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  1. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/46295/psn-pdf
    September 06, 2017 - Pain assessment and management standards for hospitals. September 6, 2017 R3 Report. August 29, 2017;11:1-7. https://psnet.ahrq.gov/issue/pain-assessment-and-management-standards-hospitals Strategies to manage pain safely have been reexamined in light of the opioid epidemic. This report highlights Joint Commissio…
  2. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/45549/psn-pdf
    October 12, 2016 - Preventing diagnostic errors in primary care. October 12, 2016 Ely JW, Graber ML. Preventing Diagnostic Errors in Primary Care. Am Fam Physician. 2016;94(6):426-32. https://psnet.ahrq.gov/issue/preventing-diagnostic-errors-primary-care The Improving Diagnosis in Health Care report advocated for enhancing patient en…
  3. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/852804/psn-pdf
    August 23, 2023 - Five new ways to advance diagnostic safety in your clinical practice. August 23, 2023 Bradford A, Goeschel C, Shofer M, et al. Am Fam Physician. 2023;108(1):14-16. https://psnet.ahrq.gov/issue/five-new-ways-advance-diagnostic-safety-your-clinical-practice Diagnostic errors are common in the ambulatory environment.…
  4. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/838929/psn-pdf
    October 26, 2022 - Toolkit To Improve Antibiotic Use in Ambulatory Care. October 26, 2022 Rockville, MD: Agency for Healthcare Research and Quality; October 2022. https://psnet.ahrq.gov/issue/toolkit-improve-antibiotic-use-ambulatory-care Inappropriate antibiotic prescribing is associated with increased risk potential. This toolkit a…
  5. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/41026/psn-pdf
    March 02, 2012 - SBAR: electronic handoff tool for noncomplicated procedural patients. March 2, 2012 Wentworth L, Diggins J, Bartel D, et al. SBAR: electronic handoff tool for noncomplicated procedural patients. J Nurs Care Qual. 2012;27(2):125-31. doi:10.1097/NCQ.0b013e31823cc9a0. https://psnet.ahrq.gov/issue/sbar-electronic-hand…
  6. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/848044/psn-pdf
    April 26, 2023 - Effect of a hospital command centre on patient safety: an interrupted time series study. April 26, 2023 Mebrahtu TF, McInerney CD, Benn J, et al. BMJ Health Care Inform. 2023;30(1):e100653. https://psnet.ahrq.gov/issue/effect-hospital-command-centre-patient-safety-interrupted-time-series-study Command centers…
  7. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/42551/psn-pdf
    May 21, 2019 - Should medical malpractice prevention be considered separately or as an integral part of comprehensive health care safety improvement? May 21, 2019 Enbom JA. Should medical malpractice prevention be considered separately or as an integral part of comprehensive health care safety improvement? Am J Obstet Gynecol. 2…
  8. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/42049/psn-pdf
    February 20, 2013 - Mitigating error vulnerability at the transition of care through the use of health IT applications. February 20, 2013 Cortelyou-Ward K, Swain A, Yeung T. Mitigating Error Vulnerability at the Transition of Care through the Use of Health IT Applications. J Med Syst. 2012;36(6). doi:10.1007/s10916-012-9855-x. https:…
  9. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/74013/psn-pdf
    October 27, 2021 - Applying decision science to the prioritization of healthcare-associated infection initiatives. October 27, 2021 Tsai TH, Gerst MD, Engineer C, et al. Applying decision science to the prioritization of healthcare- associated infection initiatives. J Patient Saf. 2021;17(7):506-512. doi:10.1097/pts.0000000000000416.…
  10. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/850358/psn-pdf
    June 14, 2023 - What Happened to Patient Safety. June 14, 2023 Sheridan S. Turn on the Lights. Institute for Healthcare Improvement.  May 2023 https://psnet.ahrq.gov/issue/what-happened-patient-safety Patient engagement is an important component in patient safety. This episode from the Turn on the Lights podcast (hosted by I…
  11. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/38276/psn-pdf
    December 10, 2008 - Addressing delays in medication administration for patients transferred from the hospital to the nursing home: a pilot quality improvement project. December 10, 2008 Ward KT, Bates-Jensen B, Eslami MS, et al. Addressing delays in medication administration for patients transferred from the hospital to the nursing h…
  12. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/73869/psn-pdf
    October 21, 2021 - Disrespectful behavior in healthcare: has it improved? Please take our survey! October 21, 2021 ISMP Medication Safety Alert! Acute care edition. September 9, 2021;26(18);1-5. https://psnet.ahrq.gov/issue/disrespectful-behavior-healthcare-has-it-improved-please-take-our-survey Disrespectful behavior is a persisten…
  13. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/44475/psn-pdf
    October 03, 2017 - Scoring no goal—further adventures in transparency. October 3, 2017 Rosenbaum L. Scoring No Goal--Further Adventures in Transparency. N Engl J Med. 2015;373(15):1385- 8. doi:10.1056/NEJMp1510094. https://psnet.ahrq.gov/issue/scoring-no-goal-further-adventures-transparency This commentary explores challenges to mon…
  14. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/50811/psn-pdf
    January 15, 2020 - NHS hospitals to employ safety experts to tackle thousands of avoidable mistakes. January 15, 2020 Lintern S. NHS hospitals to employ safety experts to tackle thousands of avoidable mistakes. Independent. December 25, 2019; https://psnet.ahrq.gov/issue/nhs-hospitals-employ-safety-experts-tackle-thousands-avoidable…
  15. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/44793/psn-pdf
    February 17, 2016 - The Sociology of Healthcare Safety and Quality. February 17, 2016 Allen D, Braithwaite J, Sandall J, Waring J, eds. Sociol Health Illn. 2016;38(2):179-339. https://psnet.ahrq.gov/issue/sociology-healthcare-safety-and-quality The sociological approach to exploring safety has shown promise as a way to understand why …
  16. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/866530/psn-pdf
    August 14, 2024 - Healthcare Simulation in Nursing Practice. August 14, 2024 Watts PI. Healthcare Simulation in Nursing Practice. Nurs Clin North Am. 2024;59(3):345-510. https://psnet.ahrq.gov/issue/healthcare-simulation-nursing-practice Simulation is an established method to examine nursing process resilience and develop non-techni…
  17. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/45586/psn-pdf
    November 02, 2016 - Antimicrobial stewardship and patient safety. November 2, 2016 Zukowski CM. Antimicrobial Stewardship and Patient Safety. AORN J. 2016;104(4):354-356. doi:10.1016/j.aorn.2016.08.002. https://psnet.ahrq.gov/issue/antimicrobial-stewardship-and-patient-safety Antimicrobial stewardship has been highlighted as a strate…
  18. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/44551/psn-pdf
    September 30, 2015 - Safety culture includes "good catches." September 30, 2015 Traynor K. Safety culture includes "good catches". Am J Health Syst Pharm. 2015;72(19):1597-1599. doi:10.2146/news150065. https://psnet.ahrq.gov/issue/safety-culture-includes-good-catches Near misses can provide opportunities for learning if there is a pro…
  19. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/46726/psn-pdf
    January 31, 2018 - Toolkit to Promote Safe Surgery. January 31, 2018 Rockville, MD: Agency for Healthcare Research and Quality; November 2017. https://psnet.ahrq.gov/issue/toolkit-promote-safe-surgery Preventing surgical complications including surgical site infections are a worldwide target for improvement. This toolkit builds on t…
  20. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/45890/psn-pdf
    February 15, 2017 - A Framework for Safe, Reliable, and Effective Care. February 15, 2017 Frankel A, Haraden C, Federico F, Lenoci-Edwards J. Cambridge, MA: Institute for Healthcare Improvement and Safe & Reliable Healthcare; 2017. https://psnet.ahrq.gov/issue/framework-safe-reliable-and-effective-care A systems approach to safety ca…

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