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psnet.ahrq.gov/perspective/role-fda-ensuring-device-safety
May 28, 2020 - launched the Medical Product Safety Network (MedSun) to facilitate mandatory reporting, but also to encourage
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psnet.ahrq.gov/perspective/where-does-risk-adjusted-mortality-fit-safety-measurement-program
March 01, 2015 - trigger external inquiries that stigmatize individual hospitals, lower morale and public confidence, and encourage
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psnet.ahrq.gov/primer/maternal-safety
January 10, 2024 - In an effort to encourage improvements, the CDC developed State Strategies for Preventing Pregnancy-Related
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psnet.ahrq.gov/node/37169/psn-pdf
October 06, 2011 - The safety journal: lessons learned with an error
reporting tool to stimulate systems thinking.
October 6, 2011
Singh R, Naughton B, Singh A, et al. The Safety Journal. J Patient Saf. 2007;3(3):135-141.
doi:10.1097/0b013e31814258db.
https://psnet.ahrq.gov/issue/safety-journal-lessons-learned-error-reporting-tool-s…
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psnet.ahrq.gov/issue/involvement-parents-critical-incidents-neonatal-paediatric-intensive-care-unit
January 22, 2016 - Study
Involvement of parents in critical incidents in a neonatal-paediatric intensive care unit.
Citation Text:
Frey B, Ersch J, Bernet V, et al. Involvement of parents in critical incidents in a neonatal-paediatric intensive care unit. Qual Saf Health Care. 2009;18(6):446-9. doi:10.11…
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psnet.ahrq.gov/issue/case-safety-leadership-team-training-hospital-managers
August 31, 2011 - Study
A case for safety leadership team training of hospital managers.
Citation Text:
Singer SJ, Hayes J, Cooper JB, et al. A case for safety leadership team training of hospital managers. Health Care Manage Rev. 2011;36(2):188-200. doi:10.1097/HMR.0b013e318208cd1d.
Copy Citation
F…
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psnet.ahrq.gov/issue/liability-claims-and-costs-and-after-implementation-medical-error-disclosure-program
April 24, 2018 - Study
Classic
Liability claims and costs before and after implementation of a medical error disclosure program.
Citation Text:
Kachalia A, Kaufman SR, Boothman RC, et al. Liability claims and costs before and after implementation of a medical error disclosure …
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psnet.ahrq.gov/issue/adverse-event-reporting-practices-us-hospitals-results-national-survey
December 30, 2014 - Study
Adverse-event-reporting practices by US hospitals: results of a national survey.
Citation Text:
Farley DO, Haviland A, Champagne S, et al. Adverse-event-reporting practices by US hospitals: results of a national survey. Qual Saf Health Care. 2008;17(6):416-23. doi:10.1136/qshc.20…
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psnet.ahrq.gov/node/40134/psn-pdf
February 17, 2011 - Sleep deprivation, elective surgical procedures, and
informed consent.
February 17, 2011
Nurok M, Czeisler CA, Lehmann LS. Sleep deprivation, elective surgical procedures, and informed
consent. N Engl J Med. 2010;363(27):2577-9. doi:10.1056/NEJMp1007901.
https://psnet.ahrq.gov/issue/sleep-deprivation-elective-surg…
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psnet.ahrq.gov/node/40858/psn-pdf
December 29, 2014 - Patients' and healthcare workers' perceptions of a patient
safety advisory.
December 29, 2014
Schwappach DLB, Frank O, Koppenberg J, et al. Patients' and healthcare workers' perceptions of a patient
safety advisory. Int J Qual Health Care. 2011;23(6):713-20. doi:10.1093/intqhc/mzr062.
https://psnet.ahrq.gov/issue/…
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psnet.ahrq.gov/node/42145/psn-pdf
March 27, 2013 - Trends in adverse events over time: why are we not
improving?
March 27, 2013
Shojania KG, Thomas EJ. Trends in adverse events over time: why are we not improving? BMJ Qual Saf.
2013;22(4):273-7. doi:10.1136/bmjqs-2013-001935.
https://psnet.ahrq.gov/issue/trends-adverse-events-over-time-why-are-we-not-improving
Th…
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psnet.ahrq.gov/node/40464/psn-pdf
June 10, 2018 - Multiple latent failures align to allow a serious drug
interaction to harm a patient.
June 10, 2018
ISMP Medication Safety Alert! Acute care edition. May 5, 2011;16:1-3.
https://psnet.ahrq.gov/issue/multiple-latent-failures-align-allow-serious-drug-interaction-harm-patient
Detailing a case in which latent failures…
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psnet.ahrq.gov/node/37108/psn-pdf
October 04, 2011 - Electronic prescribing systems in pediatrics: the rationale
and functionality requirements.
October 4, 2011
Technology AA of PC on CI, Gerstle RS. Electronic prescribing systems in pediatrics: the rationale and
functionality requirements. Pediatrics. 2007;119(6):1229-31.
https://psnet.ahrq.gov/issue/electronic-pre…
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psnet.ahrq.gov/periodic-issue/periodic-issue-299
July 28, 2021 - July 7, 2021 Weekly Issue
PSNet highlights the latest patient safety literature, news, and expert commentary, including Weekly
Updates, WebM&M, and Perspectives on Safety. The current issue highlights what's new this week in patient
safety literature, news, conferences, reports, a…
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psnet.ahrq.gov/periodic-issue/periodic-issue-311
September 29, 2021 - September 29, 2021 Weekly Issue
PSNet highlights the latest patient safety literature, news, and expert commentary, including Weekly
Updates, WebM&M, and Perspectives on Safety. The current issue highlights what's new this week in patient
safety literature, news, conferences, repo…
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psnet.ahrq.gov/periodic-issue/periodic-issue-340
May 16, 2022 - May 4, 2022 Weekly Issue
PSNet highlights the latest patient safety literature, news, and expert commentary, including Weekly
Updates, WebM&M, and Perspectives on Safety. The current issue highlights what's new this week in patient
safety literature, news, conferences, reports, an…
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psnet.ahrq.gov/node/42986/psn-pdf
February 26, 2014 - Potential inaccuracy of electronically transmitted
medication history information used for medication
reconciliation.
February 26, 2014
National Alert Network. Horsham, PA: Institute for Safe Medication Practices; Bethesda, MD: American
Society of Health-System Pharmacists. February 18, 2014.
https://psnet.ahrq.g…
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psnet.ahrq.gov/node/40284/psn-pdf
March 09, 2011 - Speaking Up Constructively: Managerial Practices that
Elicit Solutions from Front-Line Employees.
March 9, 2011
Adler-Milstein JR, Singer SJ, Toffel MW. Cambridge, MA: Harvard Business School; August 25, 2010. HBS
Working Paper No. 11-005.
https://psnet.ahrq.gov/issue/speaking-constructively-managerial-practices-e…
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psnet.ahrq.gov/node/37269/psn-pdf
November 30, 2016 - ACOG Committee Opinion #681: disclosure and
discussion of adverse events.
November 30, 2016
Improvement C on PS and Q. Committee Opinion No. 681: Disclosure and Discussion of Adverse Events.
Obstet Gynecol. 2016;128(6):e257-e261.
https://psnet.ahrq.gov/issue/acog-committee-opinion-681-disclosure-and-discussion-adv…
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psnet.ahrq.gov/node/43351/psn-pdf
July 16, 2014 - Patient involvement in medication safety in hospital: an
exploratory study.
July 16, 2014
Mohsin-Shaikh S, Garfield S, Franklin BD. Patient involvement in medication safety in hospital: an
exploratory study. Int J Clin Pharm. 2014;36(3):657-66. doi:10.1007/s11096-014-9951-8.
https://psnet.ahrq.gov/issue/patient-in…