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  1. Selecting indicators for patient safety at the health system level in OECD countries. | PSNet

    psnet.ahrq.gov/issue/selecting-indicators-patient-safety-health-system-level-oecd-countries
    June 28, 2011 - Study Selecting indicators for patient safety at the health system level in OECD countries. Citation Text: McLoughlin V, Millar J, Mattke S, et al. Selecting indicators for patient safety at the health system level in OECD countries. Int J Qual Health Care. 2006;18 Suppl 1:14-20. Cop…

  2. Using Kotter's change model for implementing bedside handoff: a quality improvement project. | PSNet

    psnet.ahrq.gov/issue/using-kotters-change-model-implementing-bedside-handoff-quality-improvement-project
    September 23, 2020 - Commentary Using Kotter's change model for implementing bedside handoff: a quality improvement project. Citation Text: Small A, Gist D, Souza D, et al. Using Kotter's Change Model for Implementing Bedside Handoff: A Quality Improvement Project. J Nurs Care Qual. 2016;31(4):304-9. doi:10.…

  3. Improving adverse drug event reporting by healthcare professionals. | PSNet

    psnet.ahrq.gov/issue/improving-adverse-drug-event-reporting-healthcare-professionals
    April 12, 2019 - Review Improving adverse drug event reporting by healthcare professionals. Citation Text: Shalviri G, Mohebbi N, Mirbaha F, et al. Improving adverse drug event reporting by healthcare professionals. Cochrane Database Syst Rev. 2024;2024(10):CD012594. doi:10.1002/14651858.cd012594.pub2. …

  4. Emotional impact of patient safety incidents on family physicians and their office staff. | PSNet

    psnet.ahrq.gov/issue/emotional-impact-patient-safety-incidents-family-physicians-and-their-office-staff
    December 11, 2013 - Study Emotional impact of patient safety incidents on family physicians and their office staff. Citation Text: O'Beirne M, Sterling P, Palacios-Derflingher L, et al. Emotional impact of patient safety incidents on family physicians and their office staff. J Am Board Fam Med. 2012;25(2)…

  5. Improving end of life care: an information systems approach to reducing medical errors. | PSNet

    psnet.ahrq.gov/issue/improving-end-life-care-information-systems-approach-reducing-medical-errors
    November 04, 2015 - Study Improving end of life care: an information systems approach to reducing medical errors. Citation Text: Tamang S, Kopec D, Shagas G, et al. Improving end of life care: an information systems approach to reducing medical errors. Stud Health Technol Inform. 2005;114:93-104. Copy C…

  6. Race, postoperative complications, and death in apparently healthy children. | PSNet

    psnet.ahrq.gov/issue/race-postoperative-complications-and-death-apparently-healthy-children
    August 10, 2022 - Study Classic Race, postoperative complications, and death in apparently healthy children. Citation Text: Nafiu OO, Mpody C, Kim SS, et al. Race, postoperative complications, and death in apparently healthy children. Pediatrics. 2020;146(2):e20194113. doi:10.154…

  7. Learning from mistakes and near mistakes: using root cause analysis as a risk management tool. | PSNet

    psnet.ahrq.gov/issue/learning-mistakes-and-near-mistakes-using-root-cause-analysis-risk-management-tool
    June 19, 2024 - Commentary Learning from mistakes and near mistakes: using root cause analysis as a risk management tool. Citation Text: Cerniglia-Lowensen J. Learning From Mistakes and Near Mistakes: Using Root Cause Analysis as a Risk Management Tool. J Radiol Nurs. 2015;34(1). doi:10.1016/j.jradnu.20…

  8. Using failure mode and effects analysis to plan implementation of smart i.v. pump technology. | PSNet

    psnet.ahrq.gov/issue/using-failure-mode-and-effects-analysis-plan-implementation-smart-iv-pump-technology
    July 14, 2010 - Study Using failure mode and effects analysis to plan implementation of smart i.v. pump technology. Citation Text: Wetterneck TB, Skibinski K, Roberts TL, et al. Using failure mode and effects analysis to plan implementation of smart i.v. pump technology. Am J Health Syst Pharm. 2006;6…

  9. Prescribing decision making by medical residents on night shifts: a qualitative study. | PSNet

    psnet.ahrq.gov/issue/prescribing-decision-making-medical-residents-night-shifts-qualitative-study
    April 14, 2021 - Study Prescribing decision making by medical residents on night shifts: a qualitative study. Citation Text: Lauffenburger JC, Coll MD, Kim E, et al. Prescribing decision making by medical residents on night shifts: a qualitative study. Med Educ. 2022;56(10):1032-1041. doi:10.1111/medu.14…

  10. Residents' duty hours—toward an empirical narrative. | PSNet

    psnet.ahrq.gov/issue/residents-duty-hours-toward-empirical-narrative
    March 28, 2018 - Commentary Residents' duty hours—toward an empirical narrative. Citation Text: Rosenbaum L, Lamas D. Residents' duty hours--toward an empirical narrative. N Engl J Med. 2012;367(21):2044-9. doi:10.1056/NEJMsr1210160. Copy Citation Format: DOI Google Scholar PubMed BibTeX …

  11. Computerized physician order entry in the critical care environment: a review of current literature. | PSNet

    psnet.ahrq.gov/issue/computerized-physician-order-entry-critical-care-environment-review-current-literature
    September 19, 2012 - Review Computerized physician order entry in the critical care environment: a review of current literature. Citation Text: Maslove DM, Rizk NW, Lowe HJ. Computerized Physician Order Entry in the Critical Care Environment: A Review of Current Literature. J Intensive Care Med. 2011;26(3)…

  12. Patient safety in nursing education: contexts, tensions and feeling safe to learn. | PSNet

    psnet.ahrq.gov/issue/patient-safety-nursing-education-contexts-tensions-and-feeling-safe-learn
    September 19, 2013 - Study Patient safety in nursing education: contexts, tensions and feeling safe to learn. Citation Text: Steven A, Magnusson C, Smith P, et al. Patient safety in nursing education: contexts, tensions and feeling safe to learn. Nurse Educ Today. 2014;34(2):277-84. doi:10.1016/j.nedt.2013…

  13. 5-Red-Light-Green-Light (doc file)

    www.ahrq.gov/sites/default/files/wysiwyg/hai/tools/surgery/5-red-light-green-light.docx
    June 01, 2023 - AHRQ Safety Program for Improving Surgical Care and Recovery Red Light, Green Light: An Overview of Common Implementation Barriers and Facilitators Purpose of this tool: To help team leaders identify barriers to and facilitators of implementing Improving Surgical Care and Recovery (ISCR), an enhanced recovery program…

  14. Paramedic self-reported medication errors. | PSNet

    psnet.ahrq.gov/issue/paramedic-self-reported-medication-errors
    January 14, 2011 - Study Paramedic self-reported medication errors. Citation Text: Vilke GM, Tornabene S, Stepanski B, et al. Paramedic self-reported medication errors. Prehosp Emerg Care. 2006;10(4):457-462. Copy Citation Format: Google Scholar PubMed BibTeX EndNote X3 XML EndNote 7 XML En…

  15. In-facility delirium programs as a patient safety strategy: a systematic review. | PSNet

    psnet.ahrq.gov/issue/facility-delirium-programs-patient-safety-strategy-systematic-review
    March 13, 2013 - Review In-facility delirium programs as a patient safety strategy: a systematic review. Citation Text: Reston JT, Schoelles KM. In-facility delirium prevention programs as a patient safety strategy: a systematic review. Ann Intern Med. 2013;158(5 Pt 2):375-80. doi:10.7326/0003-4819-158…

  16. Adverse events and near misses relating to information management in a hospital. | PSNet

    psnet.ahrq.gov/issue/adverse-events-and-near-misses-relating-information-management-hospital
    December 29, 2014 - Study Adverse events and near misses relating to information management in a hospital. Citation Text: Jylhä V, Bates DW, Saranto K. Adverse events and near misses relating to information management in a hospital. Health Inf Manag. 2016;45(2):55-63. doi:10.1177/1833358316641551. Copy Ci…

  17. Evaluation of safety in a radiation oncology setting using failure mode and effects analysis. | PSNet

    psnet.ahrq.gov/issue/evaluation-safety-radiation-oncology-setting-using-failure-mode-and-effects-analysis
    January 22, 2017 - Study Evaluation of safety in a radiation oncology setting using failure mode and effects analysis. Citation Text: Ford E, Gaudette R, Myers L, et al. Evaluation of safety in a radiation oncology setting using failure mode and effects analysis. Int J Radiat Oncol Biol Phys. 2009;74(3):8…

  18. Medication errors in injured patients. | PSNet

    psnet.ahrq.gov/issue/medication-errors-injured-patients
    April 03, 2019 - Study Medication errors in injured patients. Citation Text: Dolejs SC, Janowak CF, Zarzaur BL. Medication Errors in Injured Patients. Am Surg. 2017;83(7):780-785. Copy Citation Format: Google Scholar PubMed BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged PubMedId RIS …

  19. Unrecognized cardiovascular emergencies among Medicare patients. | PSNet

    psnet.ahrq.gov/issue/unrecognized-cardiovascular-emergencies-among-medicare-patients
    November 16, 2022 - Study Unrecognized cardiovascular emergencies among Medicare patients. Citation Text: Waxman DA, Kanzaria HK, Schriger DL. Unrecognized Cardiovascular Emergencies Among Medicare Patients. JAMA Intern Med. 2018;178(4):477-484. doi:10.1001/jamainternmed.2017.8628. Copy Citation Forma…

  20. Association of patient photographs and reduced retract-and-reorder events. | PSNet

    psnet.ahrq.gov/issue/association-patient-photographs-and-reduced-retract-and-reorder-events
    February 24, 2021 - Study Association of patient photographs and reduced retract-and-reorder events. Citation Text: Rzewnicki D, Kanvinde A, Gillespie S, et al. Association of patient photographs and reduced retract-and-reorder events. JAMIA Open. 2024;7(3):ooae042. doi:10.1093/jamiaopen/ooae042. Copy Cit…
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