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  1. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/837192/psn-pdf
    May 25, 2022 - Declaration to Advance Patient Safety. May 25, 2022 National Steering Committee for Patient Safety. Boston, MA: Institute for Healthcare Improvement; May 2022. https://psnet.ahrq.gov/issue/declaration-advance-patient-safety Leadership commitment is crucial to attaining sustainable improvement in patient safety. Th…
  2. View PDF (pdf file)

    integrationacademy.ahrq.gov/print/pdf/node/23255
    View PDF View PDF Website https://bipartisanpolicy.org/?query=behavioral%20health%20integration Mission To build connections, negotiate policy, achieve bipartisan solutions, and improve lives.  Location Washington, DC United States Terms of Use Copyrighted, freely available Description A nonprofit that ensures p…
  3. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/47943/psn-pdf
    May 20, 2019 - Governing the safety of artificial intelligence in healthcare. May 20, 2019 Macrae C. Governing the safety of artificial intelligence in healthcare. BMJ Qual Saf. 2019;28(6):495-498. doi:10.1136/bmjqs-2019-009484. https://psnet.ahrq.gov/issue/governing-safety-artificial-intelligence-healthcare The unintended risk…
  4. digital.ahrq.gov/ahrq-funded-projects/patient-centered-informatics-system-enhance-health-care-rural-communities/citation/understanding
    January 01, 2023 - Understanding adoption of a personal health record in rural health care clinics: revealing barriers and facilitators of adoption including attributions about potential patient portal users and self-reported characteristics of early adopting users. Citation Butler JM, Carter M, Hayden C, et al. Underst…
  5. digital.ahrq.gov/ahrq-funded-projects/safety-through-enhanced-e-prescribing-tools-stepstools-developing-web-services/final-report
    January 01, 2023 - STEPStools: Developing Web Services for Safe Pediatric Dosing - Final Report Citation Johnson KB, Gadd Cynthia, Weinberg Stuart, et. al. STEPStools: Developing Web Services for Safe Pediatric Dosing - Final Report. (Prepared by Vanderbilt University Medical Center under Grant No. R18 HS017216). Rockvi…
  6. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/74093/psn-pdf
    November 17, 2021 - Prevent errors during emergency use of hypertonic sodium chloride solutions. November 17, 2021 ISMP Medication Safety Alert! Acute care edition. November 4, 2021;26(22); 1-4. https://psnet.ahrq.gov/issue/prevent-errors-during-emergency-use-hypertonic-sodium-chloride-solutions Delays in diagnosis and treatment duri…
  7. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/45567/psn-pdf
    October 12, 2016 - Insulin Pens Devices. October 12, 2016 Am J Health Syst Pharm. 2016;73(19 suppl 5);s1-s47. https://psnet.ahrq.gov/issue/insulin-pens-devices As a high-alert medication, insulin has the potential to result in serious patient harm if administered incorrectly. Articles in this special issue discuss recommendations de…
  8. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/43082/psn-pdf
    April 16, 2014 - Improving code team performance and survival outcomes: implementation of pediatric resuscitation team training. April 16, 2014 Knight LJ, Gabhart JM, Earnest KS, et al. Improving code team performance and survival outcomes: implementation of pediatric resuscitation team training. Crit Care Med. 2014;42(2):243-251.…
  9. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/854265/psn-pdf
    October 04, 2023 - Can AI help doctors come up with better diagnoses? October 4, 2023 Landro L. Wall Street Journal. September 24, 2023. https://psnet.ahrq.gov/issue/can-ai-help-doctors-come-better-diagnoses Artificial intelligence (AI) is being considered as a strong contender in the effort to reduce harmful diagnostic error, but c…
  10. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/45547/psn-pdf
    October 05, 2016 - Sick children face potentially deadly danger: medication errors. October 5, 2016 Furfaro H. Wall Street Journal. September 25, 2016. https://psnet.ahrq.gov/issue/sick-children-face-potentially-deadly-danger-medication-errors Medication errors in pediatric care are common in the hospital and at home. This newspaper…
  11. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/42135/psn-pdf
    April 22, 2013 - Interprofessional education in team communication: working together to improve patient safety. April 22, 2013 Brock DM, Abu-Rish E, Chiu C-R, et al. Interprofessional education in team communication: working together to improve patient safety. BMJ Qual Saf. 2013;22(5):414-23. doi:10.1136/bmjqs-2012-000952. https:/…
  12. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/72535/psn-pdf
    December 02, 2020 - Learning from influenza vaccine errors to prepare for COVID-19 vaccination campaigns. December 2, 2020 ISMP Medication Safety Alert! Acute care edition. November 19, 2020;25(23):1-6. https://psnet.ahrq.gov/issue/learning-influenza-vaccine-errors-prepare-covid-19-vaccination-campaigns Safety professionals enco…
  13. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/838031/psn-pdf
    September 13, 2022 - Addressing the Loss of Trust in Safety Culture. September 7, 2022 Philadelphia, PA: Building Trust and the ABIM Foundation; September 13, 2022.  https://psnet.ahrq.gov/issue/addressing-loss-trust-safety-culture Trust in patient safety processes encourages reporting of concerns, learning from error, and develop…
  14. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/73691/psn-pdf
    September 08, 2021 - Pump up the volume: tips for increasing error reporting and decreasing patient harm. September 8, 2021 ISMP Medication Safety Alert! Acute care edition. August 26, 2021;26(17);1-5.  https://psnet.ahrq.gov/issue/pump-volume-tips-increasing-error-reporting-and-decreasing-patient-harm Error reporting is an essen…
  15. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/60604/psn-pdf
    June 17, 2020 - The limits of current A.I. in health care: patient safety policing in hospitals. June 17, 2020 Furrow BR. NE Univ Law Rev. 2020;12(1):1-55. https://psnet.ahrq.gov/issue/limits-current-ai-health-care-patient-safety-policing-hospitals Artificial intelligence (AI) has the potential to improve the use of big data to e…
  16. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/47310/psn-pdf
    September 19, 2018 - Use of simulation to test systems and prepare staff for a new hospital transition. September 19, 2018 Adler MD, Mobley BL, Eppich W, et al. Use of Simulation to Test Systems and Prepare Staff for a New Hospital Transition. J Patient Saf. 2018;14(3):143-147. doi:10.1097/PTS.0000000000000184. https://psnet.ahrq.gov/…
  17. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/42337/psn-pdf
    December 30, 2014 - In situ simulation: detection of safety threats and teamwork training in a high risk emergency department. December 30, 2014 Patterson M, Geis GL, Falcone RA, et al. In situ simulation: detection of safety threats and teamwork training in a high risk emergency department. BMJ Qual Saf. 2013;22(6):468-77. doi:10.113…
  18. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/40070/psn-pdf
    December 08, 2010 - Epidural pump programming error leading to inadvertent 10-fold dosing error during epidural labor analgesia with ropivacaine. December 8, 2010 Thyen AB, McAllister RK, Councilman LM. Epidural Pump Programming Error Leading to Inadvertent 10- Fold Dosing Error During Epidural Labor Analgesia With Ropivacaine. J Pat…
  19. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/45160/psn-pdf
    May 18, 2016 - Clues to better health care from old malpractice lawsuits. May 18, 2016 Landro L. https://psnet.ahrq.gov/issue/clues-better-health-care-old-malpractice-lawsuits Closed claims have been considered a source for adverse event data for years, and recently such data has been utilized to inform safety improvement work. …
  20. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/47933/psn-pdf
    August 07, 2019 - Just culture: it's more than policy. August 7, 2019 Paradiso L, Sweeney N. Just culture: It's more than policy. Nurs Manage. 2019;50(6):38-45. doi:10.1097/01.NUMA.0000558482.07815.ae. https://psnet.ahrq.gov/issue/just-culture-its-more-policy This survey study examined the relationship between just culture—a cultur…