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psnet.ahrq.gov/node/33625/psn-pdf
January 01, 2006 - Aviation Safety Methods: Quickly Adopted but Questions
Remain
January 1, 2006
Thomas EJ. Aviation Safety Methods: Quickly Adopted but Questions Remain. PSNet [internet]. 2006.
https://psnet.ahrq.gov/perspective/aviation-safety-methods-quickly-adopted-questions-remain
Perspective
On August 2, 2005, Air France flig…
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psnet.ahrq.gov/node/73515/psn-pdf
August 01, 2022 - Missouri Quality Initiative (MOQI) Reduces
Hospitalizations Among Nursing Home Residents
July 28, 2021
https://psnet.ahrq.gov/innovation/missouri-quality-initiative-moqi-reduces-hospitalizations-among-nursing-
home-residents
Summary
The MOQI seeks to reduce avoidable hospitalization among nursing home residents b…
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psnet.ahrq.gov/web-mm/miscommunication-or-leads-anticoagulation-mishap
May 08, 2019 - Miscommunication in the OR Leads to Anticoagulation Mishap
Citation Text:
Solsky I, Haynes AB. Miscommunication in the OR Leads to Anticoagulation Mishap. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2017.
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psnet.ahrq.gov/primer/patient-safety-101
January 16, 2025 - Patient Safety 101
Citation Text:
Patient Safety 101. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2019.
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psnet.ahrq.gov/web-mm/refused-medication-error
November 01, 2005 - Refused Medication Error
Citation Text:
Foley M. Refused Medication Error. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2017.
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psnet.ahrq.gov/node/46481/psn-pdf
August 20, 2018 - An electronic trigger based on care escalation to identify
preventable adverse events in hospitalised patients.
August 20, 2018
Bhise V, Sittig DF, Vaghani V, et al. An electronic trigger based on care escalation to identify preventable
adverse events in hospitalised patients. BMJ Qual Saf. 2018;27(3):241-246. doi:…
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psnet.ahrq.gov/node/41461/psn-pdf
April 05, 2013 - Residents' response to duty-hour regulations—a follow-
up national survey.
April 5, 2013
Drolet BC, Christopher DA, Fischer SA. Residents' response to duty-hour regulations--a follow-up national
survey. N Engl J Med. 2012;366(24):e35. doi:10.1056/NEJMp1202848.
https://psnet.ahrq.gov/issue/residents-response-duty-h…
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psnet.ahrq.gov/node/40965/psn-pdf
December 15, 2011 - Medication errors during patient transitions into nursing
homes: characteristics and association with patient harm.
December 15, 2011
Desai R, Williams CE, Greene SB, et al. Medication errors during patient transitions into nursing homes:
characteristics and association with patient harm. Am J Geriatr Pharmacother.…
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psnet.ahrq.gov/node/47082/psn-pdf
July 02, 2019 - Effect of systematic physician cross-checking on
reducing adverse events in the emergency department:
the CHARMED cluster randomized trial.
July 2, 2019
Freund Y, Goulet H, Leblanc J, et al. Effect of Systematic Physician Cross-checking on Reducing Adverse
Events in the Emergency Department: The CHARMED Cluster Ra…
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psnet.ahrq.gov/issue/lessons-event-reports
January 16, 2025 - Multi-use Website
Lessons from Event Reports.
Citation Text:
Lessons from Event Reports. Patient Safety Authority.
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psnet.ahrq.gov/node/45220/psn-pdf
June 08, 2016 - Medical Office Survey on Patient Safety Culture: 2016
User Comparative Database Report.
June 8, 2016
Famolaro T, Yount ND, Hare R, Thornton S, Sorra J. Rockville, MD: Agency for Healthcare Research and
Quality; May 2016. AHRQ Publication No. 16-0028-EF.
https://psnet.ahrq.gov/issue/medical-office-survey-patient-sa…
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psnet.ahrq.gov/perspective/patient-safety-ambulatory-care-setting
April 27, 2022 - Annual Perspective
Patient Safety in the Ambulatory Care Setting
August 5, 2022
View more articles from the same authors.
Citation Text:
Schiff G, Mossburg SE, Dowell P, et al. Patient Safety in the Ambulatory Care Setting. PSNet [internet]. Rockville (MD): …
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psnet.ahrq.gov/curated-library/nurse-wellbeing-and-patient-safety
August 30, 2023 - Breadcrumb
Home
The PSNet Collection
Curated Libraries
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Nurse Wellbeing and Patient Safety
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Created By: Lorri Zipperer, Cybrarian, AHRQ…
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psnet.ahrq.gov/node/840174/psn-pdf
August 28, 2024 - Missed CANDOR Implementation Opportunities.
November 16, 2022
Schweitzer L. Missed CANDOR Implementation Opportunities. PSNet [internet]. 2022.
https://psnet.ahrq.gov/web-mm/missed-candor-implementation-opportunities
The Case
A 58-year-old man with a history of type 2 diabetes mellitus, hypertension, morbid obesit…
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psnet.ahrq.gov/node/866055/psn-pdf
May 29, 2024 - Reducing Preventable Patient Harm Due to Retained
Surgical Items: The RSI Bundle
May 29, 2024
https://psnet.ahrq.gov/innovation/reducing-preventable-patient-harm-due-retained-surgical-items-rsi-bundle
Summary
Retained surgical items (RSIs) cause severe yet preventable patient harm. RSIs are the most common
catego…
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psnet.ahrq.gov/node/49519/psn-pdf
September 01, 2006 - Triple Handoff
September 1, 2006
Vidyarthi A. Triple Handoff. PSNet [internet]. 2006.
https://psnet.ahrq.gov/web-mm/triple-handoff
Case Objectives
Appreciate the prevalence of handoffs and sign out related errors.
Understand the key elements of a safe and effective written and verbal sign out.
List Kotter’s 8 st…
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psnet.ahrq.gov/node/38704/psn-pdf
July 31, 2012 - Clinical Handover: Critical Communications.
July 31, 2012
Med J Aust. 2009;190(s11):s108-s157.
https://psnet.ahrq.gov/issue/clinical-handover-critical-communications
This supplement discusses Australian efforts to improve handover safety with emphasis on flexible
standardization, communication improvement, and inf…
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psnet.ahrq.gov/perspective/conversation-christie-allen-about-maternal-safety-and-perinatal-mental-health
March 29, 2023 - In Conversation with... Christie Allen about Maternal Safety and Perinatal Mental Health
March 28, 2023
Also Read the Essay
Citation Text:
In Conversation with.. Christie Allen about Maternal Safety and Perinatal Mental Health. PSNet [internet]. 2023.In Conversat…
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psnet.ahrq.gov/node/36399/psn-pdf
May 04, 2015 - Tips for Safer Surgery.
May 4, 2015
Surgical Care Improvement Project. Oklahoma City, OK: Oklahoma Foundation for Medical Quality;
2006.
https://psnet.ahrq.gov/issue/tips-safer-surgery
This tip sheet provides a list of questions consumers should ask clinicians to help improve the safety of
their surgical car…
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psnet.ahrq.gov/perspective/care-transitions
December 01, 2007 - Care Transitions
Sunil Kripalani, MD, MSc | December 1, 2007
Also Read a Conversation
View more articles from the same authors.
Citation Text:
Kripalani S. Care Transitions. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Depart…