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psnet.ahrq.gov/issue/vha-national-patient-safety-improvement-handbook
April 12, 2019 - Related Resources
Anesthesia adverse events voluntarily reported in … April 12, 2019
Actions and implementation strategies to reduce suicidal events in the … January 2, 2017
Root cause analysis of serious adverse events among older patients in … July 22, 2013
Using root cause analysis to reduce falls with injury in the psychiatric … January 4, 2006
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Hospitals
Health
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psnet.ahrq.gov/node/49580/psn-pdf
March 21, 2009 - 2008 and 2009 NPSG from the Joint Commission highlight medication reconciliation as a requirement
for hospitals … Glintborg and colleagues found that patients admitted to a hospital in Denmark failed to
report 27% … the elderly can be
enhanced not only upon hospital admission but also in ambulatory care and pharmacy … The focus of medication reconciliation in the hospital has reduced
medication errors; however, more … [go to
PubMed]
4. 2009 Hospitals' National Patient Safety Goals.
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psnet.ahrq.gov/issue/system-failure-versus-personal-accountability-case-clean-hands
February 16, 2011 - major teaching hospitals and residents' knowledge of quality and patient safety? … February 16, 2011
Effect of nonpayment for preventable infections in U.S. hospitals. … April 11, 2011
Parents as partners in obtaining the medication history. … July 31, 2023
Patient Safety Innovations
Preventing Falls … One Toxic Drug Is Not Like Another
February 1, 2011
Fixing America's hospitals
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psnet.ahrq.gov/issue/patient-assisted-incident-reporting-including-patient-patient-safety
June 16, 2011 - Related Resources
Patient Safety Innovations
Preventing Falls … March 23, 2012
Patients' identification and reporting of unsafe events at six hospitals … December 8, 2011
Fall prevention in acute care hospitals: a randomized trial. … Clinical Handoffs (MATCH) study: an analysis of medication reconciliation errors and risk factors at hospital … Care Providers
Quality and Safety Professionals
General Internal Medicine
Hospital Medicine
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psnet.ahrq.gov/issue/shift-coupon-innovative-method-monitor-adverse-events
June 25, 2010 - This study describes an alternative method to track adverse events in the hospital setting and improve … Improving patients' perceptions of safety in hospitals. … a VA hospital: design and outcomes. … review of root cause analyses of falls leading to adverse events. … August 3, 2022
Effective strategies to increase reporting of medication errors in hospitals
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psnet.ahrq.gov/issue/whole-patient-measure-safety-using-administrative-data-assess-probability-highly-undesirable
March 19, 2014 - September 26, 2018
Association of hospital participation in a surgical outcomes monitoring … January 22, 2016
Mortality rate after nonelective hospital admission. … November 18, 2016
Compensation of chief executive officers at nonprofit US hospitals. … April 21, 2010
Falls in English and Welsh hospitals: a national observational study based … General Internal Medicine
Hospital Medicine
Epidemiology of Errors and Adverse Events
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psnet.ahrq.gov/issue/improving-patient-safety-culture-through-teamwork-and-communication-teamstepps
November 21, 2016 - July 17, 2013
Using Workforce Practices to Drive Quality Improvement: A Guide for Hospitals … May 6, 2015
Partnership for Patients (PfP) Hospital Engagement Network (HEN) 2.0 Final … October 19, 2016
Hand Hygiene Project: Best Practices from Hospitals Participating in … May 24, 2015
Preventing Patient Falls: A Systematic Approach From the Joint Commission … June 12, 2007
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Hospitals
Health Care
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psnet.ahrq.gov/issue/leadership-committed-safety
December 23, 2016 - Specific suggested actions include involving hospital boards and patients in safety efforts and making … December 23, 2016
Medical device alarm safety in hospitals. … February 10, 2021
Preventing falls and fall-related injuries in health care facilities … October 3, 2017
Improving America's Hospitals: The Joint Commission's Annual Report on … September 24, 2010
The High Costs of Weak Compliance With the New York State Hospital
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psnet.ahrq.gov/issue/semi-supervised-classification-patient-safety-event-reports
October 31, 2011 - a multistate hospital network--13 academic medical centers, April-June 2020. … of adverse events between hospitals and hospital departments. … March 24, 2012
Adverse-event-reporting practices by US hospitals: results of a national … November 25, 2009
Falls in English and Welsh hospitals: a national observational study … Quality and Safety Professionals
General Internal Medicine
Hospital Medicine
View More
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psnet.ahrq.gov/issue/improving-patient-safety-intersection-safety-culture-clinician-and-staff-support-and-patient
April 15, 2015 - August 21, 2019
Is the availability of hospital IT applications associated with a hospital's … risk adjusted incidence rate for patient safety indicators: results from 66 Georgia hospitals. … December 22, 2008
Improving hospital safety culture for falls prevention through interdisciplinary … Johnson VA Medical Center in Clarksburg, West Virginia. … June 12, 2007
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Hospitals
Health Care
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psnet.ahrq.gov/issue/curriculum-development-and-implementation-national-interprofessional-fellowship-patient
November 18, 2016 - December 21, 2018
Inpatient suicide on mental health units in Veterans Affairs (VA) hospitals … September 19, 2016
Death by suicide within 1 week of hospital discharge: a retrospective … June 21, 2017
Suicide and suicide attempts on hospital grounds and clinic areas. … November 21, 2012
Root cause analysis of reported patient falls in ORs in the Veterans … January 27, 2012
Residents' suggestions for reducing errors in teaching hospitals.
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psnet.ahrq.gov/node/45511/psn-pdf
July 21, 2017 - In this cluster randomized trial, hospital wards were designated either to receive usual
hospital care … included pressure ulcers, venous thromboembolism, catheter-associated urinary tract infections, and falls … While the
participating hospital wards were able to collect safety feedback from patients in a feasible … in the patient
engagement wards and the usual care wards. … psnet.ahrq.gov/primer/health-care-associated-infections
https://psnet.ahrq.gov/issue/fall-prevention-acute-care-hospitals-randomized-trial
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psnet.ahrq.gov/issue/enhancing-electronic-health-record-usability-pediatric-patient-care-scenario-based-approach
July 13, 2010 - a multistate hospital network--13 academic medical centers, April-June 2020. … January 25, 2017
Cost of inpatient falls and cost-benefit analysis of implementation … January 13, 2021
Families as partners in hospital error and adverse event surveillance … March 28, 2011
Preventing medication errors in hospitals through a systems approach and … August 2, 2010
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See More About The Topic
Children's Hospitals
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psnet.ahrq.gov/issue/managing-risk-during-transition-new-iso-tubing-connector-standards
December 23, 2016 - The Joint Commission issues sentinel event alerts in response to significant emerging safety risks … January 25, 2023
Health care workers in the midst of crisis. … February 10, 2021
Preventing falls and fall-related injuries in health care facilities … December 23, 2016
Safe use of opioids in hospitals. … Dosing
August 21, 2005
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Hospitals
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psnet.ahrq.gov/issue/nurses-practice-environments-error-interception-practices-and-inpatient-medication-errors
December 15, 2011 - February 2, 2011
Effects of nurse staffing and nurse education on patient deaths in hospitals … a Japanese hospital. … July 19, 2010
Relationship between call light use and response time and inpatient falls … medical and surgical wards of selected hospitals in Kuwait. … January 23, 2008
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Hospitals
Nurses
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psnet.ahrq.gov/issue/practically-speaking-rethinking-hand-hygiene-improvement-programs-health-care-settings
September 03, 2011 - January 22, 2025
Decreasing handoff-related care failures in children's hospitals. … review of root cause analyses of falls leading to adverse events. … May 22, 2019
Safer Hospital Care: Strategies for Continuous Innovation, Second Edition … September 10, 2013
Hand Hygiene Project: Best Practices from Hospitals Participating … July 21, 2010
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Hospitals
Health Care
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psnet.ahrq.gov/issue/are-we-finally-getting-serious-about-medical-errors
May 11, 2016 - Copy Citation
Related Resources From the Same Author(s)
Hospital Survey on … January 27, 2021
Evaluation of a patient-centered fall-prevention tool kit to reduce falls … August 18, 2021
Combined impact of Medicare's hospital pay for performance programs on … March 21, 2017
'Global Trigger Tool' shows that adverse events in hospitals may be ten … August 26, 2009
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Hospitals
Health
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psnet.ahrq.gov/node/33730/psn-pdf
June 01, 2012 - a national approach to appointing risk managers in hospitals. … In fact, the economic incentives in hospitals still work against risk management to some extent
because … For instance, there are millions of falls reported in this database, but relatively few classic
adverse … This is very public, very visible, and if you are running a hospital you can get
tremendous heat. … If you
want to study falls on a national basis for instance, after you have 500 or 1000 falls you probably
-
psnet.ahrq.gov/node/34766/psn-pdf
March 05, 2013 - safety practices (including computerized order entry, use of
pharmacists on rounds, methods to prevent falls … nosocomial infections, and interventions to create a
culture of safety), became quite influential, in … was the first effort to subject safety practices
to the same scrutiny as other clinical practices in … now-famous list of the top 11 practices became the focus of many a new patient safety program at
hospitals … , and it is worth reviewing recent literature before adopting even the most
highly rated practices in
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psnet.ahrq.gov/issue/noise-distraction-interruption-and-safety-hazard
February 01, 2014 - in student providers: a scoping review. … December 7, 2022
Effects of a communication-and-resolution program on hospitals' malpractice … November 30, 2012
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Related Resources
Do falls and other … September 24, 2016
Interruptions and multitasking in nursing care. … Error
February 1, 2006
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Hospitals