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psnet.ahrq.gov/periodic-issue/periodic-issue-283
March 15, 2021 - March 17, 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,…
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psnet.ahrq.gov/periodic-issue/periodic-issue-287
April 28, 2021 - April 14, 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,…
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psnet.ahrq.gov/periodic-issue/periodic-issue-403
August 30, 2023 - August 9, 2023 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,…
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psnet.ahrq.gov/innovation/duke-pediatric-residency-safety-council
November 16, 2022 - The Duke Pediatric Residency Safety Council
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May 16, 2022
Innovation
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psnet.ahrq.gov/perspective/advancing-patient-safety-through-state-reporting-systems
June 01, 2007 - Advancing Patient Safety Through State Reporting Systems
Jill Rosenthal, MPH | June 1, 2007
View more articles from the same authors.
Citation Text:
Rosenthal J. Advancing Patient Safety Through State Reporting Systems. PSNet [internet]. Rockville (MD): Agency for…
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psnet.ahrq.gov/web-mm/emr-entry-error-not-so-benign
July 01, 2012 - EMR Entry Error: Not So Benign
Citation Text:
Koppel R. EMR Entry Error: Not So Benign. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2009.
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Format:
Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endno…
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psnet.ahrq.gov/issue/alarm-system-management-evidence-based-guidance-encouraging-direct-measurement
August 11, 2021 - Review
Alarm system management: evidence-based guidance encouraging direct measurement of informativeness to improve alarm response.
Citation Text:
Rayo MF, Moffatt-Bruce SD. Alarm system management: evidence-based guidance encouraging direct measurement of informativeness to improve ala…
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psnet.ahrq.gov/node/867652/psn-pdf
February 26, 2025 - their true potential, they must shift to support a psychologically safe environment where
staff are encouraged
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psnet.ahrq.gov/node/40717/psn-pdf
August 24, 2011 - Revealing their medical errors: why three doctors went
public.
August 24, 2011
O'Reilly KB.
https://psnet.ahrq.gov/issue/revealing-their-medical-errors-why-three-doctors-went-public
This news article reports on health care providers who have publicly revealed direct involvement in cases
of medical errors, with a …
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psnet.ahrq.gov/web-mm/infused-not-ingested
February 01, 2017 - not clear whether such a person had been assigned, or whether the culture was one in which staff were encouraged … seek support should raise questions regarding the overall environment for safety, which may not have encouraged
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psnet.ahrq.gov/web-mm/reconciling-doses
August 14, 2017 - But organizations should be encouraged by those who have successfully implemented a medication reconciliation … Individually, patients should be encouraged to carry their medication lists and present them at each
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psnet.ahrq.gov/node/848378/psn-pdf
May 04, 2023 - Ensuring competency and safety when onboarding newly
hired professional staff.
May 3, 2023
ISMP Medication Safety Alert! Acute care edition. April 20, 2023;28(8):1-4; May 4, 2023;23(9):1-3.
https://psnet.ahrq.gov/issue/ensuring-competency-and-safety-when-onboarding-newly-hired-professional-
staff
Psychological sa…
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psnet.ahrq.gov/node/73312/psn-pdf
May 26, 2021 - Healthcare professionals experience of psychological
safety, voice, and silence.
May 26, 2021
O'Donovan R, De Brún A, McAuliffe E. Healthcare professionals experience of psychological safety, voice,
and silence. Front Psychol. 2021;12:626689. doi:10.3389/fpsyg.2021.626689.
https://psnet.ahrq.gov/issue/healthcare-p…
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psnet.ahrq.gov/node/40009/psn-pdf
November 26, 2014 - Measuring faculty reflection on adverse patient events:
development and initial validation of a case-based
learning system.
November 26, 2014
Wittich CM, Lopez-Jimenez F, Decker LK, et al. Measuring faculty reflection on adverse patient events:
development and initial validation of a case-based learning system. J …
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psnet.ahrq.gov/node/45069/psn-pdf
June 01, 2016 - The effects of power, leadership and psychological safety
on resident event reporting.
June 1, 2016
Appelbaum NP, Dow A, Mazmanian PE, et al. The effects of power, leadership and psychological safety on
resident event reporting. Med Edu. 2016;50(3):343-350. doi:10.1111/medu.12947.
https://psnet.ahrq.gov/issue/effe…
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psnet.ahrq.gov/node/74178/psn-pdf
December 15, 2021 - Strategies to Improve Patient Safety: Final Report to
Congress Required by the Patient Safety and Quality
Improvement Act of 2005.
December 15, 2021
Rockville, MD: Agency for Healthcare Research and Quality; December 2021. AHRQ Publication No. 22-
0009.
https://psnet.ahrq.gov/issue/strategies-improve-patient-safe…
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psnet.ahrq.gov/node/39195/psn-pdf
January 28, 2010 - Lack of patient knowledge regarding hospital
medications.
January 28, 2010
Lack of patient knowledge regarding hospital medications.
https://psnet.ahrq.gov/issue/lack-patient-knowledge-regarding-hospital-medications
The Joint Commission requires that hospitals encourage patients' involvement in their own safety as…
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psnet.ahrq.gov/node/35220/psn-pdf
May 14, 2015 - Patient Safety and Quality Improvement Act of 2005.
May 14, 2015
Pub L No. 109-41.
https://psnet.ahrq.gov/issue/patient-safety-and-quality-improvement-act-2005
This bill amends the Public Health Service Act to encourage a culture of safety in health care organizations.
The bill, signed into law July 29, 2005…
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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…
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psnet.ahrq.gov/issue/encouraging-employees-speak-prevent-infections-opportunities-leverage-quality-improvement-and
January 23, 2017 - Study
Encouraging employees to speak up to prevent infections: opportunities to leverage quality improvement and care management processes.
Citation Text:
Robbins J, McAlearney AS. Encouraging employees to speak up to prevent infections: Opportunities to leverage quality improvement and …