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7341. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/845656/psn-pdf
      March 08, 2023 - Improving clinician well-being and patient safety through human-centered design. March 8, 2023 Benishek LE, Kachalia A, Daugherty Biddison L. Improving clinician well-being and patient safety through human-centered design. JAMA. 2023;329(14):1149-1150. doi:10.1001/jama.2023.2157. https://psnet.ahrq.gov/issue/impro…

7342. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/45457/psn-pdf
      September 01, 2016 - Patient safety implications of electronic alerts and alarms of maternal–fetal status during labor. September 1, 2016 Simpson KR, Lyndon A, Davidson LA. Patient Safety Implications of Electronic Alerts and Alarms of Maternal - Fetal Status During Labor. Nurs Womens Health. 2016;20(4):358-66. doi:10.1016/j.nwh.2016.…

7343. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/46079/psn-pdf
      June 28, 2017 - Death due to pharmacy compounding error reinforces need for safety focus. June 28, 2017 ISMP Medication Safety Alert! Acute Care Edition. June 15, 2017;22:1-4. https://psnet.ahrq.gov/issue/death-due-pharmacy-compounding-error-reinforces-need-safety-focus Compounding pharmacies prepare medicines for patients that a…

7344. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/74116/psn-pdf
      November 24, 2021 - NCICLE Pathways to Excellence: Expectations for an Optimal Clinical Learning Environment to Achieve Safe and High-Quality Patient Care, 2021. November 24, 2021 Chicago, IL: National Collaborative for Improving the Clinical Learning Environment; 2021. ISBN: 9781945365416. https://psnet.ahrq.gov/issue/ncicle-pathwa…

7345. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/73092/psn-pdf
      March 31, 2021 - SAFER Care: improving caregiver comprehension of discharge instructions. March 31, 2021 Uong A, Philips K, Hametz P, et al. SAFER care: improving caregiver comprehension of discharge instructions. Pediatrics. 2021;147(4):e20200031. doi:10.1542/peds.2020-0031. https://psnet.ahrq.gov/issue/safer-care-improving-careg…

7346. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/34777/psn-pdf
      February 16, 2011 - Systems errors versus physicians' errors: finding the balance in medical education. February 16, 2011 Casarett D, Helms C. Systems errors versus physicians' errors: finding the balance in medical education. Acad Med. 1999;74(1):19-22. https://psnet.ahrq.gov/issue/systems-errors-versus-physicians-errors-finding-bal…

7347. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/44186/psn-pdf
      November 10, 2015 - A comprehensive method to develop a checklist to increase safety of intra-hospital transport of critically ill patients. November 10, 2015 Brunsveld-Reinders AH, Arbous S, Kuiper SG, et al. A comprehensive method to develop a checklist to increase safety of intra-hospital transport of critically ill patients. Crit…

7348. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/45573/psn-pdf
      November 16, 2016 - High reliability of care in orthopedic surgery: are we there yet? November 16, 2016 Anoushiravani AA, Sayeed Z, El-Othmani MM, et al. High Reliability of Care in Orthopedic Surgery: Are We There Yet? Orthop Clin North Am. 2016;47(4):689-95. doi:10.1016/j.ocl.2016.05.011. https://psnet.ahrq.gov/issue/high-reliabili…

7349. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/48048/psn-pdf
      July 17, 2019 - Independent Review of Gross Negligence Manslaughter and Culpable Homicide. July 17, 2019 Manchester, UK: General Medical Council; June 2019. https://psnet.ahrq.gov/issue/independent-review-gross-negligence-manslaughter-and-culpable-homicide Finding the appropriate balance between assigning criminality and accounta…

7350. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/34803/psn-pdf
      January 05, 2017 - Systematic root cause analysis of adverse drug events in a tertiary referral hospital. January 5, 2017 Rex JH, Turnbull JE, Allen SJ, et al. Systematic Root Cause Analysis of Adverse Drug Events in a Tertiary Referral Hospital. Jt Comm J Qual Improv. 2016;26(10). doi:10.1016/s1070-3241(00)26048-3. https://psnet.ah…

7351. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/35850/psn-pdf
      May 27, 2011 - Computerization can create safety hazards: a bar-coding near miss. May 27, 2011 McDonald CJ. Computerization can create safety hazards: a bar-coding near miss. Ann Intern Med. 2006;144(7):510-6. https://psnet.ahrq.gov/issue/computerization-can-create-safety-hazards-bar-coding-near-miss This case study shares the …

7352. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/46165/psn-pdf
      July 26, 2017 - Transferring aviation practices into clinical medicine for the promotion of high reliability. July 26, 2017 Powell-Dunford N, McPherson MK, Pina JS, et al. Transferring Aviation Practices into Clinical Medicine for the Promotion of High Reliability. Aerosp Med Hum Perform. 2017;88(5):487-491. doi:10.3357/AMHP.4736…

7353. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/867046/psn-pdf
      October 30, 2024 - The future of safety and quality in radiation oncology. October 30, 2024 Talcott W, Covington E, Bazan J, et al. The future of safety and quality in radiation oncology. Semin Radiat Oncol. 2024;34(4):433-440. doi:10.1016/j.semradonc.2024.07.008. https://psnet.ahrq.gov/issue/future-safety-and-quality-radiation-oncol…

7354. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/43480/psn-pdf
      January 01, 2015 - Speaking up: factors and issues in nurses advocating for patients when patients are in jeopardy. December 15, 2014 Rainer J. Speaking up: factors and issues in nurses advocating for patients when patients are in jeopardy. J Nurs Care Qual. 2015;30(1):53-62. doi:10.1097/NCQ.0000000000000081. https://psnet.ahrq.gov/…

7355. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/866698/psn-pdf
      September 11, 2024 - Can we ensure medication safety with the use of speech recognition software? September 11, 2024 Can we ensure medication safety with the use of speech recognition software? ISMP Medication Safety Alert! Acute Care. August 22, 2024;29(17):1-3. https://psnet.ahrq.gov/issue/can-we-ensure-medication-safety-use-speech-…

7356. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/60960/psn-pdf
      September 30, 2020 - COVID-19 pandemic preparation: using simulation for systems-based learning to prepare the largest healthcare workforce and system in Canada. September 30, 2020 Dubé MM, Kaba A, Cronin T, et al. COVID-19 pandemic preparation: using simulation for systems-based learning to prepare the largest healthcare workforce an…

7357. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/45848/psn-pdf
      November 19, 2018 - New Horizons in Patient Safety: Understanding Communication: Case Studies for Physicians. November 19, 2018 Hannawa AF, Wu AW, Juhasz RS, eds. Berlin, Germany: DeGruyter; 2017. ISBN: 9783110455014. https://psnet.ahrq.gov/issue/new-horizons-patient-safety-understanding-communication-case-studies- physicians Poor c…

7358. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/44344/psn-pdf
      July 22, 2015 - Making healthcare safer by understanding, designing and buying better IT. July 22, 2015 Thimbleby H, Lewis A, Williams J. Making healthcare safer by understanding, designing and buying better IT. Clin Med (Lond). 2015;15(3):258-62. doi:10.7861/clinmedicine.15-3-258. https://psnet.ahrq.gov/issue/making-healthcare-s…

7359. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/33931/psn-pdf
      June 23, 2015 - An analysis of major errors and equipment failures in anesthesia management: considerations for prevention and detection. June 23, 2015 Cooper JB, Newbower RS, Kitz RJ. An analysis of major errors and equipment failures in anesthesia management: considerations for prevention and detection. Anesthesiology. 1984;60(…

7360. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/844783/psn-pdf
      September 04, 2019 - A lethal hidden curriculum—death of a medical student from opioid use disorder. September 4, 2019 Lucey CR, Jones L, Eastburn A. A Lethal Hidden Curriculum - Death of a Medical Student from Opioid Use Disorder. N Engl J Med. 2019;381(9):793-795. doi:10.1056/NEJMp1901537. https://psnet.ahrq.gov/issue/lethal-hidden-…