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Psn-Pdf (pdf file)
psnet.ahrq.gov/node/44425/psn-pdfFebruary 24, 2016 - Dangerous doses. February 24, 2016 Roe S, King K. Chicago Tribune. February 10–13, 2016. https://psnet.ahrq.gov/issue/dangerous-doses Drug interactions can be hazardous to patients, particularly when combined with risk factors such as age and use of medications for chronic conditions. This series of news reports d… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/41894/psn-pdfJanuary 01, 2016 - Simulator-based crew resource management training for interhospital transfer of critically ill patients by a mobile ICU. January 9, 2013 Droogh JM, Kruger HL, Ligtenberg JJM, et al. Simulator-Based Crew Resource Management Training for Interhospital Transfer of Critically Ill Patients by a Mobile ICU. Jt Comm J Qu… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/73966/psn-pdfOctober 13, 2021 - Prescribing errors with low-molecular-weight heparins. October 13, 2021 Slikkerveer M, van de Plas A, Driessen JHM, et al. Prescribing errors with low-molecular-weight heparins. J Patient Saf. 2021;17(7):e587-e592. doi:10.1097/pts.0000000000000417. https://psnet.ahrq.gov/issue/prescribing-errors-low-molecular-weigh… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/42382/psn-pdfJuly 16, 2014 - Huddling for high reliability and situation awareness. July 16, 2014 Goldenhar LM, Brady PW, Sutcliffe K, et al. Huddling for high reliability and situation awareness. BMJ Qual Saf. 2013;22(11):899-906. doi:10.1136/bmjqs-2012-001467. https://psnet.ahrq.gov/issue/huddling-high-reliability-and-situation-awareness Se… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/60983/psn-pdfOctober 07, 2020 - A qualitative exploration of the impact of a distressed family member on pediatric resuscitation teams. October 7, 2020 Deacon A, O’Neill T, Delaloye N, et al. A qualitative exploration of the impact of a distressed family member on pediatric resuscitation teams. Hosp Pediatr. 2020;10(9):758-766. doi:10.1542/hpeds.… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/44454/psn-pdfSeptember 29, 2017 - Ethical issues in patient safety research: a systematic review of the literature. September 29, 2017 Whicher DM, Kass NE, Audera-Lopez C, et al. Ethical issues in patient safety research: a systematic review of the literature. J Patient Saf. 2015;11(3):174-184. doi:10.1097/PTS.0000000000000064. https://psnet.ahrq.… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/36449/psn-pdfMay 27, 2011 - Medication-related clinical decision support in computerized provider order entry systems: a review. May 27, 2011 Kuperman GJ, Bobb A, Payne TH, et al. Medication-related clinical decision support in computerized provider order entry systems: a review. J Am Med Inform Assoc. 2007;14(1):29-40. https://psnet.ahrq.go… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/46067/psn-pdfJanuary 01, 2021 - A systematic review of measurement tools for the proactive assessment of patient safety in general practice. June 14, 2017 Lydon S, Cupples ME, Murphy AW, et al. A Systematic Review of Measurement Tools for the Proactive Assessment of Patient Safety in General Practice. J Patient Saf. 2021;17(5):e406-e412. doi:10… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/50891/psn-pdfFebruary 12, 2020 - Nurses as antimicrobial stewards: recognition, confidence, and organizational factors across nine hospitals. February 12, 2020 Monsees E, Goldman J, Vogelsmeier A, et al. Nurses as antimicrobial stewards: Recognition, confidence, and organizational factors across nine hospitals. Am J Infect Control. 2020. doi:10.1… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/764409/psn-pdfMarch 02, 2022 - She was headed to a locked psych ward. Then an ER doctor made a startling discovery. March 2, 2022 Boodman SG. Washington Post. February 12, 2022. https://psnet.ahrq.gov/issue/she-was-headed-locked-psych-ward-then-er-doctor-made-startling-discovery Misdiagnosis over a long period of time can be exacerbated by stig… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/43840/psn-pdfJanuary 28, 2015 - A qualitative study of systemic influences on paramedic decision making: care transitions and patient safety. January 28, 2015 O'Hara R, Johnson M, Siriwardena N, et al. A qualitative study of systemic influences on paramedic decision making: care transitions and patient safety. J Health Serv Res Policy. 2015;20(1 … -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/45188/psn-pdfJune 01, 2016 - Reporting and second-order problem solving can turn short-term fixes into long-term remedies. June 1, 2016 ISMP Medication Safety Alert! Acute Care Edition. May 19, 2016;21:1-4. https://psnet.ahrq.gov/issue/reporting-and-second-order-problem-solving-can-turn-short-term-fixes-long- term-remedies Workarounds are pr… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/44638/psn-pdfMay 18, 2016 - Developing an appreciation of patient safety: analysis of interprofessional student experiences with health mentors. May 18, 2016 Langlois S. Developing an appreciation of patient safety: analysis of interprofessional student experiences with health mentors. Perspect Med Educ. 2016;5(2):88-94. doi:10.1007/s40037-0… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/60016/psn-pdfMarch 04, 2020 - The influence of bullying on nursing practice errors: a systematic review. March 4, 2020 Johnson AH, Benham?Hutchins M. The Influence of Bullying on Nursing Practice Errors: A Systematic Review. AORN J. 2020;111(2). doi:10.1002/aorn.12923. https://psnet.ahrq.gov/issue/influence-bullying-nursing-practice-errors-sys… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/40177/psn-pdfJune 08, 2011 - Learning from disasters to improve patient safety: applying the generic disaster pathway to health system errors. June 8, 2011 Travaglia J, Hughes C, Braithwaite J. Learning from disasters to improve patient safety: applying the generic disaster pathway to health system errors. BMJ Qual Saf. 2011;20(1):1-8. doi:1… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/73367/psn-pdfJune 09, 2021 - Ethical challenges in child abuse: what is the harm of a misdiagnosis? June 9, 2021 Brown SD. Ethical challenges in child abuse: what is the harm of a misdiagnosis? Pediatr Radiol. 2021;51(6):1070-1075. doi:10.1007/s00247-020-04845-4. https://psnet.ahrq.gov/issue/ethical-challenges-child-abuse-what-harm-misdiagnos… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/40597/psn-pdfAugust 10, 2011 - Improving follow-up of high-risk psychiatry outpatients at resident year-end transfer. August 10, 2011 Young JQ, Pringle Z, Wachter R. Improving follow-up of high-risk psychiatry outpatients at resident year- end transfer. Jt Comm J Qual Patient Saf. 2011;37(7):300-308. https://psnet.ahrq.gov/issue/improving-follo… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/73627/psn-pdfJanuary 01, 2022 - The problem with 'My Five Moments for Hand Hygiene'. August 25, 2021 Gould D, Purssell E, Jeanes A, et al. The problem with ‘My Five Moments for Hand Hygiene’. BMJ Qual Saf. 2022;31(4):322-326. doi:10.1136/bmjqs-2020-011911. https://psnet.ahrq.gov/issue/problem-my-five-moments-hand-hygiene The “My Five Moments for… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/45799/psn-pdfMay 09, 2017 - Assessing frequency and risk of weight entry errors in pediatrics. May 9, 2017 Hagedorn PA, Kirkendall E, Kouril M, et al. Assessing Frequency and Risk of Weight Entry Errors in Pediatrics. JAMA Pediatr. 2017;171(4):392-393. doi:10.1001/jamapediatrics.2016.3865. https://psnet.ahrq.gov/issue/assessing-frequency-and… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/43997/psn-pdfAugust 02, 2015 - Sentinel events, serious reportable events, and root cause analysis. August 2, 2015 Chen TC, Schein OD, Miller JW. Sentinel events, serious reportable events, and root cause analysis. JAMA Ophthalmol. 2015;133(6):631-632. doi:10.1001/jamaophthalmol.2015.0672. https://psnet.ahrq.gov/issue/sentinel-events-serious-re…
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