf
May 17, 2023 - The time is now: addressing implicit bias in obstetrics
and gynecology education.
May 17, 2023
Royce CS, Morgan HK, Baecher-Lind L, et al. The time is now: addressing implicit bias in obstetrics and
gynecology education. Am J Obstet Gynecol. 2023;228(4):369-381. doi:10.1016/j.ajog.2022.12.016.
https://psnet.ahrq.g…
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psnet.ahrq.gov/node/842422/psn-pdf
January 11, 2023 - The REPAIR Project: a prospectus for change toward
racial justice in medical education and health sciences
research: REPAIR project steering committee.
January 11, 2023
REPAIR Project Steering Committee. Acad Med. 2022;97(12):1753-1759.
https://psnet.ahrq.gov/issue/repair-project-prospectus-change-toward-rac…
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psnet.ahrq.gov/node/43149/psn-pdf
July 23, 2014 - FDASIA Health IT Report: Proposed Strategy and
Recommendations for a Risk-Based Framework.
July 23, 2014
Washington, DC: Office of the National Coordinator for Health Information Technology, Federal
Communications Commission. Silver Spring, MD: Food and Drug Administration. April 2014.
https://psnet.ahrq.gov/issue…
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psnet.ahrq.gov/node/45748/psn-pdf
January 01, 2017 - Fatigue in hospital nurses—'Supernurse' culture is a
barrier to addressing problems: a qualitative interview
study.
December 14, 2016
Steege LM, Rainbow JG. Fatigue in hospital nurses - 'Supernurse' culture is a barrier to addressing
problems: A qualitative interview study. Int J Nurs Stud. 2017;67:20-28. doi:10.1…
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psnet.ahrq.gov/node/42862/psn-pdf
January 15, 2014 - VA Health Care: Improvements Needed in Processes
Used to Address Providers' Actions That Contribute to
Adverse Events.
January 15, 2014
Draper D. Washington, DC: United States Government Accountability Office; December 3, 2013.
Publication GAO-14-55.
https://psnet.ahrq.gov/issue/va-health-care-improvements-needed…
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psnet.ahrq.gov/node/45609/psn-pdf
November 16, 2016 - A review of healthcare failure mode and effects analysis
(HFMEA) in radiotherapy.
November 16, 2016
Giardina M, Cantone MC, Tomarchio E, et al. A Review of Healthcare Failure Mode and Effects Analysis
(HFMEA) in Radiotherapy. Health Phys. 2016;111(4):317-26. doi:10.1097/HP.0000000000000536.
https://psnet.ahrq.gov/…
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psnet.ahrq.gov/node/73284/psn-pdf
May 19, 2021 - Safety participation at the direct care level: results of a
patient questionnaire.
May 19, 2021
Duhn L, Gumapac N, Medves J. Safety participation at the direct care level: results of a patient
questionnaire. Patient Exp J. 2021;8(1):59-68. doi:10.35680/2372-0247.1506.
https://psnet.ahrq.gov/issue/safety-participat…
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psnet.ahrq.gov/node/44403/psn-pdf
June 21, 2016 - Preventability of hospital-acquired venous
thromboembolism.
June 21, 2016
Haut ER, Lau BD, Kraus PS, et al. Preventability of Hospital-Acquired Venous Thromboembolism. JAMA
Surg. 2015;150(9):912-5. doi:10.1001/jamasurg.2015.1340.
https://psnet.ahrq.gov/issue/preventability-hospital-acquired-venous-thromboembolism
…
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psnet.ahrq.gov/node/60802/psn-pdf
August 12, 2020 - Race, postoperative complications, and death in
apparently healthy children.
August 12, 2020
Nafiu OO, Mpody C, Kim SS, et al. Race, postoperative complications, and death in apparently healthy
children. Pediatrics. 2020;146(2):e20194113. doi:10.1542/peds.2019-4113.
https://psnet.ahrq.gov/issue/race-postoperative-…
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psnet.ahrq.gov/node/45416/psn-pdf
August 24, 2016 - A framework to assess patient-reported adverse
outcomes arising during hospitalization.
August 24, 2016
Okoniewska B, Santana MJ, Holroyd-Leduc J, et al. A framework to assess patient-reported adverse
outcomes arising during hospitalization. BMC Health Serv Res. 2016;16(a):357. doi:10.1186/s12913-016-
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