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psnet.ahrq.gov/node/852278/psn-pdf
August 09, 2023 - Identifying failure modes in telemedicine: an instructional
needs assessment.
August 9, 2023
Monkman H, Kuziemsky C, Homco J, et al. Identifying failure modes in telemedicine: an instructional needs
assessment. Stud Health Technol Inform. 2023;304:39-43. doi:10.3233/shti230365.
https://psnet.ahrq.gov/issue/identif…
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psnet.ahrq.gov/node/852284/psn-pdf
August 09, 2023 - ‘Medical errors are the third leading cause of death’ and
other statistics you should question.
August 9, 2023
Jaklevic MC. HealthJournalism.org. July 27, 2023.
https://psnet.ahrq.gov/issue/medical-errors-are-third-leading-cause-death-and-other-statistics-you-should-
question
Published rates of medical errors con…
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psnet.ahrq.gov/node/60020/psn-pdf
March 04, 2020 - The eNOTSS platform for surgeons’ nontechnical skills
performance improvement.
March 4, 2020
Pradarelli JC, Yule S, Smink DS. The eNOTSS Platform for Surgeons’ Nontechnical Skills Performance
Improvement. JAMA Surg. 2020;155(5):438-439. doi:10.1001/jamasurg.2019.5880.
https://psnet.ahrq.gov/issue/enotss-platform-s…
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psnet.ahrq.gov/node/842434/psn-pdf
June 01, 2024 - AHRQ Safety Program for Telemedicine.
January 22, 2024
Agency for Healthcare Research and Quality.
https://psnet.ahrq.gov/issue/ahrq-safety-program-telemedicine
Telemedicine efforts harbor both risk and reward to patients and clinicians. The AHRQ Safety Program for
Telemedicine is a national effort to develop and …
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psnet.ahrq.gov/node/72828/psn-pdf
March 10, 2021 - A recurring call to action: every healthcare organization
needs a medication safety officer!
March 10, 2021
ISMP Medication Safety Alert! Acute care edition. February 25, 2021;26(4);1-4.
https://psnet.ahrq.gov/issue/recurring-call-action-every-healthcare-organization-needs-medication-safety-
officer
Leadership ro…
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psnet.ahrq.gov/node/60929/psn-pdf
September 16, 2020 - Safer Together: A National Action Plan to Advance Patient
Safety.
September 16, 2020
Boston, MA: Institute for Healthcare Improvement: September 2020.
https://psnet.ahrq.gov/issue/national-action-plan-advance-patient-safety
This National Action Plan developed by the National Steering Committee for Pati…
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psnet.ahrq.gov/perspective/role-undergraduate-nursing-education-patient-safety
November 27, 2023 - We establish quality standards for nursing education and assist schools in implementing those standards … Students also may participate in the change process of a quality improvement committee, or in implementing
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psnet.ahrq.gov/issue/evaluation-association-between-nursing-home-survey-patient-safety-culture-nhsops-measures-and
April 05, 2017 - Study
Evaluation of the association between Nursing Home Survey on Patient Safety culture (NHSOPS) measures and catheter-associated urinary tract infections: results of a national collaborative.
Citation Text:
Smith SN, Greene MT, Mody L, et al. Evaluation of the association between Nurs…
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psnet.ahrq.gov/node/33562/psn-pdf
September 15, 2024 - Rapid Response Systems
September 15, 2024
Rapid Response Systems. PSNet [internet]. 2019.
https://psnet.ahrq.gov/primer/rapid-response-systems
PSNet primers are regularly reviewed and updated by the UC Davis PSNet Editorial Team to ensure that
they reflect current research and practice in the patient safety field.…
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psnet.ahrq.gov/node/33576/psn-pdf
December 15, 2024 - Wrong-Site, Wrong-Procedure, and Wrong-Patient
Surgery
December 15, 2024
Wrong-Site, Wrong-Procedure, and Wrong-Patient Surgery. PSNet [internet]. 2019.
https://psnet.ahrq.gov/primer/wrong-site-wrong-procedure-and-wrong-patient-surgery
PSNet primers are regularly reviewed and updated by the UC Davis PSNet Editoria…
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psnet.ahrq.gov/node/845472/psn-pdf
March 15, 2023 - We spoke
with them about their experience implementing remote patient monitoring (RPM) programs, GW’
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psnet.ahrq.gov/node/73575/psn-pdf
August 04, 2021 - Unlocking Solutions in Imaging: Working Together to
Learn from Failings in the NHS.
August 4, 2021
Manchester, UK: Parliamentary and Health Service Ombudsman; 2021. ISBN 9781528627016.
https://psnet.ahrq.gov/issue/unlocking-solutions-imaging-working-together-learn-failings-nhs
Lack of appropriate follow up o…
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psnet.ahrq.gov/node/47119/psn-pdf
September 19, 2018 - A usability and safety analysis of electronic health
records: a multi-center study.
September 19, 2018
Ratwani RM, Savage E, Will A, et al. A usability and safety analysis of electronic health records: a multi-
center study. J Am Med Inform Assoc. 2018;25(9):1197-1201. doi:10.1093/jamia/ocy088.
https://psnet.ahrq.…
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psnet.ahrq.gov/node/41456/psn-pdf
September 26, 2016 - Paradoxical effects of a hospital-based, multi-intervention
programme aimed at reducing medication round
interruptions.
September 26, 2016
Tomietto M, Sartor A, Mazzocoli E, et al. Paradoxical effects of a hospital-based, multi-intervention
programme aimed at reducing medication round interruptions. J Nurs Manag. …
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psnet.ahrq.gov/node/36734/psn-pdf
March 10, 2011 - Integrating incident reporting into an electronic patient
record system.
March 10, 2011
Haller G, Myles PS, Stoelwinder J, et al. Integrating incident reporting into an electronic patient record
system. J Am Med Inform Assoc. 2007;14(2):175-81.
https://psnet.ahrq.gov/issue/integrating-incident-reporting-electronic…
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psnet.ahrq.gov/node/850353/psn-pdf
June 14, 2023 - Perioperative handoff enhancement opportunities
through technology and artificial intelligence: a narrative
review.
June 14, 2023
Sparling J, Hong Mershon B, Abraham J. Perioperative handoff enhancement opportunities through
technology and artificial intelligence: a narrative review. Jt Comm J Qual Patient Saf. 20…
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psnet.ahrq.gov/node/74704/psn-pdf
January 26, 2022 - Improving self-reported empathy and communication
skills through harm in healthcare response training.
January 26, 2022
Samuels A, Broome ME, McDonald TB, et al. Improving self-reported empathy and communication skills
through harm in healthcare response training. J Patient Saf Risk Manage. 2021;26(6):251-260.
doi…
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psnet.ahrq.gov/node/867643/psn-pdf
February 26, 2025 - Psychology insights on apologizing to patients.
February 26, 2025
Redelmeier DA, Roach J. Psychology insights on apologizing to patients. J Hosp Med. 2024;Epub Dec 30.
doi:10.1002/jhm.13585.
https://psnet.ahrq.gov/issue/psychology-insights-apologizing-patients
Apologizing to the patient and family after a harmful …
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psnet.ahrq.gov/node/867094/psn-pdf
January 01, 2025 - Maximizing the ability of health IT and AI to improve
patient safety.
November 6, 2024
Singh H, Sittig DF, Classen DC. Maximizing the ability of health IT and AI to improve patient safety. JAMA
Intern Med. 2025;185(1):10-12. doi:10.1001/jamainternmed.2024.4343.
https://psnet.ahrq.gov/issue/maximizing-ability-healt…
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psnet.ahrq.gov/node/73654/psn-pdf
September 01, 2021 - CancelRx: a health IT tool to reduce medication
discrepancies in the outpatient setting.
September 1, 2021
Watterson TL, Stone JA, Brown RL, et al. CancelRx: a health IT tool to reduce medication discrepancies in
the outpatient setting. J Am Med Inform Assoc. 2021;28(7):1526-1533. doi:10.1093/jamia/ocab038.
https:…