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psnet.ahrq.gov/node/50769/psn-pdf
February 15, 2017 - Cultural Competence and Patient Safety
December 27, 2019
Brach C, Hall KK, Fitall E. Cultural Competence and Patient Safety. PSNet [internet]. 2019.
https://psnet.ahrq.gov/perspective/cultural-competence-and-patient-safety
Background
Culture can be defined as the “personal identification, language, thoughts, co…
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psnet.ahrq.gov/node/33881/psn-pdf
August 01, 2019 - In Conversation With… Erik Hollnagel, PhD
June 1, 2019
In Conversation With… Erik Hollnagel, PhD. PSNet [internet]. 2019.
https://psnet.ahrq.gov/perspective/conversation-erik-hollnagel-phd
Editor's note: Dr. Hollnagel is Senior Professor of Patient Safety at the University of Jönköping (Sweden)
as well as Visiting…
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psnet.ahrq.gov/node/33816/psn-pdf
October 01, 2016 - In Conversation With… Richard Platt, MD, MSc
October 1, 2016
In Conversation With… Richard Platt, MD, MSc. PSNet [internet]. 2016.
https://psnet.ahrq.gov/perspective/conversation-richard-platt-md-msc
Editor's note: Dr. Platt is Professor and Chair of the Harvard Medical School Department of Population
Medicine. He…
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psnet.ahrq.gov/node/841567/psn-pdf
December 14, 2022 - Measuring Patient Safety
December 14, 2022
Schreiber M, Van C, Mossburg SE. Measuring Patient Safety. PSNet [internet]. 2022.
https://psnet.ahrq.gov/perspective/measuring-patient-safety
Following the landmark report To Err is Human: Building a Safer Health System, developed by the Institute
of Medicine in 1999, pa…
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psnet.ahrq.gov/web-mm/insulin-administration-pen-vs-vial-similar-not-interchangeable
December 20, 2023 - Insulin Administration: Pen vs Vial – Similar, but Not Interchangeable
Citation Text:
Camarillo H. Insulin Administration: Pen vs Vial – Similar, but Not Interchangeable. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2023.
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psnet.ahrq.gov/web-mm/workaround-error
October 30, 2024 - Workaround Error
Citation Text:
Pape T. Workaround Error. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2006.
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…
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psnet.ahrq.gov/node/49532/psn-pdf
March 15, 2007 - Back to Basics
March 1, 2007
Hellman R. Back to Basics. PSNet [internet]. 2007.
https://psnet.ahrq.gov/web-mm/back-basics
The Case
A 48-year-old woman with insulin-dependent diabetes mellitus presents to the emergency department with
right upper quadrant pain, fever, and leukocytosis, prompting admission for pres…
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psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.443_slideshow.ppt
May 01, 2018 - Spotlight
Spotlight
Out of Sight, Out of Mind: Out-of-Office Test Result Management
1
Source and Credits
This presentation is based on the May 2018
AHRQ WebM&M Spotlight Case
See the full article at https://psnet.ahrq.gov/webmm
CME credit is available
Commentary by: Eric Poon, MD, MPH, Duke University School o…
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psnet.ahrq.gov/node/33876/psn-pdf
August 01, 2018 - Building a Safety Program in a Vast Health Care Network
March 1, 2019
Phrampus P. Building a Safety Program in a Vast Health Care Network. PSNet [internet]. 2019.
https://psnet.ahrq.gov/perspective/building-safety-program-vast-health-care-network
Perspective
Background
As hospital-based health care in the United …
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psnet.ahrq.gov/node/33698/psn-pdf
August 01, 2010 - In Conversation with...Richard P. Shannon, MD
August 1, 2010
In Conversation with..Richard P. Shannon, MD. PSNet [internet]. 2010.
https://psnet.ahrq.gov/perspective/conversation-withrichard-p-shannon-md
Editor's note: Richard P. Shannon, MD, is the Frank Wister Thomas Professor of Medicine at the
University of Pe…
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psnet.ahrq.gov/primer/medication-errors-and-adverse-drug-events
December 15, 2024 - Medication Errors and Adverse Drug Events
Citation Text:
Medication Errors and Adverse Drug Events. 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/issue/20-years-later-err-leadership-failure
November 30, 2016 - Special or Theme Issue
20 years later: to err is a leadership failure.
Citation Text:
20 years later: to err is a leadership failure. Castellucci M, Meyer H. Modern Healthcare: November 11, 2019;49:18-22;28-30;32-34.
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P…
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psnet.ahrq.gov/issue/medical-liability-and-patient-safety-setting-proper-course
January 12, 2011 - Commentary
Medical liability and patient safety: setting the proper course.
Citation Text:
Pearlman MD, Gluck PA. Medical liability and patient safety: setting the proper course. Obstet Gynecol. 2005;105(5 Pt 1):941-943.
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psnet.ahrq.gov/issue/ismp-long-term-care-advise-err
June 07, 2017 - Newsletter/Journal
ISMP Long-Term Care Advise-ERR.
Citation Text:
ISMP Long-Term Care Advise-ERR. Horsham, PA; Institute for Safe Medication Practices.
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psnet.ahrq.gov/issue/role-physician-specialty-board-certification-status-quality-movement
October 01, 2007 - Review
The role of physician specialty board certification status in the quality movement.
Citation Text:
Brennan TA, Horwitz RI, Duffy FD, et al. The Role of Physician Specialty Board Certification Status in the Quality Movement. JAMA. 2004;292(9). doi:10.1001/jama.292.9.1038.
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psnet.ahrq.gov/issue/supporting-nurses-essential-partners-diagnosis
August 05, 2020 - Newspaper/Magazine Article
Supporting nurses as essential partners in diagnosis.
Citation Text:
Supporting nurses as essential partners in diagnosis. Carr S. ImproveDx. March 2021:8(2)
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psnet.ahrq.gov/issue/employee-discipline-solution-patient-safety
September 15, 2011 - Commentary
Is employee discipline the solution for patient safety?
Citation Text:
Mace KA. Is employee discipline the solution for patient safety? Nurs Manag. 2005;36(12):57-59.
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psnet.ahrq.gov/issue/anesthesia-outside-or-cause-patient-safety-concerns
May 25, 2022 - Newspaper/Magazine Article
Anesthesia outside of the OR: cause for patient safety concerns?
Citation Text:
Anesthesia outside of the OR: cause for patient safety concerns? DePeau-Wilson M. MedPage Today. January 13, 2023.
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psnet.ahrq.gov/issue/nhs-patient-safety-strategy
April 15, 2020 - Organizational Policy/Guidelines
The NHS Patient Safety Strategy.
Citation Text:
The NHS Patient Safety Strategy. NHS England
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psnet.ahrq.gov/issue/ebola-case-raises-concern-about-everyday-hospital-safety
June 21, 2017 - Newspaper/Magazine Article
Ebola case raises concern about everyday hospital safety.
Citation Text:
Ebola case raises concern about everyday hospital safety. Rodricks D. Baltimore Sun. October 14, 2014.
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