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  1. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/851923/psn-pdf
    August 02, 2023 - Patient, carer and family experiences of seeking redress and reconciliation following a life-changing event: systematic review of qualitative evidence. August 2, 2023 Shaw L, Lawal HM, Briscoe S, et al. Patient, carer and family experiences of seeking redress and reconciliation following a life?changing event: sys…

  2. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/46606/psn-pdf
    July 10, 2019 - Implementation of a mock root cause analysis to provide simulated patient safety training. July 10, 2019 Murphy M, Duff J, Whitney J, et al. Implementation of a mock root cause analysis to provide simulated patient safety training. BMJ Open Qual. 2017;6(2). doi:10.1136/bmjoq-2017-000096. https://psnet.ahrq.gov/iss…

  3. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/867637/psn-pdf
    February 26, 2025 - Patient safety incident reporting and learning guidelines implemented by health care professionals in specialized care units: scoping review. February 26, 2025 Gqaleni TM, Mkhize SW, Chironda G. Patient safety incident reporting and learning guidelines implemented by health care professionals in specialized care u…

  4. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/866589/psn-pdf
    August 28, 2024 - Developing a process to measure actual harm from medication errors in paediatric inpatients: from design to implementation. August 28, 2024 Mumford V, Raban MZ, Li L, et al. Developing a process to measure actual harm from medication errors in paediatric inpatients: from design to implementation. Br J Clin Pharmac…

  5. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/866082/psn-pdf
    June 05, 2024 - Putting the "action" in RCA(2): an analysis of intervention strength after adverse events. June 5, 2024 Zerillo JA, Tardiff SA, Flood D, et al. Putting the "action" in RCA(2): an analysis of intervention strength after adverse events. Jt Comm J Qual Patient Saf. 2024;50(7):492-499. doi:10.1016/j.jcjq.2024.03.012. …

  6. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/61091/psn-pdf
    November 04, 2020 - Prioritising recommendations following analyses of adverse events in healthcare: a systematic review. November 4, 2020 Bos K, van der Laan MJ, Dongelmans DA. Prioritising recommendations following analyses of adverse events in healthcare: a systematic review. BMJ Open Qual. 2020;9(4):e000843. doi:10.1136/bmjoq-2019…

  7. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/838917/psn-pdf
    October 26, 2022 - The e-Autopsy/e-Biopsy: a systematic chart review to increase safety and diagnostic accuracy. October 26, 2022 Kanter MH, Ghobadi A, Lurvey LD, et al. The e-Autopsy/e-Biopsy: a systematic chart review to increase safety and diagnostic accuracy. Diagnosis (Berl). 2022;9(4):430-436. doi:10.1515/dx-2022-0083. https:/…

  8. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/46168/psn-pdf
    June 14, 2017 - The HOSPITAL score predicts potentially preventable 30- day readmissions in conditions targeted by the Hospital Readmissions Reduction Program. June 14, 2017 Burke RE, Schnipper JL, Williams M, et al. The HOSPITAL Score Predicts Potentially Preventable 30-Day Readmissions in Conditions Targeted by the Hospital Rea…

  9. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/837025/psn-pdf
    May 04, 2022 - Central venous catheter guidewire retention: lessons from England's never event database. May 4, 2022 Mariyaselvam MZA, Patel V, Young HE, et al. Central venous catheter guidewire retention: lessons from England's never event database. J Patient Saf. 2022;18(2):e387-e392. doi:10.1097/pts.0000000000000826. https:/…

  10. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/43815/psn-pdf
    February 04, 2015 - Patient safety skills in primary care: a national survey of GP educators. February 4, 2015 Ahmed M, Arora S, McKay J, et al. Patient safety skills in primary care: a national survey of GP educators. BMC Fam Pract. 2014;15:206. doi:10.1186/s12875-014-0206-5. https://psnet.ahrq.gov/issue/patient-safety-skills-primar…

  11. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/845630/psn-pdf
    March 08, 2023 - The effect of transitions intervention to ensure patient safety and satisfaction when transferred from hospital to home health care-a systematic review. March 8, 2023 Oksholm T, Gissum KR, Hunskår I, et al. The effect of transitions intervention to ensure patient safety and satisfaction when transferred from hospi…

  12. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/60836/psn-pdf
    August 26, 2020 - Factors associated with workarounds in barcode-assisted medication administration in hospitals. August 26, 2020 Veen W, Taxis K, Wouters H, et al. Factors associated with workarounds in barcode?assisted medication administration in hospitals. J Clin Nurs. 2020;29(13-14):2239-2250. doi:10.1111/jocn.15217. https://p…

  13. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/47251/psn-pdf
    July 25, 2018 - Fail-safe patient ID matching remains just out of reach. July 25, 2018 Arndt RZ. Mod Healthc. July 14, 2018. https://psnet.ahrq.gov/issue/fail-safe-patient-id-matching-remains-just-out-reach Similarities in patient names and clinical situations can result in medical errors. Discussing how digital technologies can …

  14. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/73652/psn-pdf
    September 01, 2021 - Dimensions of safety culture: a systematic review of quantitative, qualitative and mixed methods for assessing safety culture in hospitals. September 1, 2021 Churruca K, Ellis LA, Pomare C, et al. Dimensions of safety culture: a systematic review of quantitative, qualitative and mixed methods for assessing safety …

  15. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/45613/psn-pdf
    September 01, 2018 - Patients as partners in learning from unexpected events. September 1, 2018 Etchegaray J, Ottosen M, Aigbe A, et al. Patients as Partners in Learning from Unexpected Events. Health Serv Res. 2016;51 Suppl 3:2600-2614. doi:10.1111/1475-6773.12593. https://psnet.ahrq.gov/issue/patients-partners-learning-unexpected-eve…

  16. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/45463/psn-pdf
    April 12, 2017 - Implementation of the trigger review method in Scottish general practices: patient safety outcomes and potential for quality improvement. April 12, 2017 de Wet C, Black C, Luty S, et al. Implementation of the trigger review method in Scottish general practices: patient safety outcomes and potential for quality imp…

  17. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/836722/psn-pdf
    March 09, 2022 - Key use cases for artificial intelligence to reduce the frequency of adverse drug events: a scoping review. March 9, 2022 Syrowatka A, Song W, Amato MG, et al. Key use cases for artificial intelligence to reduce the frequency of adverse drug events: a scoping review. Lancet Digit Health. 2022;4(2):e137-e148. doi:10…

  18. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/40543/psn-pdf
    March 23, 2012 - Can we rely on patients' reports of adverse events? March 23, 2012 Zhu J, Stuver SO, Epstein AM, et al. Can we rely on patients' reports of adverse events? Med Care. 2011;49(10):948-55. doi:10.1097/MLR.0b013e31822047a8. https://psnet.ahrq.gov/issue/can-we-rely-patients-reports-adverse-events Traditional methods of…

  19. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/73634/psn-pdf
    August 25, 2021 - Validation of an electronic trigger to measure missed diagnosis of stroke in emergency departments. August 25, 2021 Vaghani V, Wei L, Mushtaq U, et al. Validation of an electronic trigger to measure missed diagnosis of stroke in emergency departments. J Am Med Inform Assoc. 2021;28(10):2202-2211. doi:10.1093/jamia…

  20. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/837308/psn-pdf
    June 01, 2022 - Delays in diagnosis, treatment, and surgery: root causes, actions taken, and recommendations for healthcare improvement. June 1, 2022 Politi RE, Mills PD, Zubkoff L, et al. Delays in diagnosis, treatment, and surgery: root causes, actions taken, and recommendations for healthcare improvement. J Patient Saf. 2022;1…
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