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psnet.ahrq.gov/glossary/forcing-functionSeptember 13, 2021 - Forcing Function September 13, 2021 Anonymous (not verified) An aspect of a design that prevents a target action from being performed or allows its performance only if another specific action is performed first. For example, automobiles are now designed so that the driver cannot shift into reverse without first…
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Psn-Pdf (pdf file)
psnet.ahrq.gov/node/42090/psn-pdfMarch 06, 2013 - Adverse drug events in a paediatric intensive care unit: a prospective cohort. March 6, 2013 Silva DCB, Araujo OR, Arduini RG, et al. Adverse drug events in a paediatric intensive care unit: a prospective cohort. BMJ Open. 2013;3(2):e001868. doi:10.1136/bmjopen-2012-001868. https://psnet.ahrq.gov/issue/adverse-dru… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/40728/psn-pdfOctober 21, 2011 - What prevents incident disclosure, and what can be done to promote it? October 21, 2011 Iedema R, Allen S, Sorensen R, et al. What prevents incident disclosure, and what can be done to promote it? Jt Comm J Qual Patient Saf. 2011;37(9):409-417. https://psnet.ahrq.gov/issue/what-prevents-incident-disclosure-and-wha… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/36745/psn-pdfMarch 10, 2011 - Reevaluating recovery: perceived violations and preemptive interventions on emergency psychiatry rounds. March 10, 2011 Cohen T, Blatter B, Almeida C, et al. Reevaluating recovery: perceived violations and preemptive interventions on emergency psychiatry rounds. J Am Med Inform Assoc. 2007;14(3):312-9. https://ps… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/39500/psn-pdfJanuary 03, 2017 - Using in situ simulation to improve in-hospital cardiopulmonary resuscitation. January 3, 2017 Lighthall GK, Poon T, Harrison K. Using in situ simulation to improve in-hospital cardiopulmonary resuscitation. Jt Comm J Qual Patient Saf. 2010;36(5):209-16. https://psnet.ahrq.gov/issue/using-situ-simulation-improve-h… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/41013/psn-pdfJanuary 01, 2012 - Patient safety in emergency medical services: a systematic review of the literature. December 21, 2011 Bigham BL, Buick JE, Brooks SC, et al. Patient safety in emergency medical services: a systematic review of the literature. Prehosp Emerg Care. 2012;16(1):20-35. doi:10.3109/10903127.2011.621045. https://psnet.ah… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/40584/psn-pdfJuly 25, 2011 - Crisis checklists for the operating room: development and pilot testing. July 25, 2011 Ziewacz JE, Arriaga AF, Bader AM, et al. Crisis checklists for the operating room: development and pilot testing. J Am Coll Surg. 2011;213(2):212-217.e10. doi:10.1016/j.jamcollsurg.2011.04.031. https://psnet.ahrq.gov/issue/crisi… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/43241/psn-pdfJune 11, 2014 - "It is the left eye, right?" June 11, 2014 Pikkel D, Sharabi-Nov A, Pikkel J. "It is the left eye, right?". Risk Manag Healthc Policy. 2014;7:77-80. doi:10.2147/RMHP.S60728. https://psnet.ahrq.gov/issue/it-left-eye-right In this study, cataract surgeons were asked to identify the correct eye for surgery when given… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/42591/psn-pdfJuly 16, 2015 - Underreporting of robotic surgery complications. July 16, 2015 Cooper M, Ibrahim AM, Lyu H, et al. Underreporting of robotic surgery complications. J Healthc Qual. 2015;37(2):133-8. doi:10.1111/jhq.12036. https://psnet.ahrq.gov/issue/underreporting-robotic-surgery-complications By cross-referencing court records a… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/43586/psn-pdfOctober 22, 2014 - Exploring the causes of junior doctors' prescribing mistakes: a qualitative study. October 22, 2014 Lewis PJ, Ashcroft DM, Dornan T, et al. Exploring the causes of junior doctors' prescribing mistakes: a qualitative study. Br J Clin Pharmacol. 2014;78(2):310-9. doi:10.1111/bcp.12332. https://psnet.ahrq.gov/issue/e… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/43495/psn-pdfDecember 15, 2014 - Disruptive behaviors among physicians. December 15, 2014 Sanchez LT. Disruptive behaviors among physicians. JAMA. 2014;312(21):2209-2210. doi:10.1001/jama.2014.10218. https://psnet.ahrq.gov/issue/disruptive-behaviors-among-physicians This commentary spotlights concerns about physicians with disruptive behaviors an… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/38785/psn-pdfSeptember 02, 2009 - An ethnographic study of classifying and accounting for risk at the sharp end of medical wards. September 2, 2009 Dixon-Woods M, Suokas A, Pitchforth E, et al. An ethnographic study of classifying and accounting for risk at the sharp end of medical wards. Soc Sci Med. 2009;69(3):362-9. doi:10.1016/j.socscimed.2009.… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/35310/psn-pdfJanuary 02, 2017 - Using the AHRQ Quality Indicators to improve health care quality. January 2, 2017 Elixhauser A, Pancholi M, Clancy CM. Using the AHRQ Quality Indicators to Improve Health Care Quality. Jt Comm J Qual Patient Saf. 2016;31(9):533-538. doi:10.1016/s1553-7250(05)31069-5. https://psnet.ahrq.gov/issue/using-ahrq-quality… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/43718/psn-pdfDecember 03, 2014 - Patient safety culture in nephrology nurse practice settings: initial findings. December 3, 2014 Ulrich B, Kear T. Nephrol Nurs J. 2014;41:459-476. https://psnet.ahrq.gov/issue/patient-safety-culture-nephrology-nurse-practice-settings-initial-findings This study utilized AHRQ patient safety culture surveys to asse… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/41499/psn-pdfDecember 29, 2014 - Strategies for sustaining a quality improvement collaborative and its patient safety gains. December 29, 2014 Parand A, Benn J, Burnett S, et al. Strategies for sustaining a quality improvement collaborative and its patient safety gains. Int J Qual Health Care. 2012;24(4):380-90. doi:10.1093/intqhc/mzs030. https:/… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/41185/psn-pdfMarch 24, 2012 - Learning from near misses: from quick fixes to closing off the Swiss-cheese holes. March 24, 2012 Jeffs L, Berta W, Lingard LA, et al. Learning from near misses: from quick fixes to closing off the Swiss- cheese holes. BMJ Qual Saf. 2012;21(4):287-94. doi:10.1136/bmjqs-2011-000256. https://psnet.ahrq.gov/issue/lea… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/42304/psn-pdfNovember 21, 2016 - Strategies for improving family engagement during family-centered rounds. November 21, 2016 Kelly MM, Xie A, Carayon P, et al. Strategies for improving family engagement during family-centered rounds. J Hosp Med. 2013;8(4):201-7. doi:10.1002/jhm.2022. https://psnet.ahrq.gov/issue/strategies-improving-family-engage… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/41343/psn-pdfDecember 29, 2014 - Prevalence of preventable medication-related hospitalizations in Australia: an opportunity to reduce harm. December 29, 2014 Kalisch LM, Caughey GE, Barratt JD, et al. Prevalence of preventable medication-related hospitalizations in Australia: an opportunity to reduce harm. Int J Qual Health Care. 2012;24(3):239-4… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/41346/psn-pdfMay 02, 2012 - Team mental models and their potential to improve teamwork and safety: a review and implications for future research in healthcare. May 2, 2012 Burtscher MJ, Manser T. Team mental models and their potential to improve teamwork and safety: A review and implications for future research in healthcare. Safety Sci. 201… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/39708/psn-pdfSeptember 09, 2010 - Adverse drug events in the outpatient setting: an 11-year national analysis. September 9, 2010 Bourgeois FT, Shannon MW, Valim C, et al. Adverse drug events in the outpatient setting: an 11-year national analysis. Pharmacoepidemiol Drug Saf. 2010;19(9):901-10. doi:10.1002/pds.1984. https://psnet.ahrq.gov/issue/adv…
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