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psnet.ahrq.gov/node/34700/psn-pdf
January 04, 2017 - Reducing adverse drug events: lessons from a
breakthrough series collaborative.
January 4, 2017
Leape L, Kabcenell AI, Gandhi TK, et al. Reducing adverse drug events: lessons from a breakthrough
series collaborative. Jt Comm J Qual Improv. 2000;26(6):321-31.
https://psnet.ahrq.gov/issue/reducing-adverse-drug-event…
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psnet.ahrq.gov/node/60736/psn-pdf
July 29, 2020 - Use of an electronic decision support tool to reduce
polypharmacy in elderly people with chronic diseases:
cluster randomised controlled trial.
July 29, 2020
Rieckert A, Reeves D, Altiner A, et al. Use of an electronic decision support tool to reduce polypharmacy in
elderly people with chronic diseases: cluster ra…
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psnet.ahrq.gov/node/47816/psn-pdf
June 26, 2019 - Clinical reasoning assessment methods: a scoping
review and practical guidance.
June 26, 2019
Daniel M, Rencic J, Durning SJ, et al. Clinical Reasoning Assessment Methods: A Scoping Review and
Practical Guidance. Acad Med. 2019;94(6):902-912. doi:10.1097/ACM.0000000000002618.
https://psnet.ahrq.gov/issue/clinical-…
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psnet.ahrq.gov/node/45819/psn-pdf
March 15, 2017 - How doctors think: common diagnostic errors in clinical
judgment--lessons from an undiagnosed and rare disease
program.
March 15, 2017
Kliegman RM, Bordini BJ, Basel D, et al. How Doctors Think: Common Diagnostic Errors in Clinical
Judgment-Lessons from an Undiagnosed and Rare Disease Program. Pediatr Clin North A…
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August 04, 2021 - Coping strategies in health care providers as second
victims: a systematic review.
August 4, 2021
Kappes M, Romero?García M, Delgado?Hito P. Coping strategies in health care providers as second
victims: a systematic review. Int Nurs Rev. 2021;68(4):471-481. doi:10.1111/inr.12694.
https://psnet.ahrq.gov/issue/copin…
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psnet.ahrq.gov/node/35928/psn-pdf
June 09, 2011 - Clinical pharmacists and inpatient medical care: a
systematic review.
June 9, 2011
Kaboli PJ, Hoth AB, McClimon BJ, et al. Clinical pharmacists and inpatient medical care: a systematic
review. Arch Intern Med. 2006;166(9):955-64.
https://psnet.ahrq.gov/issue/clinical-pharmacists-and-inpatient-medical-care-systemat…
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psnet.ahrq.gov/node/61017/psn-pdf
October 14, 2020 - Impact of pharmacist interventions on medication errors
in hospitalized pediatric patients: a systematic review and
meta-analysis.
October 14, 2020
Naseralallah LM, Hussain TA, Jaam M, et al. Impact of pharmacist interventions on medication errors in
hospitalized pediatric patients: a systematic review and meta-an…
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psnet.ahrq.gov/node/36496/psn-pdf
February 28, 2011 - Literacy and misunderstanding prescription drug labels.
February 28, 2011
Davis TC, Wolf MS, Bass PF, et al. Literacy and misunderstanding prescription drug labels. Ann Intern
Med. 2006;145(12):887-94.
https://psnet.ahrq.gov/issue/literacy-and-misunderstanding-prescription-drug-labels
Poor health literacy has been…
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psnet.ahrq.gov/node/47012/psn-pdf
August 01, 2018 - Trigger alerts associated with laboratory abnormalities on
identifying potentially preventable adverse drug events in
the intensive care unit and general ward.
August 1, 2018
Buckley MS, Rasmussen JR, Bikin DS, et al. Trigger alerts associated with laboratory abnormalities on
identifying potentially preventable ad…
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psnet.ahrq.gov/node/47638/psn-pdf
February 06, 2019 - Decreasing surgical site infections by developing a high
reliability culture.
February 6, 2019
Pettis AM. Decreasing Surgical Site Infections by Developing a High Reliability Culture. AORN J.
2018;108(6):644-650. doi:10.1002/aorn.12416.
https://psnet.ahrq.gov/issue/decreasing-surgical-site-infections-developing-hi…
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psnet.ahrq.gov/node/73611/psn-pdf
August 18, 2021 - Racial disparities in diagnostic delay among women with
breast cancer.
August 18, 2021
Miller-Kleinhenz JM, Collin LJ, Seidel R, et al. Racial disparities in diagnostic delay among women with
breast cancer. J Am Coll Radiol. 2021;18(10):1384-1393. doi:10.1016/j.jacr.2021.06.019.
https://psnet.ahrq.gov/issue/racial…
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psnet.ahrq.gov/node/37721/psn-pdf
April 30, 2008 - Errors and the burden of errors: attitudes, perceptions,
and the culture of safety in pediatric cardiac surgical
teams.
April 30, 2008
Bognár A, Barach P, Johnson J, et al. Errors and the burden of errors: attitudes, perceptions, and the
culture of safety in pediatric cardiac surgical teams. Ann Thorac Surg. 2008;…
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psnet.ahrq.gov/node/44130/psn-pdf
May 13, 2015 - Recent Evidence That Health IT Improves Patient Safety:
Issue Brief.
May 13, 2015
Banger A, Graber ML. Washington, DC: Office of the National Coordinator for Health Information
Technology; February 2015.
https://psnet.ahrq.gov/issue/recent-evidence-health-it-improves-patient-safety-issue-brief
Rapid implementatio…
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psnet.ahrq.gov/node/39298/psn-pdf
June 11, 2010 - Medication error reporting in nursing homes: identifying
targets for patient safety improvement.
June 11, 2010
Greene SB, Williams CE, Pierson S, et al. Medication error reporting in nursing homes: identifying targets
for patient safety improvement. Qual Saf Health Care. 2010;19(3):218-22. doi:10.1136/qshc.2008.031…
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psnet.ahrq.gov/node/848092/psn-pdf
April 26, 2023 - Doctors must stop tuning out Black women. It happened
to me, as a pregnant OB-GYN.
April 26, 2023
Gillispie-Bell V. USA Today. April 14, 2023.
https://psnet.ahrq.gov/issue/doctors-must-stop-tuning-out-black-women-it-happened-me-pregnant-ob-gyn
Structural racism and implicit biases can lead to poor quality of care …
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psnet.ahrq.gov/node/73164/psn-pdf
April 21, 2021 - Effectiveness of communication interventions in
obstetrics--a systematic review.
April 21, 2021
Lippke S, Derksen C, Keller FM, et al. Effectiveness of communication interventions in obstetrics--a
systematic review. Int J Environ Res Public Health. 2021;18(5):2616. doi:10.3390/ijerph18052616.
https://psnet.ahrq.go…
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psnet.ahrq.gov/node/866439/psn-pdf
August 07, 2024 - Associations between negative patient safety climate and
infection prevention practices.
August 7, 2024
Johnson CT, Hessels AJ. Associations between negative patient safety climate and infection prevention
practices. Am J Infect Control. 2024;52(9):1102-1104. doi:10.1016/j.ajic.2024.06.010.
https://psnet.ahrq.gov/…
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psnet.ahrq.gov/node/42362/psn-pdf
July 10, 2013 - How to improve change of shift handovers and
collaborative grounding and what role does the electronic
patient record system play? Results of a systematic
literature review.
July 10, 2013
Flemming D, Hübner U. How to improve change of shift handovers and collaborative grounding and what
role does the electronic p…
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psnet.ahrq.gov/node/74097/psn-pdf
November 24, 2021 - Inattentional blindness in anesthesiology: a gorilla is
worth one thousand words.
November 24, 2021
De Cassai A, Negro S, Geraldini F, et al. Inattentional blindness in anesthesiology: a gorilla is worth one
thousand words. PLoS One. 2021;16(9):e0257508. doi:10.1371/journal.pone.0257508.
https://psnet.ahrq.gov/iss…
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psnet.ahrq.gov/node/44199/psn-pdf
September 09, 2015 - Raising the alarm: a cross-sectional study exploring the
factors affecting patients' willingness to escalate care on
surgical wards.
September 9, 2015
Johnston MJ, Davis R, Arora S, et al. Raising the Alarm: A Cross-Sectional Study Exploring the Factors
Affecting Patients' Willingness to Escalate Care on Surgical …