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psnet.ahrq.gov/node/864352/psn-pdf
March 13, 2024 - Creating a just culture in the perioperative setting.
March 13, 2024
Hooven K, Altmiller G. Creating a just culture in the perioperative setting. AORN J. 2024;119(2):152-160.
doi:10.1002/aorn.14074.
https://psnet.ahrq.gov/issue/creating-just-culture-perioperative-setting
Fear of retaliation by leaders or colleague…
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psnet.ahrq.gov/node/45832/psn-pdf
April 05, 2017 - Best Practices in Patient Safety: 2nd Global Ministerial
Summit on Patient Safety.
April 5, 2017
Federal Ministry of Health and World Health Organization: Bonn, Germany; March 2017.
https://psnet.ahrq.gov/issue/best-practices-patient-safety-2nd-global-ministerial-summit-patient-safety
This report summarizes a wide…
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psnet.ahrq.gov/node/846162/psn-pdf
July 01, 2020 - The effect of virtual nursing and missed nursing care.
July 1, 2020
Schuelke S, Aurit S, Connot N, et al. The effect of virtual nursing and missed nursing care. Nurs Adm Q.
2020;44(3):280-287. doi:10.1097/naq.0000000000000419.
https://psnet.ahrq.gov/issue/effect-virtual-nursing-and-missed-nursing-care
The COVID-19…
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psnet.ahrq.gov/node/43440/psn-pdf
August 13, 2014 - Hospital Experiences Using Electronic Health Records to
Support Medication Reconciliation.
August 13, 2014
Grossman JM, Gourevitch R, Cross D. Washington, DC: National Institute for Health Care Reform; July
2014. NIHCR Research Brief No. 17.
https://psnet.ahrq.gov/issue/hospital-experiences-using-electronic-health…
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psnet.ahrq.gov/node/46468/psn-pdf
December 13, 2017 - The effect of opioid prescribing guidelines on
prescriptions by emergency physicians in Ohio.
December 13, 2017
Weiner SG, Baker O, Poon SJ, et al. The Effect of Opioid Prescribing Guidelines on Prescriptions by
Emergency Physicians in Ohio. Ann Emerg Med. 2017;70(6):799-808.e1.
doi:10.1016/j.annemergmed.2017.03.0…
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psnet.ahrq.gov/node/44946/psn-pdf
February 01, 2017 - Quality gaps identified through mortality review.
February 1, 2017
Kobewka DM, van Walraven C, Turnbull J, et al. Quality gaps identified through mortality review. BMJ Qual
Saf. 2017;26(2):141-149. doi:10.1136/bmjqs-2015-004735.
https://psnet.ahrq.gov/issue/quality-gaps-identified-through-mortality-review
Inpatien…
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psnet.ahrq.gov/node/41559/psn-pdf
August 01, 2012 - Design and trial of a new ambulance-to-emergency
department handover protocol: 'IMIST-AMBO.'
August 1, 2012
Iedema R, Ball C, Daly B, et al. Design and trial of a new ambulance-to-emergency department handover
protocol: 'IMIST-AMBO'. BMJ Qual Saf. 2012;21(8):627-33. doi:10.1136/bmjqs-2011-000766.
https://psnet.ahr…
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psnet.ahrq.gov/node/39741/psn-pdf
October 13, 2010 - Disclosure and reporting of surgical complications: a
double-edged sword?
October 13, 2010
Stahel PF, Flierl MA, Smith WR, et al. Disclosure and reporting of surgical complications: a double-edged
sword? Am J Med Qual. 2010;25(5):398-401. doi:10.1177/1062860610370989.
https://psnet.ahrq.gov/issue/disclosure-and-re…
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psnet.ahrq.gov/node/837077/psn-pdf
May 11, 2022 - At US hospitals, a drug mix-up is just a few keystrokes
away.
May 11, 2022
Kelman B. Kaiser Health News. April 29, 2022.
https://psnet.ahrq.gov/issue/us-hospitals-drug-mix-just-few-keystrokes-away
Technological solutions harbor unique risks that can result in patient harm. This article shares a response
to report…
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psnet.ahrq.gov/node/39060/psn-pdf
October 28, 2009 - Impact of duty-hour restriction on resident inpatient
teaching.
October 28, 2009
Mazotti LA, Vidyarthi AR, Wachter RM, et al. Impact of duty-hour restriction on resident inpatient teaching.
J Hosp Med. 2009;4(8). doi:10.1002/jhm.448.
https://psnet.ahrq.gov/issue/impact-duty-hour-restriction-resident-inpatient-teac…
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psnet.ahrq.gov/node/866437/psn-pdf
August 07, 2024 - Wake Up Safe in the USA & international patient safety.
August 7, 2024
Iyer RS, Dave N, Du T, et al. Wake Up Safe in the USA & international patient safety. Paediatr Anaesth.
2024;34(9):958-969. doi:10.1111/pan.14920.
https://psnet.ahrq.gov/issue/wake-safe-usa-international-patient-safety
Patient safety organizati…
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psnet.ahrq.gov/node/44574/psn-pdf
October 21, 2015 - Patient safety and quality improvement: reducing risk of
harm.
October 21, 2015
Leonard M. Patient Safety and Quality Improvement: Reducing Risk of Harm. Pediatr Rev.
2015;36(10):448-56; quiz 457-8. doi:10.1542/pir.36-10-448.
https://psnet.ahrq.gov/issue/patient-safety-and-quality-improvement-reducing-risk-harm
T…
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psnet.ahrq.gov/node/42468/psn-pdf
August 07, 2013 - A comprehensive quality assurance program for
personnel and procedures in radiation oncology: value of
voluntary error reporting and checklists.
August 7, 2013
Kalapurakal JA, Zafirovski A, Smith J, et al. A comprehensive quality assurance program for personnel and
procedures in radiation oncology: value of volunt…
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psnet.ahrq.gov/node/839814/psn-pdf
January 01, 2023 - Influencing a culture of quality and safety through
huddles.
November 9, 2022
McCain N, Ferguson T, Barry Hultquist T, et al. Influencing a culture of quality and safety through huddles.
J Nurs Care Qual. 2023;38(1):26-32. doi:10.1097/ncq.0000000000000642.
https://psnet.ahrq.gov/issue/influencing-culture-quality-a…
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psnet.ahrq.gov/node/48104/psn-pdf
August 28, 2019 - The computer will see you now.
August 28, 2019
Whitaker P. New Statesman. August 2, 2019;148:38-43.
https://psnet.ahrq.gov/issue/computer-will-see-you-now
Artificial intelligence (AI) and advanced computing technologies can enhance clinical decision-making.
Exploring the strengths and weaknesses of artificial inte…
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psnet.ahrq.gov/node/72535/psn-pdf
December 02, 2020 - Learning from influenza vaccine errors to prepare for
COVID-19 vaccination campaigns.
December 2, 2020
ISMP Medication Safety Alert! Acute care edition. November 19, 2020;25(23):1-6.
https://psnet.ahrq.gov/issue/learning-influenza-vaccine-errors-prepare-covid-19-vaccination-campaigns
Safety professionals enco…
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psnet.ahrq.gov/node/42844/psn-pdf
May 29, 2014 - Does the concept of safety culture help or hinder systems
thinking in safety?
May 29, 2014
Reiman T, Rollenhagen C. Does the concept of safety culture help or hinder systems thinking in safety?
Accid Anal Prev. 2014;68(July):5-15. doi:10.1016/j.aap.2013.10.033.
https://psnet.ahrq.gov/issue/does-concept-safety-cult…
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psnet.ahrq.gov/node/45257/psn-pdf
July 27, 2016 - Exploring approaches to patient safety: the case of spinal
manipulation therapy.
July 27, 2016
Rozmovits L, Mior S, Boon H. Exploring approaches to patient safety: the case of spinal manipulation
therapy. BMC Complement Altern Med. 2016;16:164. doi:10.1186/s12906-016-1149-2.
https://psnet.ahrq.gov/issue/exploring-…
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psnet.ahrq.gov/node/46483/psn-pdf
October 04, 2017 - Fall Prevention in Hospitals Training Program.
October 4, 2017
Rockville, MD: Agency for Healthcare Research and Quality; 2017.
https://psnet.ahrq.gov/issue/fall-prevention-hospitals-training-program
Falls are a primary focus of quality and patient safety improvement efforts in hospitals. This training
program pro…
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psnet.ahrq.gov/node/42540/psn-pdf
September 04, 2013 - A qualitative study comparing experiences of the surgical
safety checklist in hospitals in high-income and low-
income countries.
September 4, 2013
Aveling E-L, McCulloch P, Dixon-Woods M. A qualitative study comparing experiences of the surgical
safety checklist in hospitals in high-income and low-income countrie…