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psnet.ahrq.gov/issue/survey-impact-disruptive-behaviors-and-communication-defects-patient-safety
February 03, 2010 - Study
Classic
A survey of the impact of disruptive behaviors and communication defects on patient safety.
Citation Text:
Rosenstein AH, O'Daniel M. A survey of the impact of disruptive behaviors and communication defects on patient safety. Jt Comm J Qual Patie…
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psnet.ahrq.gov/issue/medication-administration-aged-care-facilities-mixed-methods-systematic-review
March 05, 2025 - Review
Medication administration in aged care facilities: a mixed-methods systematic review.
Citation Text:
Garratt S, Dowling A, Manias E. Medication administration in aged care facilities: a mixed‐methods systematic review. J Adv Nurs. 2025;81(2):621-640. doi:10.1111/jan.16318.
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psnet.ahrq.gov/issue/reframing-morbidity-and-mortality-conference-impact-just-culture
November 15, 2018 - Review
Reframing the morbidity and mortality conference: the impact of a just culture.
Citation Text:
Brook K, Agarwala AV, Tewfik GL. Reframing the morbidity and mortality conference: the impact of a just culture. J Patient Saf. 2024;40(4):280-287. doi:10.1097/pts.0000000000001224.
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psnet.ahrq.gov/issue/effects-cpoe-based-medication-ordering-outcomes-overview-systematic-reviews
March 10, 2021 - Review
Effects of CPOE-based medication ordering on outcomes: an overview of systematic reviews.
Citation Text:
Abraham J, Kitsiou S, Meng A, et al. Effects of CPOE-based medication ordering on outcomes: an overview of systematic reviews. BMJ Qual Saf. 2020;29(10):854–863. doi:10.1136/bm…
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psnet.ahrq.gov/issue/problem-making-safety-ii-work-healthcare
April 28, 2021 - Commentary
The problem with making Safety-II work in healthcare.
Citation Text:
Verhagen MJ, de Vos MS, Sujan M, et al. The problem with making Safety-II work in healthcare. BMJ Qual Saf. 2022;31(5):402-408. doi:10.1136/bmjqs-2021-014396.
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psnet.ahrq.gov/issue/disparities-racial-ethnic-and-payer-groups-pediatric-safety-events-us-hospitals
February 21, 2024 - Study
Disparities in racial, ethnic, and payer groups for pediatric safety events in US hospitals.
Citation Text:
Parikh K, Hall M, Tieder JS, et al. Disparities in racial, ethnic, and payer groups for pediatric safety events in US hospitals. Pediatrics. 2024;153(3):e2023063714. doi:10.1…
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psnet.ahrq.gov/issue/dispensing-error-rates-pharmacy-systematic-review-and-meta-analysis
June 10, 2020 - Review
Dispensing error rates in pharmacy: a systematic review and meta-analysis.
Citation Text:
Um IS, Clough A, Tan ECK. Dispensing error rates in pharmacy: a systematic review and meta-analysis. Res Social Adm Pharm. 2024;20(1):1-9. doi:10.1016/j.sapharm.2023.10.003.
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psnet.ahrq.gov/issue/practice-respect-icu
August 09, 2018 - Commentary
Emerging Classic
The practice of respect in the ICU.
Citation Text:
Brown SM, Azoulay E, Benoit D, et al. The Practice of Respect in the ICU. Am J Respir Crit Care Med. 2018;197(11):1389-1395. doi:10.1164/rccm.201708-1676CP.
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psnet.ahrq.gov/issue/health-care-worker-fatigue-and-patient-safety
December 23, 2016 - Sentinel Event Alerts
Health care worker fatigue and patient safety.
Citation Text:
Health care worker fatigue and patient safety. Sentinel Event Alert. December 14, 2011;(48):1-4. (addendum May 14, 2018).
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www.ahrq.gov/pqmp/implementation-qi/lessons.html
August 01, 2021 - Lessons from the Field Reports
The Pediatric Quality Measures Program (PQMP) was established to increase the portfolio of evidence-based, consensus pediatric quality measures available to public and private purchasers of children's health care services. It was established following enactment of the Children's H…
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psnet.ahrq.gov/issue/evaluation-design-and-structure-electronic-medication-labels-improve-patient-health-knowledge
October 16, 2024 - Review
Evaluation of the design and structure of electronic medication labels to improve patient health knowledge and safety: a systematic review.
Citation Text:
Saif S, Bui TTT, Srivastava G, et al. Evaluation of the design and structure of electronic medication labels to improve patien…
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psnet.ahrq.gov/issue/association-between-electronic-health-record-implementations-and-hospital-acquired-conditions
September 01, 2016 - Study
Association between electronic health record implementations and hospital-acquired conditions in pediatric hospitals.
Citation Text:
Rabbani N, Pageler NM, Hoffman JM, et al. Association between electronic health record implementations and hospital-acquired conditions in pediatric …
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psnet.ahrq.gov/issue/addressing-opioid-epidemic-united-states-lessons-department-veterans-affairs
September 07, 2022 - Commentary
Classic
Addressing the opioid epidemic in the United States: lessons from the Department of Veterans Affairs.
Citation Text:
Gellad WF, Good CB, Shulkin DJ. Addressing the Opioid Epidemic in the United States: Lessons From the Department of Veterans A…
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psnet.ahrq.gov/issue/error-management-lessons-aviation
September 13, 2011 - Commentary
Classic
On error management: lessons from aviation.
Citation Text:
Helmreich RL. On error management: lessons from aviation. BMJ . 2000;320(7237):781-785.
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psnet.ahrq.gov/issue/safety-evaluation-impact-maternity-orientated-human-factors-training-safety-culture-tertiary
October 19, 2022 - Study
A safety evaluation of the impact of maternity-orientated human factors training on safety culture in a tertiary maternity unit.
Citation Text:
Ansari SP, Rayfield ME, Wallis VA, et al. A Safety Evaluation of the Impact of Maternity-Orientated Human Factors Training on Safety Cultu…
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psnet.ahrq.gov/issue/burnout-nursing-home-health-care-aide-systematic-review
May 18, 2022 - Review
Burnout in the nursing home health care aide: a systematic review.
Citation Text:
Cooper SL, Carleton HL, Chamberlain SA, et al. Burnout in the nursing home health care aide: A systematic review. Burn Res. 2016;3(3):76-87. doi:10.1016/j.burn.2016.06.003.
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psnet.ahrq.gov/issue/alliance-innovation-maternal-health-consensus-bundle-sepsis-obstetric-care
August 21, 2024 - Organizational Policy/Guidelines
Alliance for Innovation on Maternal Health: Consensus Bundle on Sepsis in Obstetric Care.
Citation Text:
Bauer ME, Albright C, Prabhu M, et al. Alliance for Innovation on Maternal Health: Consensus Bundle on Sepsis in Obstetric Care. Obstet Gynecol. 2023;…
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psnet.ahrq.gov/issue/changes-supervision-community-pharmacy-pharmacist-and-pharmacy-support-staff-views
June 17, 2020 - Study
Changes to supervision in community pharmacy: pharmacist and pharmacy support staff views.
Citation Text:
Bradley F, Schafheutle EI, Willis SC, et al. Changes to supervision in community pharmacy: pharmacist and pharmacy support staff views. Health Soc Care Community. 2013;21(6):…
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psnet.ahrq.gov/issue/occurrence-wrong-site-surgery-self-reported-candidates-certification-american-board
June 03, 2020 - Study
The occurrence of wrong-site surgery self-reported by candidates for certification by the American Board of Orthopaedic Surgery.
Citation Text:
James MA, Seiler JG, Harrast JJ, et al. The occurrence of wrong-site surgery self-reported by candidates for certification by the Americ…
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psnet.ahrq.gov/issue/communication-and-patient-safety-training-programme-all-healthcare-staff-can-it-make
July 01, 2017 - Study
A 'Communication and Patient Safety' training programme for all healthcare staff: can it make a difference?
Citation Text:
Lee P, Allen K, Daly M. A ‘Communication and Patient Safety’ training programme for all healthcare staff: can it make a difference? BMJ Qual Saf. 2011;21(1).…