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  1. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/864861/psn-pdf
    September 19, 2022 - Should audits consider the care pathway model? A new approach to benchmarking real-world activities. September 19, 2022 Kwok CS, Waters D, Phan T, et al. Should audits consider the care pathway model? A new approach to benchmarking real-world activities. Healthcare. 2022;10(9):1798. doi:10.3390/healthcare10091798. …
  2. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/850172/psn-pdf
    June 07, 2023 - Clinical nurse competence and its effect on patient safety culture: a systematic review. June 7, 2023 Zaitoun RA, Said NB, de Tantillo L. Clinical nurse competence and its effect on patient safety culture: a systematic review. BMC Nurs. 2023;22(1):173. doi:10.1186/s12912-023-01305-w. https://psnet.ahrq.gov/issue/c…
  3. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/74758/psn-pdf
    February 09, 2022 - Emotional harm in the radiology department: analysis of an underrecognized preventable error. February 9, 2022 Siewert B, Swedeen S, Brook OR, et al. Emotional harm in the radiology department: analysis of an underrecognized preventable error. Radiology. 2022;302(3):613-619. doi:10.1148/radiol.2021211846. https://…
  4. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/34673/psn-pdf
    December 23, 2008 - Relationship between medication errors and adverse drug events. December 23, 2008 Bates DW, Boyle DL, Vliet MBV, et al. Relationship between medication errors and adverse drug events. J Gen Intern Med. 1995;10(4):199-205. https://psnet.ahrq.gov/issue/relationship-between-medication-errors-and-adverse-drug-events …
  5. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/73494/psn-pdf
    July 14, 2021 - A scoping review of communication tools applicable to patients and their primary care providers after discharge from hospital. July 14, 2021 Spencer RA, Singh Punia H. A scoping review of communication tools applicable to patients and their primary care providers after discharge from hospital. Patient Educ Couns. …
  6. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/34639/psn-pdf
    March 02, 2011 - Preventable deaths: who, how often, and why? March 2, 2011 Dubois RW, Brook RH. Preventable deaths: who, how often, and why? Ann Intern Med. 1988;109(7):582-9. https://psnet.ahrq.gov/issue/preventable-deaths-who-how-often-and-why One of the first studies to examine the link between quality of care and hospital deat…
  7. www.ahrq.gov/sites/default/files/wysiwyg/hai/tools/mrsa/148-investigating-defect-lfd-worksheet.docx
    June 02, 2025 - AHRQ Safety Program for MRSA Prevention Investigating A Defect Worksheet ICU & Non-ICUTop Contributing Factors Interventions To Reduce Risk Who Will Do It and By When Status Enter contributing factor Enter intervention Enter responsible staff, deadline Enter status Enter contributing factor Enter intervention Enter re…
  8. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/861277/psn-pdf
    January 24, 2024 - Clinical deterioration as a nurse sensitive indicator in the out-of-hospital context: a scoping review. January 24, 2024 Mccullough K, Baker M, Bloxsome D, et al. Clinical deterioration as a nurse sensitive indicator in the out?of ?hospital context: a scoping review. J Clin Nurs. 2024;33(3):874-889. doi:10.1111/joc…
  9. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/837765/psn-pdf
    August 03, 2022 - Pediatric musculoskeletal radiographs: anatomy and fractures prone to diagnostic error among emergency physicians. August 3, 2022 Li W, Stimec J, Camp M, et al. Pediatric musculoskeletal radiographs: anatomy and fractures prone to diagnostic error among emergency physicians. J Emerg Med. 2022;62(4):524-533. doi:1…
  10. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/48076/psn-pdf
    July 24, 2019 - Simulation-based event analysis improves error discovery and generates improved strategies for error prevention. July 24, 2019 Lobos A-T, Ward N, Farion KJ, et al. Simulation-based event analysis improves error discovery and generates improved strategies for error prevention. Simul Healthc. 2019;14(4):209-216. do…
  11. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/50630/psn-pdf
    November 06, 2019 - Non-dispensing pharmacists' actions and solutions of drug therapy problems among elderly polypharmacy patients in primary care. November 6, 2019 Hazen ACM, Zwart DLM, Poldervaart JM, et al. Non-dispensing pharmacists' actions and solutions of drug therapy problems among elderly polypharmacy patients in primary car…
  12. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/847725/psn-pdf
    April 19, 2023 - A scoping review of the hidden curriculum in pharmacy education. April 19, 2023 Park SK, Chen AMH, Daugherty KK, et al. A scoping review of the hidden curriculum in pharmacy education. Am J Pharm Educ. 2023;87(3):ajpe8999. doi:10.5688/ajpe8999. https://psnet.ahrq.gov/issue/scoping-review-hidden-curriculum-pharmacy…
  13. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/60955/psn-pdf
    September 30, 2020 - The emergency department trigger tool: a novel approach to screening for quality and safety events. September 30, 2020 Griffey RT, Schneider RM, Todorov AA. The emergency department trigger tool: a novel approach to screening for quality and safety events. Ann Emerg Med. 2020;76(2):230-240. doi:10.1016/j.annemergm…
  14. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/849605/psn-pdf
    May 31, 2023 - Identification of patient safety threats in a post-intensive care clinic. May 31, 2023 Karlic KJ, Valley TS, Cagino LM, et al. Identification of patient safety threats in a post-intensive care clinic. Am J Med Qual. 2023;38(3):117-121. doi:10.1097/jmq.0000000000000118. https://psnet.ahrq.gov/issue/identification-p…
  15. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/852753/psn-pdf
    August 23, 2023 - Status of patient safety culture in community pharmacy settings: a systematic review. August 23, 2023 Kwon K-E, Nam DR, Lee M-S, et al. Status of patient safety culture in community pharmacy settings: a systematic review. J Patient Saf. 2023;19(6):353-361. doi:10.1097/pts.0000000000001147. https://psnet.ahrq.gov/i…
  16. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/845347/psn-pdf
    March 01, 2023 - Race differences in a malpractice event database in a large healthcare system. March 1, 2023 Thomas AD, Pandit C, Krevat S. Race differences in a malpractice event database in a large healthcare system. J Patient Saf. 2023;19(2):67-70. doi:10.1097/pts.0000000000001090. https://psnet.ahrq.gov/issue/race-differences…
  17. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/73186/psn-pdf
    April 28, 2021 - Inappropriate dosing of direct oral anticoagulants in patients with atrial fibrillation. April 28, 2021 Sugrue A, Sanborn D, Amin M, et al. Inappropriate dosing of direct oral anticoagulants in patients with atrial fibrillation. Am J Cardiol. 2020;144:52-59. doi:10.1016/j.amjcard.2020.12.062. https://psnet.ahrq.go…
  18. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/74084/psn-pdf
    November 17, 2021 - Healthcare failure mode and effect analysis in the chemotherapy preparation process. November 17, 2021 Pueyo-López C, Sánchez-Cuervo M, Vélez-Díaz-Pallarés M, et al. Healthcare failure mode and effect analysis in the chemotherapy preparation process. J Oncol Pharm Pract. 2021;27(7):1588-1595. doi:10.1177/107815522…
  19. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/47568/psn-pdf
    March 06, 2019 - Trends in anesthesia-related liability and lessons learned. March 6, 2019 Mora JC, Kaye AD, Romankowski ML, et al. Trends in Anesthesia-Related Liability and Lessons Learned. Adv Anesth. 2018;36(1):231-249. doi:10.1016/j.aan.2018.07.009. https://psnet.ahrq.gov/issue/trends-anesthesia-related-liability-and-lessons-l…
  20. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/863760/psn-pdf
    March 06, 2024 - Imagining improved interactions: patients' designs to address implicit bias. March 6, 2024 Yang C, Coney L, Mohanraj D, et al. AMIA Annu Symp Proc. 2023;2023:774-783. https://psnet.ahrq.gov/issue/imagining-improved-interactions-patients-designs-address-implicit-bias Implicit biases can compromise decision making a…