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Psn-Pdf (pdf file)
psnet.ahrq.gov/node/49421/psn-pdfOctober 01, 2003 - Urine a Tough Position October 1, 2003 Gandhi TK. Urine a Tough Position. PSNet [internet]. 2003. https://psnet.ahrq.gov/web-mm/urine-tough-position The Case A 22-year-old unmarried woman came to her doctor’s office worried that she might be pregnant. Although she did not want to have a baby at that time, she sta… -
Spotlight Case [MONTH] 2003 (ppt file)
psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.251_slideshow.pptOctober 01, 2011 - Spotlight Case [MONTH] 2003 Spotlight Case Mobility Lost in the ICU * * Source and Credits This presentation is based on the October 2011 AHRQ WebM&M Spotlight Case See the full article at http://webmm.ahrq.gov CME credit is available Commentary by: Jim Smith, PT, DPT, MA; Associate Professor of Physical … -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/836878/psn-pdfApril 27, 2022 - The Media’s Role in Patient Safety April 27, 2022 Millenson ML, Dowell P, Mossburg SE. The Media’s Role in Patient Safety. PSNet [internet]. 2022. https://psnet.ahrq.gov/perspective/medias-role-patient-safety Brief History of the Media Influencing Patient Safety Despite studies raising questions about avoidable ha… -
Spotlight Case July 2008 (ppt file)
psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.299_slideshow.pptMay 01, 2013 - Spotlight Case July 2008 Spotlight Case Right Regimen, Wrong Cancer: Patient Catches Medical Error * * Source and Credits This presentation is based on the May 2013 AHRQ WebM&M Spotlight Case See the full article at http://webmm.ahrq.gov CME credit is available Commentary by: Joseph O. Jacobson, MD, MSc… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/47456/psn-pdfApril 30, 2019 - ISMP Gap Analysis Tool (GAT) for Safe IV Push Medication Practices. April 30, 2019 Horsham, PA: Institute for Safe Medication Practices; 2018. https://psnet.ahrq.gov/issue/ismp-gap-analysis-tool-gat-safe-iv-push-medication-practices Standardized practices have not been uniformly adopted to support safe IV medicati… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/43403/psn-pdfAugust 06, 2014 - Strategies to enhance adoption of ventilator-associated pneumonia prevention interventions: a systematic literature review. August 6, 2014 Goutier JM, Holzmueller CG, Edwards KC, et al. Strategies to enhance adoption of ventilator-associated pneumonia prevention interventions: a systematic literature review. Infec… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/60842/psn-pdfAugust 26, 2020 - Longitudinal medication reconciliation at hospital admission, discharge and post-discharge. August 26, 2020 Daliri S, Bouhnouf M, van de Meerendonk HWPC, et al. Longitudinal medication reconciliation at hospital admission, discharge and post-discharge. Res Social Adm Pharm. 2020;17(4):677-684. doi:10.1016/j.saphar… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/44794/psn-pdfMay 21, 2019 - Medical Device Use Error: Root Cause Analysis. May 21, 2019 Wiklund M, Dwyer A, Davis E. Boca Raton, FL: CRC Press; 2015. ISBN: 9781498705790. https://psnet.ahrq.gov/issue/medical-device-use-error-root-cause-analysis Applying human factors engineering to examine mistakes associated with medical device use can lead … -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/48141/psn-pdfJuly 24, 2019 - Evidence Brief: Implementation of High Reliability Organization Principles. July 24, 2019 Veazie S, Peterson K, Bourne D. Washington DC: United States Department of Veterans Affairs; May 2019. https://psnet.ahrq.gov/issue/evidence-brief-implementation-high-reliability-organization-principles This brief evalu… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/849339/psn-pdfMay 24, 2023 - Just a Cup of Tea – an Introduction to the SEIPS Framework. May 24, 2023 Epsom and St Helier University Hospitals. Epsom, UK: National Health Service; March 21, 2023. https://psnet.ahrq.gov/issue/just-cup-tea-introduction-seips-framework The Systems Engineering Initiative for Patient Safety (SEIPS) framework … -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/867639/psn-pdfFebruary 26, 2025 - Framing diagnostic error: an epidemiological perspective. February 26, 2025 Hunter MK, Singareddy C, Mundt KA. Framing diagnostic error: an epidemiological perspective. Front Public Health. 2024;12:1479750. doi:10.3389/fpubh.2024.1479750. https://psnet.ahrq.gov/issue/framing-diagnostic-error-epidemiological-perspec… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/43343/psn-pdfDecember 04, 2016 - Parents' perspective on safety in neonatal intensive care: a mixed-methods study. December 4, 2016 Lyndon A, Jacobson CH, Fagan KM, et al. Parents' perspectives on safety in neonatal intensive care: a mixed-methods study. BMJ Qual Saf. 2014;23(11):902-9. doi:10.1136/bmjqs-2014-003009. https://psnet.ahrq.gov/issue/… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/46621/psn-pdfNovember 22, 2017 - Patient involvement for improved patient safety: a qualitative study of nurses' perceptions and experiences. November 22, 2017 Skagerström J, Ericsson C, Nilsen P, et al. Patient involvement for improved patient safety: A qualitative study of nurses' perceptions and experiences. Nurs Open. 2017;4(4):230-239. doi:10… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/854391/psn-pdfOctober 11, 2023 - Patient Engagement for Patient Safety: The Why, What, and How of Patient Engagement for Improving Patient Safety. October 11, 2023 Kendir C, Fujisawa R, Brito Fernandes O, et al. Paris, France: OECD Publishing; 2023. OECD Health Working Papers, No. 159. https://psnet.ahrq.gov/issue/patient-engagement-patient-safe… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/45122/psn-pdfOctober 08, 2016 - Transformational leadership in nursing and medication safety education: a discussion paper. October 8, 2016 Vaismoradi M, Griffiths P, Turunen H, et al. Transformational leadership in nursing and medication safety education: a discussion paper. J Nurs Manag. 2016;24(7):970-980. doi:10.1111/jonm.12387. https://psn… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/865667/psn-pdfApril 24, 2024 - Impact of short-notice accreditation assessments on hospitals' patient safety and quality culture--a scoping review. April 24, 2024 Scanlan R, Flenady T, Judd J. Impact of short?notice accreditation assessments on hospitals' patient safety and quality culture- a scoping review. J Adv Nurs. 2024;80(10):3965-3976. d… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/41740/psn-pdfOctober 10, 2012 - Effectiveness of a radiofrequency detection system as an adjunct to manual counting protocols for tracking surgical sponges: a prospective trial of 2,285 patients. October 10, 2012 Rupp CC, Kagarise MJ, Nelson SM, et al. Effectiveness of a radiofrequency detection system as an adjunct to manual counting protocols … -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/35340/psn-pdfJuly 10, 2008 - Posthospital medication discrepancies: prevalence and contributing factors. July 10, 2008 Coleman EA, Smith JD, Raha D, et al. Posthospital medication discrepancies: prevalence and contributing factors. Arch Intern Med. 2005;165(16):1842-1847. https://psnet.ahrq.gov/issue/posthospital-medication-discrepancies-prev… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/854993/psn-pdfNovember 01, 2023 - Building cultures of high reliability: lessons from the high reliability organization paradigm. November 1, 2023 Sutcliffe KM. Building cultures of high reliability: lessons from the high reliability organization paradigm. Anesthesiol Clin. 2023;41(4):707-717. doi:10.1016/j.anclin.2023.03.012. https://psnet.ahrq.g… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/50400/psn-pdfOctober 02, 2019 - The role of personal health information management in promoting patient safety in the home: a qualitative analysis October 2, 2019 Demiris G, Lin S-Y, Turner AM. The role of personal health information management in promoting patient safety in the home: a qualitative analysis. Stud Health Technol Inform . 2019;264…
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