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psnet.ahrq.gov/issue/evaluating-impact-radio-frequency-identification-retained-surgical-instruments-tracking
August 03, 2022 - Review
Evaluating the impact of radio frequency identification retained surgical instruments tracking on patient safety: literature review.
Citation Text:
Schnock KO, Biggs B, Fladger A, et al. Evaluating the impact of radio frequency identification retained surgical instruments tracking…
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psnet.ahrq.gov/issue/how-safe-are-paediatric-emergency-departments-national-prospective-cohort-study
May 20, 2020 - Study
How safe are paediatric emergency departments? A national prospective cohort study.
Citation Text:
Plint AC, Newton AS, Stang A, et al. How safe are paediatric emergency departments? A national prospective cohort study. BMJ Qual Saf. 2022;31(11):806-817. doi:10.1136/bmjqs-2021-0146…
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psnet.ahrq.gov/issue/ambulatory-computerized-prescribing-and-preventable-adverse-drug-events
June 11, 2014 - Study
Ambulatory computerized prescribing and preventable adverse drug events.
Citation Text:
Overhage JM, Gandhi TK, Hope C, et al. Ambulatory Computerized Prescribing and Preventable Adverse Drug Events. J Patient Saf. 2016;12(2):69-74. doi:10.1097/PTS.0000000000000194.
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psnet.ahrq.gov/issue/trigger-tool-method-measure-harmful-medication-errors-children
August 03, 2022 - Study
The trigger tool as a method to measure harmful medication errors in children.
Citation Text:
Maaskant JM, Smeulers M, Bosman D, et al. The Trigger Tool as a Method to Measure Harmful Medication Errors in Children. J Patient Saf. 2018;14(2):95-100. doi:10.1097/PTS.0000000000000177.…
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psnet.ahrq.gov/issue/assessing-excess-costs-hospital-adverse-events-covered-ahrqs-patient-safety-indicators
January 10, 2024 - Study
Assessing the excess costs of the in-hospital adverse events covered by the AHRQ's Patient Safety Indicators in Switzerland.
Citation Text:
Giese A, Khanam R, Nghiem S, et al. Assessing the excess costs of the in-hospital adverse events covered by the AHRQ’s Patient Safety Indicato…
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psnet.ahrq.gov/issue/readmissions-observation-and-hospital-readmissions-reduction-program
October 25, 2017 - Study
Classic
Readmissions, observation, and the Hospital Readmissions Reduction Program.
Citation Text:
Zuckerman RB, Sheingold SH, Orav J, et al. Readmissions, Observation, and the Hospital Readmissions Reduction Program. N Engl J Med. 2016;374(16):1543-51. do…
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psnet.ahrq.gov/issue/developing-reliable-and-valid-patient-measure-safety-hospitals-pmos-validation-study
January 19, 2014 - Study
Developing a reliable and valid patient measure of safety in hospitals (PMOS): a validation study.
Citation Text:
McEachan RRC, Lawton R, O'Hara JK, et al. Developing a reliable and valid patient measure of safety in hospitals (PMOS): a validation study. BMJ Qual Saf. 2014;23(7):56…
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psnet.ahrq.gov/issue/electronic-medication-reconciliation-and-medication-errors
November 16, 2022 - Study
Electronic medication reconciliation and medication errors.
Citation Text:
Hron JD, Manzi S, Dionne R, et al. Electronic medication reconciliation and medication errors. Int J Qual Health Care. 2015;27(4):314-9. doi:10.1093/intqhc/mzv046.
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psnet.ahrq.gov/issue/nursing-time-devoted-medication-administration-long-term-care-clinical-safety-and-resource
February 11, 2009 - Study
Nursing time devoted to medication administration in long-term care: clinical, safety, and resource implications.
Citation Text:
Thomson MS, Gruneir A, Lee M, et al. Nursing time devoted to medication administration in long-term care: clinical, safety, and resource implications. J …
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psnet.ahrq.gov/issue/changing-experience-adverse-medical-events-national-health-service-comparison-two-population
February 16, 2011 - Study
Changing experience of adverse medical events in the National Health Service: comparison of two population surveys in 2001 and 2013.
Citation Text:
Gray AM, Fenn P, Rickman N, et al. Changing experience of adverse medical events in the National Health Service: Comparison of two pop…
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psnet.ahrq.gov/periodic-issue/periodic-issue-386
April 26, 2023 - Study
Using the Generic Analysis Method to analyze sentinel event reports across … This study pooled sentinel event reports from 28 Dutch hospitals to identify common system-level contributing
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psnet.ahrq.gov/node/49475/psn-pdf
March 01, 2005 - Source of New Failures
Just a few years ago, prior to development of digital radiology, this type of event … The source of this event is not human error on the part of the surgeon.
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psnet.ahrq.gov/web-mm/high-risk-medications-high-risk-transfers
December 21, 2017 - High-Risk Medications, High-Risk Transfers
Citation Text:
Staggers N. High-Risk Medications, High-Risk Transfers. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2017.
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psnet.ahrq.gov/issue/reporting-adverse-events-patients-step-step-approach
November 16, 2022 - Newspaper/Magazine Article
Reporting adverse events to patients: a step-by-step approach.
Citation Text:
Cherry RA, Marcus L, Dorn B. Reporting adverse events to patients: a step-by-step approach. Physician Executive. 2010;36(3):4-6, 8-9.
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psnet.ahrq.gov/issue/association-patient-photographs-and-reduced-retract-and-reorder-events
February 24, 2021 - Study
Association of patient photographs and reduced retract-and-reorder events.
Citation Text:
Rzewnicki D, Kanvinde A, Gillespie S, et al. Association of patient photographs and reduced retract-and-reorder events. JAMIA Open. 2024;7(3):ooae042. doi:10.1093/jamiaopen/ooae042.
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psnet.ahrq.gov/issue/hospital-costs-associated-adverse-events-gynecological-oncology
March 09, 2022 - Study
Hospital costs associated with adverse events in gynecological oncology.
Citation Text:
Kondalsamy-Chennakesavan S, Gordon LG, Sanday K, et al. Hospital costs associated with adverse events in gynecological oncology. Gynecol Oncol. 2011;121(1):70-5. doi:10.1016/j.ygyno.2010.11.03…
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psnet.ahrq.gov/issue/surgical-complications-disclosing-adverse-events-and-medical-errors
September 23, 2020 - Commentary
Surgical complications: disclosing adverse events and medical errors.
Citation Text:
Wang AS, Eisen DB. Surgical complications: disclosing adverse events and medical errors. J Am Acad Dermatol. 2013;68(1):144-6. doi:10.1016/j.jaad.2012.09.008.
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psnet.ahrq.gov/issue/dangerous-deception-hiding-evidence-adverse-drug-events
November 09, 2022 - Commentary
Dangerous deception--hiding the evidence of adverse drug events.
Citation Text:
Avorn J. Dangerous deception--hiding the evidence of adverse drug effects. N Engl J Med. 2006;355(21):2169-71.
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psnet.ahrq.gov/issue/detecting-adverse-drug-events-through-data-mining
February 17, 2009 - Commentary
Detecting adverse drug events through data mining.
Citation Text:
Glasgow JM, Kaboli PJ. Detecting adverse drug events through data mining. Am J Health Syst Pharm. 2010;67(4):317-20. doi:10.2146/ajhp090115.
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psnet.ahrq.gov/issue/enhancing-culture-safety-through-disclosure-adverse-events
October 26, 2022 - Newspaper/Magazine Article
Enhancing a culture of safety through disclosure of adverse events.
Citation Text:
Enhancing a culture of safety through disclosure of adverse events. Cornelissen C, Call RC, Harbell MW, et al. APSF Newsletter. February 202136(1);25-27
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