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psnet.ahrq.gov/issue/improving-handoff-communications-critical-care-utilizing-simulation-based-training-toward
February 16, 2011 - Study
Improving handoff communications in critical care: utilizing simulation-based training toward process improvement in managing patient risk.
Citation Text:
Berkenstadt H, Haviv Y, Tuval A, et al. Improving handoff communications in critical care: utilizing simulation-based training …
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psnet.ahrq.gov/issue/what-learning-review-safety-literature-define-learning-incidents-accidents-and-disasters
December 17, 2010 - Review
What is learning? A review of the safety literature to define learning from incidents, accidents and disasters.
Citation Text:
Drupsteen L, Guldenmund FW. What Is Learning? A Review of the Safety Literature to Define Learning from Incidents, Accidents and Disasters. J Contingencie…
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psnet.ahrq.gov/issue/differences-medication-knowledge-and-risk-errors-between-graduating-nursing-students-and
December 29, 2014 - Study
Differences in medication knowledge and risk of errors between graduating nursing students and working registered nurses: comparative study.
Citation Text:
Simonsen BO, Daehlin GK, Johansson I, et al. Differences in medication knowledge and risk of errors between graduating nursing…
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psnet.ahrq.gov/issue/aspen-safe-practices-enteral-nutrition-therapy
June 12, 2018 - Organizational Policy/Guidelines
ASPEN Safe Practices for Enteral Nutrition Therapy.
Citation Text:
Boullata JI, Carrera AL, Harvey L, et al. ASPEN Safe Practices for Enteral Nutrition Therapy. JPEN J Parenter Enteral Nutr. 2017;41(1):15-103. doi:10.1177/0148607116673053.
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psnet.ahrq.gov/issue/are-measurements-patient-safety-culture-and-adverse-events-valid-and-reliable-results-cross
February 04, 2015 - Study
Are measurements of patient safety culture and adverse events valid and reliable? Results from a cross sectional study.
Citation Text:
Farup PG. Are measurements of patient safety culture and adverse events valid and reliable? Results from a cross sectional study. BMC Health Serv R…
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psnet.ahrq.gov/issue/peer-feedback-learning-and-improvement-answering-call-institute-medicine-report-diagnostic
March 20, 2024 - Commentary
Peer feedback, learning, and improvement: answering the call of the Institute of Medicine report on diagnostic error.
Citation Text:
Larson DB, Donnelly LF, Podberesky DJ, et al. Peer Feedback, Learning, and Improvement: Answering the Call of the Institute of Medicine Report o…
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psnet.ahrq.gov/issue/optimizing-smart-pump-technology-increasing-critical-safety-alerts-and-reducing-clinically
February 12, 2014 - Study
Optimizing smart pump technology by increasing critical safety alerts and reducing clinically insignificant alerts.
Citation Text:
Mansfield J, Jarrett S. Optimizing smart pump technology by increasing critical safety alerts and reducing clinically insignificant alerts. Hosp Pharm.…
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psnet.ahrq.gov/issue/blood-sampling-guidelines-focus-patient-safety-and-identification-review
August 10, 2016 - Review
Blood sampling guidelines with focus on patient safety and identification—a review.
Citation Text:
Cornes M, Ibarz M, Ivanov H, et al. Blood sampling guidelines with focus on patient safety and identification - a review. Diagnosis (Berl). 2019;6(1):33-37. doi:10.1515/dx-2018-0042.…
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psnet.ahrq.gov/issue/iatrogenesis-context-residential-dementia-care-concept-analysis
August 17, 2022 - Commentary
Iatrogenesis in the context of residential dementia care: a concept analysis.
Citation Text:
Morris P, McCloskey R, Bulman D. Iatrogenesis in the context of residential dementia care: a concept analysis. Innov Aging. 2022;6(4):iagc028. doi:10.1093/geroni/igac028.
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psnet.ahrq.gov/issue/patient-safety-features-clinical-computer-systems-questionnaire-survey-gp-views
May 31, 2011 - Study
Patient safety features of clinical computer systems: questionnaire survey of GP views.
Citation Text:
Morris CJ, Savelyich BSP, Avery A, et al. Patient safety features of clinical computer systems: questionnaire survey of GP views. Qual Saf Health Care. 2005;14(3):164-8.
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psnet.ahrq.gov/issue/prevention-intravenous-drug-incompatibilities-intensive-care-unit
February 28, 2009 - Study
Prevention of intravenous drug incompatibilities in an intensive care unit.
Citation Text:
Bertsche T, Mayer Y, Stahl R, et al. Prevention of intravenous drug incompatibilities in an intensive care unit. Am J Health Syst Pharm. 2008;65(19):1834-40. doi:10.2146/ajhp070633.
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psnet.ahrq.gov/issue/improving-patient-safety-avoiding-unread-imaging-exams-national-va-enterprise-electronic
March 12, 2025 - Study
Improving patient safety: avoiding unread imaging exams in the National VA enterprise electronic health record.
Citation Text:
Bastawrous S, Carney B. Improving Patient Safety: Avoiding Unread Imaging Exams in the National VA Enterprise Electronic Health Record. J Digit Imaging. 20…
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psnet.ahrq.gov/issue/identifying-discrepancies-electronic-medical-records-through-pharmacist-medication
August 03, 2022 - Study
Identifying discrepancies in electronic medical records through pharmacist medication reconciliation.
Citation Text:
Stewart AL, Lynch KJ. Identifying discrepancies in electronic medical records through pharmacist medication reconciliation. J Am Pharm Assoc (2003). 2012;52(1):59-…
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psnet.ahrq.gov/issue/errors-allies-error-management-training-health-professions-education
January 22, 2016 - Commentary
Errors as allies: error management training in health professions education.
Citation Text:
King A, Holder MG, Ahmed RA. Errors as allies: error management training in health professions education. BMJ Qual Saf. 2013;22(6):516-9. doi:10.1136/bmjqs-2012-000945.
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/mvp/modules/sustainability/sustainability-scorecard.docx
January 01, 2017 - AHRQ Safety Program for Mechanically Ventilated Patients
Sustainability Scorecard
Instructions: This Sustainability Scorecard is a tool you can use to quickly assess your unit’s progress in applying the Comprehensive Unit-based Safety Program to the care of mechanically ventilated patients. For each question selec…
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www.ahrq.gov/hai/tools/mvp/sustainability/scorecard.html
January 01, 2017 - Sustainability Scorecard
AHRQ Safety Program for Mechanically Ventilated Patients
Instructions: This Sustainability Scorecard is a tool you can use to quickly assess your unit’s progress in applying the Comprehensive Unit-based Safety Program to the care of mechanically ventilated patients. For e…
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psnet.ahrq.gov/issue/evidence-based-medicine-cornerstone-clinical-care-not-quality-improvement
September 01, 2021 - Commentary
Evidence-based medicine: a cornerstone for clinical care but not for quality improvement.
Citation Text:
Mondoux S, Shojania KG. Evidence-based medicine: A cornerstone for clinical care but not for quality improvement. J Eval Clin Pract. 2019;25(3):363-368. doi:10.1111/jep.131…
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psnet.ahrq.gov/issue/development-medical-checklists-improved-quality-patient-care
March 23, 2011 - Review
Development of medical checklists for improved quality of patient care.
Citation Text:
Hales B, Terblanche M, Fowler R, et al. Development of medical checklists for improved quality of patient care. International Journal for Quality in Health Care. 2007;20(1). doi:10.1093/intqhc…
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psnet.ahrq.gov/issue/armstrong-institute-residentfellow-scholars-multispecialty-curriculum-train-future-leaders
October 19, 2022 - Commentary
The Armstrong Institute Resident/Fellow Scholars: a multispecialty curriculum to train future leaders in patient safety and quality improvement.
Citation Text:
Rinke ML, Mock CK, Persing NM, et al. The Armstrong Institute Resident/Fellow Scholars: A Multispecialty Curriculum t…
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psnet.ahrq.gov/issue/incorporation-patient-safety-board-certification-examinations
October 26, 2010 - Commentary
The incorporation of patient safety into board certification examinations.
Citation Text:
Kachalia A, Johnson J, Miller ST, et al. The incorporation of patient safety into board certification examinations. Acad Med. 2006;81(4):317-25.
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