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  1. How to Improve Electronic Health Record Usability and Patient Safety. | PSNet

    psnet.ahrq.gov/issue/how-improve-electronic-health-record-usability-and-patient-safety
    February 08, 2017 - Fact Sheet/FAQs How to Improve Electronic Health Record Usability and Patient Safety. Citation Text: How to Improve Electronic Health Record Usability and Patient Safety. Philadelphia, PA: Pew Charitable Trusts; September 6, 2016. Copy Citation Save Save to your l…

  2. Health IT Safety Center Roadmap. | PSNet

    psnet.ahrq.gov/issue/health-it-safety-center-roadmap
    June 29, 2016 - Government Resource Health IT Safety Center Roadmap. Citation Text: Health IT Safety Center Roadmap. RTI International. Washington, DC: Office of the National Coordinator for Health Information Technology; July 2015. Copy Citation Save Save to your library P…

  3. The Top Five: A Review of Post-Pandemic Patient Safety Priorities. | PSNet

    psnet.ahrq.gov/issue/top-five-review-post-pandemic-patient-safety-priorities
    July 10, 2024 - Book/Report The Top Five: A Review of Post-Pandemic Patient Safety Priorities. Citation Text: The Top Five: A Review of Post-Pandemic Patient Safety Priorities. Sacramento, CA: Hospital Quality Institute; 2024. Copy Citation Save Save to your library Print…

  4. The Field Guide to Human Error Investigations, Third Edition. | PSNet

    psnet.ahrq.gov/issue/field-guide-human-error-investigations-third-edition
    April 13, 2018 - Book/Report Classic The Field Guide to Human Error Investigations, Third Edition. Citation Text: The Field Guide to Human Error Investigations, Third Edition. Dekker S. Boca Baton, FL: CRC Press; 2017. Copy Citation Save Save to your libr…

  5. Enhancing physicians' use of clinical guidelines. | PSNet

    psnet.ahrq.gov/issue/enhancing-physicians-use-clinical-guidelines
    July 01, 2017 - Commentary Enhancing physicians' use of clinical guidelines. Citation Text: Pronovost P. Enhancing physicians' use of clinical guidelines. JAMA. 2013;310(23):2501-2. doi:10.1001/jama.2013.281334. Copy Citation Format: DOI Google Scholar PubMed BibTeX EndNote X3 XML EndNote …

  6. First annual review of data submitted to the ISMP National Vaccine Errors Reporting Program (VERP). | PSNet

    psnet.ahrq.gov/issue/first-annual-review-data-submitted-ismp-national-vaccine-errors-reporting-program-verp
    June 10, 2018 - Newspaper/Magazine Article First annual review of data submitted to the ISMP National Vaccine Errors Reporting Program (VERP). Citation Text: First annual review of data submitted to the ISMP National Vaccine Errors Reporting Program (VERP). ISMP Medication Safety Alert! Acute Care Editi…

  7. We need leaders: the 48th Annual Rovenstine Lecture. | PSNet

    psnet.ahrq.gov/issue/we-need-leaders-48th-annual-rovenstine-lecture
    July 01, 2017 - Commentary We need leaders: the 48th Annual Rovenstine Lecture. Citation Text: Pronovost P. We need leaders: The 48th Annual Rovenstine Lecture. Anesthesiology. 2010;112(4):779-785. doi:10.1097/ALN.0b013e3181d32047. Copy Citation Format: DOI Google Scholar PubMed BibTeX E…

  8. Disrespectful behavior in healthcare...have we made any progress in the last decade? | PSNet

    psnet.ahrq.gov/issue/disrespectful-behavior-healthcarehave-we-made-any-progress-last-decade
    March 15, 2022 - Newspaper/Magazine Article Disrespectful behavior in healthcare...have we made any progress in the last decade? Citation Text: Disrespectful behavior in healthcare...have we made any progress in the last decade? ISMP Medication Safety Alert! Acute Care Edition. June 27, 2013. Copy Cita…

  9. The Sociology of Healthcare Safety and Quality. | PSNet

    psnet.ahrq.gov/issue/sociology-healthcare-safety-and-quality
    March 02, 2016 - Special or Theme Issue The Sociology of Healthcare Safety and Quality. Citation Text: The Sociology of Healthcare Safety and Quality. Allen D, Braithwaite J, Sandall J, Waring J, eds. Sociol Health Illn. 2016;38(2):179-339. Copy Citation Save Save to your librar…

  10. Investigation into Management of Venous Thromboembolism Risk in Patients Following Thrombolysis for an Acute Stroke. | PSNet

    psnet.ahrq.gov/issue/investigation-management-venous-thromboembolism-risk-patients-following-thrombolysis-acute
    November 13, 2019 - Book/Report Investigation into Management of Venous Thromboembolism Risk in Patients Following Thrombolysis for an Acute Stroke. Citation Text: Investigation into Management of Venous Thromboembolism Risk in Patients Following Thrombolysis for an Acute Stroke. Farnborough, UK; Healthcare…

  11. Critical Radiology Alert Process | PSNet

    psnet.ahrq.gov/innovation/critical-radiology-alert-process
    November 16, 2022 - Critical Radiology Alert Process Save Save to your library Print Download PDF Share Facebook Twitter Linkedin Copy URL October 30, 2024 View more articles from the same authors. Innovation Contact …

  12. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49757/psn-pdf
    April 01, 2016 - Situational Awareness and Patient Safety April 1, 2016 Farnan JE. Situational Awareness and Patient Safety. PSNet [internet]. 2016. https://psnet.ahrq.gov/web-mm/situational-awareness-and-patient-safety The Case A 40-year-old woman with a history of cirrhosis and known esophageal varices was admitted to the hospit…

  13. Mark My Tooth | PSNet

    psnet.ahrq.gov/web-mm/mark-my-tooth
    June 01, 2014 - Mark My Tooth Citation Text: Smith RA. Mark My Tooth. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2007. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged PubMedId RIS D…

  14. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/867655/psn-pdf
    February 26, 2025 - Learning Health Systems for Patient Safety February 26, 2025 Savitz LA, Sousane Z, Mossburg SE. Learning Health Systems for Patient Safety. PSNet [internet]. 2025. https://psnet.ahrq.gov/perspective/learning-health-systems-patient-safety Despite an observable decrease in adverse events in health care over time, rat…

  15. Spotlight Case July 2008 (ppt file)

    psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.266_slideshow.ppt
    May 01, 2012 - Spotlight Case July 2008 Spotlight Case The Perils of Cross Coverage * * Source and Credits This presentation is based on the May 2012 AHRQ WebM&M Spotlight Case See the full article at http://webmm.ahrq.gov CME credit is available Commentary by: Jeanne M. Farnan, MD, MHPE, and Vineet M. Arora, MD, MAPP, …

  16. “This is the wrong patient's blood!”: Evaluating a Near-Miss Wrong Transfusion Event | PSNet

    psnet.ahrq.gov/web-mm/wrong-patients-blood-evaluating-near-miss-wrong-transfusion-event
    July 01, 2017 - SPOTLIGHT CASE “This is the wrong patient's blood!”: Evaluating a Near-Miss Wrong Transfusion Event Citation Text: Barnhard S. “This is the wrong patient's blood!”: Evaluating a Near-Miss Wrong Transfusion Event. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Dep…

  17. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49857/psn-pdf
    March 01, 2019 - orders following optimization interventions.(10) These included drug-related interventions such as identifying

  18. Delayed Diagnosis of Kidney Transplant Complications | PSNet

    psnet.ahrq.gov/web-mm/delayed-diagnosis-kidney-transplant-complications
    January 29, 2020 - Delayed Diagnosis of Kidney Transplant Complications Citation Text: Kapa N, Morfín JA. Delayed Diagnosis of Kidney Transplant Complications. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2022. Copy Citation Format: Goo…

  19. Medication Reconciliation Victory After an Avoidable Error | PSNet

    psnet.ahrq.gov/web-mm/medication-reconciliation-victory-after-avoidable-error
    April 01, 2015 - Medication Reconciliation Victory After an Avoidable Error Citation Text: Cutler TW. Medication Reconciliation Victory After an Avoidable Error. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2009. Copy Citation Format: …

  20. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49706/psn-pdf
    January 01, 2015 - Clostridium Difficile Relapse Secondary to Medication Access Issue April 1, 2014 Walker PC, Nagel J. Clostridium Difficile Relapse Secondary to Medication Access Issue. PSNet [internet]. 2014. https://psnet.ahrq.gov/web-mm/clostridium-difficile-relapse-secondary-medication-access-issue The Case A 24-year-old wom…
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