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psnet.ahrq.gov/node/43232/psn-pdf
June 04, 2014 - Standardization in patient safety: the WHO High 5s
project.
June 4, 2014
Leotsakos A, Zheng H, Croteau R, et al. Standardization in patient safety: the WHO High 5s project. Int J
Qual Health Care. 2014;26(2):109-16. doi:10.1093/intqhc/mzu010.
https://psnet.ahrq.gov/issue/standardization-patient-safety-who-high-5s-…
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psnet.ahrq.gov/node/46090/psn-pdf
December 22, 2018 - More than a tick box: medical checklist development,
design, and use.
December 22, 2018
Burian BK, Clebone A, Dismukes K, et al. More Than a Tick Box: Medical Checklist Development, Design,
and Use. Anesth Analg. 2018;126(1):223-232. doi:10.1213/ANE.0000000000002286.
https://psnet.ahrq.gov/issue/more-tick-box-medi…
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psnet.ahrq.gov/node/35749/psn-pdf
May 09, 2014 - Chemotherapy dose limits set by users of a computer
order entry system.
May 9, 2014
DuBeshter B; Griggs J; Angel C; Loughner J.
https://psnet.ahrq.gov/issue/chemotherapy-dose-limits-set-users-computer-order-entry-system
To avoid excessive dosing of chemotherapeutic agents, standardized dose limits must be agreed u…
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psnet.ahrq.gov/node/43219/psn-pdf
January 01, 2015 - Developing a reporting and tracking tool for nursing
student errors and near misses.
May 28, 2014
Disch J, Barnsteiner J. Developing a Reporting and Tracking Tool for Nursing Student Errors and Near
Misses. J Nurs Reg. 2015;5(1):4-10. doi:10.1016/s2155-8256(15)30093-4.
https://psnet.ahrq.gov/issue/developing-repor…
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psnet.ahrq.gov/node/44227/psn-pdf
November 19, 2018 - A scholarly pathway in quality improvement and patient
safety.
November 19, 2018
Ferguson CC, Lamb G. A Scholarly Pathway in Quality Improvement and Patient Safety. Acad Med.
2015;90(10):1358-62. doi:10.1097/ACM.0000000000000772.
https://psnet.ahrq.gov/issue/scholarly-pathway-quality-improvement-and-patient-safety…
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psnet.ahrq.gov/node/47766/psn-pdf
March 27, 2019 - Advancing the Safety of Acute Pain Management.
March 27, 2019
Boston, MA: Institute for Healthcare Improvement; 2019.
https://psnet.ahrq.gov/issue/advancing-safety-acute-pain-management
Pain management has emerged as a complex safety concern. This report discusses four organizational
prerequisites to improve pain …
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psnet.ahrq.gov/node/43740/psn-pdf
December 10, 2014 - Participation in EHR based simulation improves
recognition of patient safety issues.
December 10, 2014
Stephenson LS, Gorsuch A, Hersh WR, et al. Participation in EHR based simulation improves recognition
of patient safety issues. BMC Med Educ. 2014;14:224. doi:10.1186/1472-6920-14-224.
https://psnet.ahrq.gov/issu…
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psnet.ahrq.gov/node/853251/psn-pdf
July 19, 2024 - Annual Speak Up Data Reports.
July 19, 2024
Stratford, London; The National Guardian.
https://psnet.ahrq.gov/issue/annual-speak-data-reports
Organizational efforts to collect and respond to the concerns of staff and patients are a cornerstone to
patient safety improvement despite challenges to implement them. This…
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psnet.ahrq.gov/node/40478/psn-pdf
June 13, 2011 - Evaluating the medication process in the context of CPOE
use: the significance of working around the system.
June 13, 2011
Niazkhani Z, Pirnejad H, van der Sijs H, et al. Evaluating the medication process in the context of CPOE
use: the significance of working around the system. Int J Med Inform. 2011;80(7):490-506…
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psnet.ahrq.gov/node/44141/psn-pdf
November 06, 2015 - Failures in communication through documents and
documentation across the perioperative pathway.
November 6, 2015
Braaf S, Riley R, Manias E. Failures in communication through documents and documentation across the
perioperative pathway. J Clin Nurs. 2015;24(13-14):1874-1884. doi:10.1111/jocn.12809.
https://psnet.a…
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psnet.ahrq.gov/node/73489/psn-pdf
July 15, 2021 - A diagnostic time-out to improve differential diagnosis in
pediatric abdominal pain.
July 15, 2021
Kasick RT, Melvin JE, Perera ST, et al. A diagnostic time-out to improve differential diagnosis in pediatric
abdominal pain. Diagnosis (Berl). 2021;8(2):209-217. doi:10.1515/dx-2019-0054.
https://psnet.ahrq.gov/issue…
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psnet.ahrq.gov/node/44588/psn-pdf
November 21, 2016 - Patient and family advisory councils. The Massachusetts
experience.
November 21, 2016
Wachenheim D. Patient Saf Qual Healthc. December 8, 2015.
https://psnet.ahrq.gov/issue/patient-and-family-advisory-councils-massachusetts-experience
Patient and family advisory councils are considered valuable method to help hosp…
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psnet.ahrq.gov/node/40732/psn-pdf
November 23, 2011 - Increasing adoption of computerized provider order entry,
and persistent regional disparities, in US emergency
departments.
November 23, 2011
Pallin DJ, Sullivan AF, Espinola JA, et al. Increasing adoption of computerized provider order entry, and
persistent regional disparities, in US emergency departments. Ann E…
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psnet.ahrq.gov/node/37486/psn-pdf
January 23, 2009 - Medication report reduces number of medication errors
when elderly patients are discharged from hospital.
January 23, 2009
Midlöv P, Holmdahl L, Eriksson T, et al. Medication report reduces number of medication errors when
elderly patients are discharged from hospital. Pharm World Sci. 2007;30(1):92-98. doi:10.1007…
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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/40081/psn-pdf
December 21, 2014 - Electronic health record adoption by children's hospitals
in the United States.
December 21, 2014
Nakamura MM, Ferris T, DesRoches CM, et al. Electronic health record adoption by children's hospitals in
the United States. Arch Pediatr Adolesc Med. 2010;164(12):1145-51. doi:10.1001/archpediatrics.2010.234.
https://…
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psnet.ahrq.gov/node/74703/psn-pdf
January 26, 2022 - Research to improve diagnosis: time to study the real
world.
January 26, 2022
Ranji SR, Thomas EJ. Research to improve diagnosis: time to study the real world. BMJ Qual Saf.
2022;31(4):255-258. doi:10.1136/bmjqs-2021-014071.
https://psnet.ahrq.gov/issue/research-improve-diagnosis-time-study-real-world
Diagnostic …
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psnet.ahrq.gov/node/41721/psn-pdf
October 03, 2012 - Rural inpatient telepharmacy consultation demonstration
for after-hours medication review.
October 3, 2012
Cole SL, Grubbs JH, Din C, et al. Rural inpatient telepharmacy consultation demonstration for after-hours
medication review. Telemed J E Health. 2012;18(7):530-7. doi:10.1089/tmj.2011.0222.
https://psnet.ahrq…
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psnet.ahrq.gov/node/45949/psn-pdf
July 11, 2017 - Beyond medication reconciliation: the correct medication
list.
July 11, 2017
Rose AJ, Fischer SH, Paasche-Orlow MK. Beyond Medication Reconciliation: The Correct Medication List.
JAMA. 2017;317(20):2057-2058. doi:10.1001/jama.2017.4628.
https://psnet.ahrq.gov/issue/beyond-medication-reconciliation-correct-medicati…
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psnet.ahrq.gov/node/43126/psn-pdf
April 23, 2014 - Safe and appropriate use of insulin and other
antihyperglycemic agents in hospital.
April 23, 2014
Cornish W. Safe and appropriate use of insulin and other antihyperglycemic agents in hospital. Can J
Diabetes. 2014;38(2):94-100. doi:10.1016/j.jcjd.2014.01.002.
https://psnet.ahrq.gov/issue/safe-and-appropriate-use-…