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psnet.ahrq.gov/node/50787/psn-pdf
January 08, 2020 - Q3 Health Innovation Partners.
January 8, 2020
New Jersey Hospital Association, the Ohio Hospital Association and The Hospital and Healthsystem
Association of Pennsylvania.
https://psnet.ahrq.gov/issue/q3-health-innovation-partners
Local efforts that draw from the experience of its leaders serve an important role …
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psnet.ahrq.gov/node/43492/psn-pdf
September 03, 2014 - Rethinking hospital restraints.
September 3, 2014
Parikh R. The Atlantic. August 18, 2014.
https://psnet.ahrq.gov/issue/rethinking-hospital-restraints
The inappropriate use of physical restraints on patients is considered a sentinel event. Although restraints
may be used to protect patients from harm, this magazin…
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psnet.ahrq.gov/node/43237/psn-pdf
June 04, 2014 - After a medical error, patients could become hospital
insiders.
June 4, 2014
Clark C. HealthLeaders Media. May 22, 2014.
https://psnet.ahrq.gov/issue/after-medical-error-patients-could-become-hospital-insiders
Highlighting examples of patients who have experienced errors partnering in safety efforts, this news art…
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psnet.ahrq.gov/perspective/medias-role-patient-safety
April 27, 2022 - The Media’s Role in Patient Safety
April 27, 2022
Also Read the Conversation
View more articles from the same authors.
Citation Text:
Millenson ML, Dowell P, Mossburg SE. The Media’s Role in Patient Safety. PSNet [internet]. Rockville (MD): Agency for Healthcar…
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psnet.ahrq.gov/perspective/conversation-michael-l-millenson
April 27, 2022 - In Conversation With... Michael L. Millenson
April 27, 2022
Also Read the Essay
Citation Text:
In Conversation With.. Michael L. Millenson. PSNet [internet]. 2022.In Conversation With... Michael L. Millenson. PSNet [internet]. Rockville (MD): Agency for Healthcar…
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psnet.ahrq.gov/web-mm/code-status-vs-care-status
September 30, 2020 - SPOTLIGHT CASE
Code Status vs. Care Status
Citation Text:
Krisman RK, Spero H. Code Status vs. Care Status. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2020.
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psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.239_slideshow.ppt
May 01, 2011 - Spotlight Case July 2008
Spotlight Case
Duty to Disclose Someone Else’s Error
*
*
Source and Credits
This presentation is based on the May 2011
AHRQ WebM&M Spotlight Case
See the full article at http://webmm.ahrq.gov
CME credit is available
Commentary by: Thomas H. Gallagher, MD University of Washington
…
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psnet.ahrq.gov/perspective/conversation-susan-mcgrath-phd-and-george-blike-md-about-surveillance-monitoring
April 26, 2023 - In Conversation with... Susan McGrath, PhD and George Blike, MD about Surveillance Monitoring
April 26, 2023
Also Read the Essay
Citation Text:
In Conversation with.. Susan McGrath, PhD and George Blike, MD about Surveillance Monitoring. PSNet [internet]. 2023.In…
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psnet.ahrq.gov/node/41833/psn-pdf
November 14, 2012 - Risks related to patient bed safety.
November 14, 2012
Sharkey JE, Van Leuven K, Radovich P. Risks related to patient bed safety. J Nurs Care Qual.
2012;27(4):346-51. doi:10.1097/NCQ.0b013e318264744b.
https://psnet.ahrq.gov/issue/risks-related-patient-bed-safety
Reviewing the three major contributing factors to me…
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psnet.ahrq.gov/node/50647/psn-pdf
November 06, 2019 - ‘Fear of falling’: how hospitals do even more harm by
keeping patients in bed.
November 6, 2019
Bailey M. Kaiser Health News. October 17, 2019.
https://psnet.ahrq.gov/issue/fear-falling-how-hospitals-do-even-more-harm-keeping-patients-bed
Patient falls with harm are a common sentinel event. This news story discuss…
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psnet.ahrq.gov/node/39847/psn-pdf
September 15, 2010 - Adult Hospital Stays with Infections Due to Medical Care,
2007.
September 15, 2010
Lucado J, Paez K, Andrews R, Steiner C. HCUP Statistical Brief #94. Rockville, MD: Agency for Healthcare
Research and Quality; August 2010.
https://psnet.ahrq.gov/issue/adult-hospital-stays-infections-due-medical-care-2007
This rep…
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psnet.ahrq.gov/node/38041/psn-pdf
July 02, 2009 - Never events: Utah hospitals saw nearly 60 serious errors
in 2007.
July 2, 2009
May H. Salt Lake Tribune. August 18, 2008.
https://psnet.ahrq.gov/issue/never-events-utah-hospitals-saw-nearly-60-serious-errors-2007
This article examines 2007 state health data on never events in the context of a label-related medica…
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psnet.ahrq.gov/issue/transitioning-newborns-nicu-home-resource-toolkit
August 01, 2012 - Government Resource
Transitioning Newborns From NICU to Home: A Resource Toolkit.
Citation Text:
Transitioning Newborns From NICU to Home: A Resource Toolkit. Rockville, MD: Agency for Healthcare Research and Quality; December 2013. AHRQ Publication No. 12(14)-0054-EF.
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psnet.ahrq.gov/issue/medication-safety-issue-brief-bar-code-implementation-strategies
June 17, 2014 - Fact Sheet/FAQs
Medication safety issue brief. Bar code implementation strategies.
Citation Text:
Association AH, Pharmacists AS of H-S, Networks H and H. Medication Safety Issue Brief. Bar Code implementation strategies. Hospitals & health networks. 2005;79(7):65-6.
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psnet.ahrq.gov/issue/adverse-glycemic-events-and-critical-emergencies
December 14, 2022 - Newspaper/Magazine Article
Adverse glycemic events and critical emergencies.
Citation Text:
Adverse glycemic events and critical emergencies. ISMP Medication Safety Alert! Acute care edition. December 2, 2021;(24)1-4.
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psnet.ahrq.gov/issue/missed-or-rationed-nursing-care
February 12, 2020 - Special or Theme Issue
Missed or Rationed Nursing Care.
Citation Text:
Missed or Rationed Nursing Care. J Nurs Manag. 2020;28(8): i-iv, 1767-2275.
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psnet.ahrq.gov/issue/survey-results-pharmacists-provide-support-enhance-organizational-response-codes
November 02, 2022 - Newspaper/Magazine Article
Survey results from pharmacists provide support to enhance the organizational response to codes.
Citation Text:
Survey results from pharmacists provide support to enhance the organizational response to codes. ISMP Medication Safety Alert! Acute care edition. Oc…
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psnet.ahrq.gov/issue/patient-safety-some-progress-and-many-challenges
June 22, 2009 - Commentary
Patient safety: some progress and many challenges.
Citation Text:
Gluck PA. Patient safety: some progress and many challenges. Obstet Gynecol. 2012;120(5):1149-1159.
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psnet.ahrq.gov/issue/physician-liability-age-data-reliance-and-errors
March 18, 2020 - Commentary
Physician liability in the age of data reliance and errors.
Citation Text:
Physician liability in the age of data reliance and errors. Montesantos L. Ann Health Law Life Sci. 2022;31(Spring):179-215.
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psnet.ahrq.gov/issue/attitudes-teamwork-and-safety-operating-theatre
December 22, 2010 - Study
Attitudes to teamwork and safety in the operating theatre.
Citation Text:
Flin R, Yule S, McKenzie L, et al. Attitudes to teamwork and safety in the operating theatre. Surgeon. 2006;4(3):145-51.
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