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  1. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/43849/psn-pdf
    January 28, 2015 - Advancing the science of measurement of diagnostic errors in healthcare: the Safer Dx framework. January 28, 2015 Singh H, Sittig DF. Advancing the science of measurement of diagnostic errors in healthcare: the Safer Dx framework. BMJ Qual Saf. 2015;24(2):103-110. doi:10.1136/bmjqs-2014-003675. https://psnet.ahrq.…
  2. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/41393/psn-pdf
    June 06, 2012 - Prescribers' interactions with medication alerts at the point of prescribing: a multi-method, in situ investigation of the human–computer interaction. June 6, 2012 Russ AL, Zillich AJ, McManus S, et al. Prescribers' interactions with medication alerts at the point of prescribing: A multi-method, in situ investigat…
  3. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/46062/psn-pdf
    December 19, 2017 - Frequency and nature of medication errors and adverse drug events in mental health hospitals: a systematic review. December 19, 2017 Alshehri GH, Keers RN, Ashcroft DM. Frequency and nature of medication errors and adverse drug events in mental health hospitals: a systematic review. Drug Saf. 2017;40(10):871-886. …
  4. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/72735/psn-pdf
    February 10, 2021 - Deficiencies in Inpatient Mental Health Care Coordination and Processes Prior to a Patient's Death by Suicide, Harry S. Truman Memorial Veterans' Hospital in Columbia, Missouri. February 10, 2021 Washington, DC: Department of Veterans Affairs, Office of Inspector General. January 5, 2021. Report No. 20-01521-48. …
  5. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/47154/psn-pdf
    May 23, 2018 - Comparison of military and civilian methods for determining potentially preventable deaths: a systematic review. May 23, 2018 Janak JC, Sosnov JA, Bares JM, et al. Comparison of Military and Civilian Methods for Determining Potentially Preventable Deaths: A Systematic Review. JAMA Surg. 2018;153(4):367-375. doi:1…
  6. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/74729/psn-pdf
    February 02, 2022 - Healing our own: a randomized trial to assess benefits of peer support. February 2, 2022 Rivera-Chiauzzi EY, Smith HA, Moore-Murray T, et al. Healing our own: a randomized trial to assess benefits of peer support. J Patient Saf. 2022;18(1):e308-e314. doi:10.1097/pts.0000000000000771. https://psnet.ahrq.gov/issue/h…
  7. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/43143/psn-pdf
    April 25, 2016 - Surgical programs in the Veterans Health Administration maintain briefing and debriefing following medical team training. April 25, 2016 West P, Neily J, Warner L, et al. Surgical programs in the Veterans Health Administration maintain briefing and debriefing following medical team training. Jt Comm J Qual Patient…
  8. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/72606/psn-pdf
    December 23, 2020 - Best Practices in Developing Proprietary Names for Human Prescription Drug Products Guidance for Industry. December 23, 2020 Rockville, MD: US Department of Health and Human Services, Food and Drug Administration, Center for Drug Evaluation and Research; December 2020. https://psnet.ahrq.gov/issue/best-practices-d…
  9. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/42264/psn-pdf
    May 25, 2022 - Safety Considerations for Container Labels and Carton Labeling Design to Minimize Medication Errors: Guidance for Industry. May 25, 2022 Rockville, MD: US Department of Health and Human Services, Food and Drug Administration, Center for Drug Evaluation and Research; May 18, 2022. https://psnet.ahrq.gov/issue/safe…
  10. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/43932/psn-pdf
    March 04, 2015 - Safety considerations to mitigate the risks of misconnections with small-bore connectors intended for enteral applications. March 4, 2015 Rockville, MD: Center for Devices and Radiological Health, US Food and Drug Administration; February 11, 2015. https://psnet.ahrq.gov/issue/safety-considerations-mitigate-risks…
  11. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/840144/psn-pdf
    November 16, 2022 - Dedicated teams to optimize quality and safety of surgery: a systematic review. November 16, 2022 Lentz CM, De Lind Van Wijngaarden RAF, Willeboordse F, et al. Dedicated teams to optimize quality and safety of surgery: a systematic review. Int J Qual Health Care. 2022;34(4):mzac078. doi:10.1093/intqhc/mzac078. ht…
  12. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/44458/psn-pdf
    September 09, 2015 - Utilizing pharmacy students in transitions-of-care services. September 9, 2015 L'Hommedieu T, DeCoske M, Lababidi RE, et al. Utilizing pharmacy students in transitions-of-care services. Am J Health Syst Pharm. 2015;72(15):1266-8. doi:10.2146/ajhp140561. https://psnet.ahrq.gov/issue/utilizing-pharmacy-students-tran…
  13. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/37631/psn-pdf
    May 18, 2015 - The science of improvement. May 18, 2015 Berwick DM. The science of improvement. JAMA. 2008;299(10):1182-4. doi:10.1001/jama.299.10.1182. https://psnet.ahrq.gov/issue/science-improvement This commentary by Dr. Donald Berwick, president of the Institute for Healthcare Improvement, addresses the growing tension betw…
  14. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/36888/psn-pdf
    November 30, 2016 - Hospital Survey on Patient Safety Culture: 2007 Comparative Database Report. November 30, 2016 Sorra J, Nieva V, Famolaro T, et al. Rockville, MD: Agency for Healthcare; 2007. AHRQ publication, no. 07- 0025. https://psnet.ahrq.gov/issue/hospital-survey-patient-safety-culture-2007-comparative-database-report A key…
  15. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/73417/psn-pdf
    June 23, 2021 - Classification of failures in the perception of conversational agents (CAs) and their implications on patient safety. June 23, 2021 Aftab H, Shah SHH, Habli I. Classification of failures in the perception of conversational agents (CAs) and their implications on patient safety. Stud Health Technol Inform. 2021;281:…
  16. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/45124/psn-pdf
    June 22, 2016 - The impact of surgical safety checklists on theatre departments: a critical review of the literature. June 22, 2016 Cadman V. The impact of surgical safety checklists on theatre departments: a critical review of the literature. J Perioper Pract. 2016;26(4):62-71. https://psnet.ahrq.gov/issue/impact-surgical-safety…
  17. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/73701/psn-pdf
    September 15, 2021 - Simulation-based education enhances patient safety behaviors during central venous catheter placement. September 15, 2021 Jagneaux T, Caffery TS, Musso MW, et al. Simulation-based education enhances patient safety behaviors during central venous catheter placement. J Patient Saf. 2021;17(6):425-429. doi:10.1097/pt…
  18. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/42862/psn-pdf
    January 15, 2014 - VA Health Care: Improvements Needed in Processes Used to Address Providers' Actions That Contribute to Adverse Events. January 15, 2014 Draper D. Washington, DC: United States Government Accountability Office; December 3, 2013. Publication GAO-14-55. https://psnet.ahrq.gov/issue/va-health-care-improvements-needed…
  19. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/45886/psn-pdf
    July 05, 2017 - Organizational perspectives of nurse executives in 15 hospitals on the impact and effectiveness of rapid response teams. July 5, 2017 Smith PL, McSweeney J. Organizational Perspectives of Nurse Executives in 15 Hospitals on the Impact and Effectiveness of Rapid Response Teams. Jt Comm J Qual Patient Saf. 2017;43(6…
  20. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/46760/psn-pdf
    January 24, 2018 - Systematic evidence review of rates and burden of harm of intravenous admixture drug preparation errors in healthcare settings. January 24, 2018 Hedlund N, Beer I, Hoppe-Tichy T, et al. Systematic evidence review of rates and burden of harm of intravenous admixture drug preparation errors in healthcare settings. B…