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psnet.ahrq.gov/node/48078/psn-pdf
August 14, 2019 - Prompting rounding teams to address a daily best
practice checklist in a pediatric intensive care unit.
August 14, 2019
Cifra CL, Houston M, Otto A, et al. Prompting rounding teams to address a daily best practice checklist in a
pediatric intensive care unit. Jt Comm J Qual Patient Saf. 2019;45(8):543-551.
doi:10.…
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psnet.ahrq.gov/node/47637/psn-pdf
January 16, 2019 - Case-based simulation empowering pediatric residents to
communicate about diagnostic uncertainty.
January 16, 2019
Olson ME, Borman-Shoap E, Mathias K, et al. Case-based simulation empowering pediatric residents to
communicate about diagnostic uncertainty. Diagnosis (Berl). 2018;5(4):243-248. doi:10.1515/dx-2018-
…
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psnet.ahrq.gov/node/34664/psn-pdf
December 23, 2008 - Healthcare in a land called PeoplePower: nothing about
me without me.
December 23, 2008
Delbanco T, Berwick D, Boufford JI, et al. Healthcare in a land called PeoplePower: nothing about me
without me. Health Expect. 2001;4(3):144-50.
https://psnet.ahrq.gov/issue/healthcare-land-called-peoplepower-nothing-about-me-…
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psnet.ahrq.gov/node/73091/psn-pdf
March 31, 2021 - Has the COVID pandemic strengthened or weakened
health care teams? A field guide to healthy workforce
best practices.
March 31, 2021
Thompson R, Kusy M. Has the COVID pandemic strengthened or weakened health care teams? A field
guide to healthy workforce best practices. Nurs Adm Q. 2021;45(2):135-141.
doi:10.1097…
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digital.ahrq.gov/document-type/informed-consent-document
January 01, 2023 - Informed Consent Document
Focus Group Consent Form (Spanish)
Description
Example consent form used in an AHRQ-funded project involving older adults. The study involves a focus group on medication management practices. The form is in Spanish.
Document Source …
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psnet.ahrq.gov/issue/patient-stories
March 27, 2024 - Multi-use Website
Patient Stories.
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March 6, 2013
This Web site hosts documentary accounts of medical errors to encourage clinici…
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digital.ahrq.gov/location/usa-va-reston
January 01, 2023 - USA, VA, Reston
"First, Do No Harm": Using Health Information Technology to Reduce Use of Preventive Services with Potential Harms
Description
This project convened a meeting in March of 2010 with experts to discuss “don’t do” recommendations by clinicians to their patients in…
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psnet.ahrq.gov/node/837034/psn-pdf
May 04, 2022 - Understanding the link between burnout and sub-optimal
care: why should healthcare education be interested in
employee silence?
May 4, 2022
Montgomery A, Lainidi O. Understanding the link between burnout and sub-optimal care: why should
healthcare education be interested in employee silence? Front Psychiatry. 2022…
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hcup-us.ahrq.gov/datainnovations/clinicaldata/FL9MeetingAgenda.pdf
April 22, 2008 - CHARLIE CRIST
GOVERNOR HOLLY BENSON
SECRETARY
V is i t A H C A o n l i n e a t
h t t p : / / a h c a . m y f l o r i d a . c o m
2 7 27 M ah an D r i ve , M S#
T a l l a hass ee , F l o r i da 3 23 08
Adding Clinical Data to Statewide Administrative Data Pilot Project
Tuesday April 22, 2008…
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psnet.ahrq.gov/node/47545/psn-pdf
December 19, 2018 - Adverse events during dental care for children:
implications for practitioner health and wellness.
December 19, 2018
Nainar SMH. Adverse events during dental care for children: implications for practitioner health and
wellness. Pediatr Dent. 2018;40(5):323-326.
https://psnet.ahrq.gov/issue/adverse-events-during-de…
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psnet.ahrq.gov/node/837972/psn-pdf
September 01, 2022 - Patient safety: where to aim when zero harm is not the
target-a case for learning and resilience.
September 1, 2022
Stockwell DC, Kayes DC, Thomas EJ. Patient safety: where to aim when zero harm is not the target-a case
for learning and resilience. J Patient Saf. 2022;18(5):e877-e882. doi:10.1097/pts.00000000000009…
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psnet.ahrq.gov/node/40743/psn-pdf
February 01, 2019 - Radiation risks of diagnostic imaging and fluoroscopy.
December 23, 2016
Sentinel Event Alert. August 24, 2011;47:1-4. (revised February 2019).
https://psnet.ahrq.gov/issue/radiation-risks-diagnostic-imaging
The Joint Commission issues Sentinel Event Alerts periodically to highlight emerging patient safety issues
…
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psnet.ahrq.gov/node/34729/psn-pdf
October 31, 2016 - Set Phasers on Stun: And Other True Tales of Design,
Technology, and Human Error, Second Edition.
October 31, 2016
Casey SM. Santa Barbara, CA: Aegean; 1998. ISBN 9780963617880.
https://psnet.ahrq.gov/issue/set-phasers-stun-and-other-true-tales-design-technology-and-human-error-
second-edition
This book introduce…
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psnet.ahrq.gov/node/35617/psn-pdf
January 01, 2016 - Reconciling medications at admission: safe practice
recommendations and implementation strategies.
June 13, 2011
Rogers G, Alper E, Brunelle D, et al. Reconciling Medications at Admission: Safe Practice
Recommendations and Implementation Strategies. Jt Comm J Qual Patient Saf. 2016;32(1):37-50.
doi:10.1016/s1553-7…
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psnet.ahrq.gov/node/73449/psn-pdf
June 30, 2021 - Adverse events and emergency department opioid
prescriptions in adolescents.
June 30, 2021
Worsham CM, Woo J, Jena AB, et al. Adverse events and emergency department opioid prescriptions in
adolescents. Health Aff (Millwood). 2021;40(6):970-978. doi:10.1377/hlthaff.2020.01762.
https://psnet.ahrq.gov/issue/adverse-…
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psnet.ahrq.gov/node/46606/psn-pdf
July 10, 2019 - Implementation of a mock root cause analysis to provide
simulated patient safety training.
July 10, 2019
Murphy M, Duff J, Whitney J, et al. Implementation of a mock root cause analysis to provide simulated
patient safety training. BMJ Open Qual. 2017;6(2). doi:10.1136/bmjoq-2017-000096.
https://psnet.ahrq.gov/iss…
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psnet.ahrq.gov/node/61109/psn-pdf
November 11, 2020 - Making communication and resolution programmes
mission critical in healthcare organisations.
November 11, 2020
Gallagher TH, Boothman RC, Schweitzer L, et al. Making communication and resolution programmes
mission critical in healthcare organisations. BMJ Qual Saf. 2020;29(11):875-878. doi:10.1136/bmjqs-2020-
0108…
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psnet.ahrq.gov/node/838250/psn-pdf
October 06, 2022 - The impact of electronic communication of medication
discontinuation (CancelRx) on medication safety: a pilot
study.
October 6, 2022
Pitts S, Yang Y, Woodroof T, et al. The impact of electronic communication of medication discontinuation
(CancelRx) on medication safety: a pilot study. J Patient Saf. 2022;18(6):e93…
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psnet.ahrq.gov/node/867691/psn-pdf
March 05, 2025 - Surgeon perception and attitude towards the moral
imperative of institutionally addressing second-victim
syndrome in surgery.
March 5, 2025
Hsiao L-H, Kopar PK. Surgeon perception and attitude towards the moral imperative of institutionally
addressing second-victim syndrome in surgery. J Am Coll Surg. 2025;240(2):…
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psnet.ahrq.gov/node/36378/psn-pdf
October 28, 2010 - Teaching but not learning: how medical residency
programs handle errors.
October 28, 2010
Hoff T, Pohl H, Bartfield J. Teaching but not learning: how medical residency programs handle errors. J
Organ Behav. 2006;27(7). doi:10.1002/job.395.
https://psnet.ahrq.gov/issue/teaching-not-learning-how-medical-residency-pr…