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  1. Case study: getting boards on board at Allen Memorial Hospital, Iowa Health System. | PSNet

    psnet.ahrq.gov/issue/case-study-getting-boards-board-allen-memorial-hospital-iowa-health-system
    August 04, 2021 - Commentary Case study: getting boards on board at Allen Memorial Hospital, Iowa Health System. Citation Text: Slessor SR, Crandall JB, Nielsen GA. Case study: getting boards on board at Allen Memorial Hospital, Iowa Health System. Jt Comm J Qual Patient Saf. 2008;34(4):221-227. Copy …

  2. It is time to define antimicrobial never events. | PSNet

    psnet.ahrq.gov/issue/it-time-define-antimicrobial-never-events
    November 16, 2022 - Commentary It is time to define antimicrobial never events. Citation Text: Liu J, Kaye KS, Mercuro NJ, et al. It is time to define antimicrobial never events. Infect Control Hosp Epidemiol. 2019;40(2):206-207. doi:10.1017/ice.2018.313. Copy Citation Format: DOI Google Schol…

  3. Implementing handoff communication. | PSNet

    psnet.ahrq.gov/issue/implementing-handoff-communication
    August 25, 2010 - Commentary Implementing handoff communication. Citation Text: Ardoin KB, Broussard L. Implementing handoff communication. J Nurses Staff Dev. 2011;27(3):128-35. doi:10.1097/NND.0b013e318217b3dd. Copy Citation Format: DOI Google Scholar PubMed BibTeX EndNote X3 XML EndNote…

  4. Implementing bedside handoff in the emergency department: a practice improvement project. | PSNet

    psnet.ahrq.gov/issue/implementing-bedside-handoff-emergency-department-practice-improvement-project
    November 14, 2018 - Commentary Implementing bedside handoff in the emergency department: a practice improvement project. Citation Text: Campbell D, Dontje K. Implementing Bedside Handoff in the Emergency Department: A Practice Improvement Project. J Emerg Nurs. 2019;45(2):149-154. doi:10.1016/j.jen.2018.09.…

  5. Findings from the ISMP Medication Safety Self-Assessment for hospitals. | PSNet

    psnet.ahrq.gov/issue/findings-ismp-medication-safety-self-assessment-hospitals
    September 26, 2017 - Study Findings from the ISMP Medication Safety Self-Assessment for hospitals. Citation Text: Smetzer JL, Vaida AJ, Cohen MR, et al. Findings from the ISMP Medication Safety Self-Assessment for hospitals. Jt Comm J Qual Patient Saf. 2003;29(11):586-597. Copy Citation Format: …

  6. A model for building a standardized hand-off protocol.  | PSNet

    psnet.ahrq.gov/issue/model-building-standardized-hand-protocol
    September 22, 2010 - Commentary A model for building a standardized hand-off protocol.  Citation Text: Arora V, Johnson J. A model for building a standardized hand-off protocol. Jt Comm J Qual Saf. 2006;32(11):646-655. Copy Citation Format: Google Scholar PubMed BibTeX EndNote X3 XML EndNote …

  7. Beyond "see one, do one, teach one": toward a different training paradigm. | PSNet

    psnet.ahrq.gov/issue/beyond-see-one-do-one-teach-one-toward-different-training-paradigm
    March 01, 2011 - Commentary Beyond "see one, do one, teach one": toward a different training paradigm. Citation Text: Rodriguez-Paz JM, Kennedy M, Salas E, et al. Beyond "see one, do one, teach one": toward a different training paradigm. Qual Saf Health Care. 2009;18(1):63-8. doi:10.1136/qshc.2007.02…

  8. Another surgeon's error: must you tell the patient? | PSNet

    psnet.ahrq.gov/issue/another-surgeons-error-must-you-tell-patient
    October 02, 2013 - Commentary Another surgeon's error: must you tell the patient? Citation Text: Moffatt-Bruce SD, Denlinger CE, Sade RM. Another surgeon's error: must you tell the patient? Ann Thorac Surg. 2014;98(2):396-401. doi:10.1016/j.athoracsur.2014.04.073. Copy Citation Format: DOI Go…

  9. 2022 Updated Results for the AHRQ Surveys on Patient Safety Culture (SOPS) Diagnostic Safety Supplemental Items. | PSNet

    psnet.ahrq.gov/issue/2022-updated-results-ahrq-surveys-patient-safety-culture-sops-diagnostic-safety-supplemental
    April 06, 2022 - Book/Report 2022 Updated Results for the AHRQ Surveys on Patient Safety Culture (SOPS) Diagnostic Safety Supplemental Items. Citation Text: 2022 Updated Results for the AHRQ Surveys on Patient Safety Culture (SOPS) Diagnostic Safety Supplemental Items. Famolaro T, Hare R, Tapia A, et al.…

  10. CPOE: strategies for success. | PSNet

    psnet.ahrq.gov/issue/cpoe-strategies-success
    October 09, 2019 - Commentary CPOE: strategies for success. Citation Text: Manor PJ. CPOE: Strategies for success. Nurs Manage. 2010;41(5):18-20. doi:10.1097/01.NUMA.0000372028.99240.7f. Copy Citation Format: DOI Google Scholar PubMed BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged PubMed…

  11. View from the cockpit: what the airline industry can teach us about patient safety. | PSNet

    psnet.ahrq.gov/issue/view-cockpit-what-airline-industry-can-teach-us-about-patient-safety
    January 08, 2020 - Commentary View from the cockpit: what the airline industry can teach us about patient safety. Citation Text: Doucette JN. View from the cockpit: what the airline industry can teach us about patient safety. Nursing (Brux). 2006;36(11):50-53. Copy Citation Format: Google S…

  12. Using simulation to improve patient safety: dawn of a new era. | PSNet

    psnet.ahrq.gov/issue/using-simulation-improve-patient-safety-dawn-new-era
    October 29, 2017 - Commentary Using simulation to improve patient safety: dawn of a new era. Citation Text: Cheng A, Grant V, Auerbach M. Using simulation to improve patient safety: dawn of a new era. JAMA Pediatr. 2015;169(5):419-20. doi:10.1001/jamapediatrics.2014.3817. Copy Citation Format: …

  13. Introducing the patient safety professional: why, what, who, how, and where? | PSNet

    psnet.ahrq.gov/issue/introducing-patient-safety-professional-why-what-who-how-and-where
    July 03, 2014 - Commentary Introducing the patient safety professional: why, what, who, how, and where? Citation Text: Saint S, Krein SL, Manojlovich M, et al. Introducing the patient safety professional: why, what, who, how, and where? J Patient Saf. 2011;7(4):175-80. doi:10.1097/PTS.0b013e318230e58…

  14. Hospital safety scores: do grades really matter? | PSNet

    psnet.ahrq.gov/issue/hospital-safety-scores-do-grades-really-matter
    September 24, 2017 - Study Hospital safety scores: do grades really matter? Citation Text: Gonzalez AA, Ghaferi AA. Hospital Safety Scores: do grades really matter? JAMA Surg. 2014;149(5):413-4. Copy Citation Format: Google Scholar PubMed BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged PubMe…

  15. Just culture: it's more than policy. | PSNet

    psnet.ahrq.gov/issue/just-culture-its-more-policy
    July 05, 2017 - Study Just culture: it's more than policy. Citation Text: Paradiso L, Sweeney N. Just culture: It's more than policy. Nurs Manage. 2019;50(6):38-45. doi:10.1097/01.NUMA.0000558482.07815.ae. Copy Citation Format: DOI Google Scholar PubMed BibTeX EndNote X3 XML EndNote 7 XML …

  16. Barriers to reporting medication errors: a measurement equivalence perspective. | PSNet

    psnet.ahrq.gov/issue/barriers-reporting-medication-errors-measurement-equivalence-perspective
    March 28, 2012 - Study Barriers to reporting medication errors: a measurement equivalence perspective. Citation Text: Etchegaray J, Throckmorton T. Barriers to reporting medication errors: a measurement equivalence perspective. Qual Saf Health Care. 2010;19(6):e14. doi:10.1136/qshc.2008.031534. Copy …

  17. The Financial and Human Cost of Medical Error... and How Massachusetts Can Lead the Way on Patient Safety. | PSNet

    psnet.ahrq.gov/issue/financial-and-human-cost-medical-error-and-how-massachusetts-can-lead-way-patient-safety
    April 03, 2019 - Book/Report The Financial and Human Cost of Medical Error... and How Massachusetts Can Lead the Way on Patient Safety. Citation Text: The Financial and Human Cost of Medical Error... and How Massachusetts Can Lead the Way on Patient Safety. Boston, MA: Betsy Lehman Center for Patient Saf…

  18. What if?: Transforming Diagnostic Research by Leveraging a Diagnostic Process Map to Engage Patients in Learning from Errors. | PSNet

    psnet.ahrq.gov/issue/what-if-transforming-diagnostic-research-leveraging-diagnostic-process-map-engage-patients
    October 27, 2021 - Book/Report What if?: Transforming Diagnostic Research by Leveraging a Diagnostic Process Map to Engage Patients in Learning from Errors. Citation Text: Sheridan S, Merryweather P, Rusz D, et al. What If?: Transforming Diagnostic Research By Leveraging A Diagnostic Process Map To Engage …

  19. Medication safety in emergency medical services: approaching an evidence-based method of verification to reduce errors. | PSNet

    psnet.ahrq.gov/issue/medication-safety-emergency-medical-services-approaching-evidence-based-method-verification
    September 28, 2022 - Study Medication safety in emergency medical services: approaching an evidence-based method of verification to reduce errors. Citation Text: Misasi P, Keebler JR. Medication safety in emergency medical services: approaching an evidence-based method of verification to reduce errors. Ther …

  20. Did hospital engagement networks actually improve care? | PSNet

    psnet.ahrq.gov/issue/did-hospital-engagement-networks-actually-improve-care
    July 18, 2016 - Commentary Did hospital engagement networks actually improve care? Citation Text: Pronovost P, Jha AK. Did hospital engagement networks actually improve care? N Engl J Med. 2014;371(8):691-693. doi:10.1056/NEJMp1405800. Copy Citation Format: DOI Google Scholar PubMed BibTeX…
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