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  1. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/44516/psn-pdf
    June 10, 2018 - Managing hospitalized patients with ambulatory pumps: findings from an ISMP survey—Part 1. June 10, 2018 ISMP Medication Safety Alert! Acute care edition. November 19, 2015;20(23):1-5. https://psnet.ahrq.gov/issue/managing-hospitalized-patients-ambulatory-pumps-findings-ismp-survey-part-1 Infusion therapies are in…
  2. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/33671/psn-pdf
    July 01, 2008 - The Soil, Not the Seed: The Real Problem with Root Cause Analysis July 1, 2008 Spath P, Minogue W. The Soil, Not the Seed: The Real Problem with Root Cause Analysis. PSNet [internet]. 2008. https://psnet.ahrq.gov/perspective/soil-not-seed-real-problem-root-cause-analysis Perspective Throughout most of his life, …
  3. psnet.ahrq.gov/perspective/peacehealth-governance-journey-support-quality-and-safety
    August 01, 2007 - The PeaceHealth Governance Journey in Support of Quality and Safety John L. Haughom, MD | August 1, 2007  Also Read a Conversation View more articles from the same authors. Citation Text: Haughom JL. The PeaceHealth Governance Journey in Support of Quality and …
  4. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/50696/psn-pdf
    November 27, 2019 - Lorazepam was likely selected for this patient because it had been utilized to treat anxiety during prior hospitalizations
  5. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/74830/psn-pdf
    June 01, 2022 - The Michigan Hospital Medicine Safety Consortium (HMS) Finds Infectious Diseases (ID) Physician Approval for Placement of Peripherally Inserted Central Catheters (PICCs) Prevents Unnecessary PICC Use and Reduces Complications February 23, 2022 https://psnet.ahrq.gov/innovation/michigan-hospital-medicine-safety-co…
  6. psnet.ahrq.gov/issue/evaluation-association-between-nursing-home-survey-patient-safety-culture-nhsops-measures-and
    April 05, 2017 - Study Evaluation of the association between Nursing Home Survey on Patient Safety culture (NHSOPS) measures and catheter-associated urinary tract infections: results of a national collaborative. Citation Text: Smith SN, Greene MT, Mody L, et al. Evaluation of the association between Nurs…
  7. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/33562/psn-pdf
    September 15, 2024 - Rapid Response Systems September 15, 2024 Rapid Response Systems. PSNet [internet]. 2019. https://psnet.ahrq.gov/primer/rapid-response-systems PSNet primers are regularly reviewed and updated by the UC Davis PSNet Editorial Team to ensure that they reflect current research and practice in the patient safety field.…
  8. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/846756/psn-pdf
    March 29, 2023 - Frequency of medication administration timing error in hospitals: a systematic review. March 29, 2023 Pullam T, Russell CL, White-Lewis S. Frequency of medication administration timing error in hospitals: a systematic review. J Nurs Care Qual. 2023;38(2):126-133. doi:10.1097/ncq.0000000000000668. https://psnet.ahr…
  9. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/853072/psn-pdf
    September 01, 2014 - Compendium of Strategies to Prevent HAIs in Acute Care Hospitals 2014. September 1, 2014 Infect Control Hosp Epidemiol. 2014;35(Suppl 2):s1-s178;35:460-463;797-801. https://psnet.ahrq.gov/issue/compendium-strategies-prevent-hais-acute-care-hospitals-2014 Preventing healthcare-acquired infections (HAIs) remains a p…
  10. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/44172/psn-pdf
    September 28, 2016 - Preventing high-alert medication errors in hospital patients. September 28, 2016 Anderson P, Townsend T. Am Nurse Today. May 2015;10:18-23. https://psnet.ahrq.gov/issue/preventing-high-alert-medication-errors-hospital-patients High-alert medications have the potential to cause serious patient harm. This article fo…
  11. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/34811/psn-pdf
    March 28, 2005 - Medication error prevention by clinical pharmacists in two children's hospitals. March 28, 2005 Folli HL; Poole RL; Benitz WE; Russo JC https://psnet.ahrq.gov/issue/medication-error-prevention-clinical-pharmacists-two-childrens-hospitals This prospective study recorded the rate and potential for harm caused by err…
  12. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/37452/psn-pdf
    January 09, 2008 - A randomized clinical trial to compare the use of safety net enclosures with standard restraints in agitated hospitalized patients. January 9, 2008 Nawaz H, Abbas A, Sarfraz A, et al. A randomized clinical trial to compare the use of safety net enclosures with standard restraints in agitated hospitalized patients.…
  13. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/50744/psn-pdf
    December 18, 2019 - EMS crews brought patients to the hospital with misplaced breathing tubes. None of them survived December 18, 2019 Arditi L. Peoples Public Radio. December 3, 2019. https://psnet.ahrq.gov/issue/ems-crews-brought-patients-hospital-misplaced-breathing-tubes-none-them- survived Emergency medical services are often p…
  14. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/73589/psn-pdf
    August 11, 2021 - Suicide and suicide attempts on hospital grounds and clinic areas. August 11, 2021 Mills PD, Watts BV, Hemphill RR. Suicide and suicide attempts on hospital grounds and clinic areas. J Patient Saf. 2021;17(5):e423-e428. doi:10.1097/pts.0000000000000356. https://psnet.ahrq.gov/issue/suicide-and-suicide-attempts-hos…
  15. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/852801/psn-pdf
    August 23, 2023 - Nearly all hospital pharmacists say drug shortages are negatively impacting care; a third say impacts are ‘critical.’ August 23, 2023 McPhillips D. CNN. August 10, 2023. https://psnet.ahrq.gov/issue/nearly-all-hospital-pharmacists-say-drug-shortages-are-negatively-impacting- care-third-say Drug shortages present…
  16. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/838312/psn-pdf
    October 12, 2022 - Causes of adverse events in home mechanical ventilation: a nursing perspective. October 12, 2022 Lipprandt M, Liedtke W, Langanke M, et al. Causes of adverse events in home mechanical ventilation: a nursing perspective. BMC Nurs. 2022;21(1):264. doi:10.1186/s12912-022-01038-2. https://psnet.ahrq.gov/issue/causes-a…
  17. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/60237/psn-pdf
    April 15, 2020 - Coronavirus strains hospitals, cancer patients face treatment delays, uncertainty. April 15, 2020 Stone W. Health Shots. National Public Radio. April 2, 2020. https://psnet.ahrq.gov/issue/coronavirus-strains-hospitals-cancer-patients-face-treatment-delays- uncertainty Lack of access to services is emerging as a p…
  18. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/48134/psn-pdf
    August 14, 2019 - Root cause analysis for hospital-acquired pressure injury. August 14, 2019 Black JM. Root cause analysis for hospital-acquired pressure injury. J Wound Ostomy Continence Nurs. 2019;46(4):298-304. doi:10.1097/WON.0000000000000546. https://psnet.ahrq.gov/issue/root-cause-analysis-hospital-acquired-pressure-injury Pr…
  19. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/863763/psn-pdf
    March 06, 2024 - After his wife died, he joined nurses to push for new staffing rules in hospitals. March 6, 2024 Wells K. Health Shots. KFF News and Michigan Public. February 22, 2024. https://psnet.ahrq.gov/issue/after-his-wife-died-he-joined-nurses-push-new-staffing-rules-hospitals Mandatory staffing ratios are a controversial …
  20. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/46522/psn-pdf
    October 29, 2017 - Public reporting of surgical outcomes: surgeons, hospitals, or both? October 29, 2017 Jha AK. Public Reporting of Surgical Outcomes: Surgeons, Hospitals, or Both? JAMA. 2017;318(15):1429- 1430. doi:10.1001/jama.2017.13815. https://psnet.ahrq.gov/issue/public-reporting-surgical-outcomes-surgeons-hospitals-or-both …

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