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psnet.ahrq.gov/issue/medication-reconciliation-acute-care-ensuring-accurate-drug-regimen-admission-and-discharge
October 28, 2020 - Commentary
Medication reconciliation in acute care: ensuring an accurate drug regimen on admission and discharge.
Citation Text:
Rodehaver C, Fearing D. Medication reconciliation in acute care: ensuring an accurate drug regimen on admission and discharge. Jt Comm J Qual Patient Saf. 2005…
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psnet.ahrq.gov/issue/how-do-community-pharmacies-recover-e-prescription-errors
November 04, 2014 - Study
How do community pharmacies recover from e-prescription errors?
Citation Text:
Odukoya OK, Stone JA, Chui MA. How do community pharmacies recover from e-prescription errors? Res Social Adm Pharm. 2014;10(6):837-852. doi:10.1016/j.sapharm.2013.11.009.
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psnet.ahrq.gov/issue/role-talking-and-keeping-silent-physician-coping-medical-error-qualitative-study
February 16, 2011 - Study
The role of talking (and keeping silent) in physician coping with medical error: a qualitative study.
Citation Text:
May NB, Plews-Ogan M. The role of talking (and keeping silent) in physician coping with medical error: a qualitative study. Patient Educ Couns. 2012;88(3):449-54. …
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psnet.ahrq.gov/issue/recurring-problem-retained-swabs-and-instruments
June 19, 2019 - Review
The recurring problem of retained swabs and instruments.
Citation Text:
Mahran MA, Toeima E, Morris EP. The recurring problem of retained swabs and instruments. Best Pract Res Clin Obstet Gynaecol. 2013;27(4):489-95. doi:10.1016/j.bpobgyn.2013.03.001.
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psnet.ahrq.gov/issue/electronic-prescribing-within-electronic-health-record-reduces-ambulatory-prescribing-errors
March 21, 2017 - Study
Electronic prescribing within an electronic health record reduces ambulatory prescribing errors.
Citation Text:
Dupree E, Anderson R, McEvoy MD, et al. Professionalism: a necessary ingredient in a culture of safety. Jt Comm J Qual Patient Saf. 2011;37(10):447-455.
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psnet.ahrq.gov/issue/impact-workplace-mistreatment-patient-safety-risk-and-nurse-assessed-patient-outcomes
September 24, 2010 - Study
Impact of workplace mistreatment on patient safety risk and nurse-assessed patient outcomes.
Citation Text:
Laschinger HKS. Impact of workplace mistreatment on patient safety risk and nurse-assessed patient outcomes. J Nurs Adm. 2014;44(5):284-90. doi:10.1097/NNA.0000000000000068. …
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psnet.ahrq.gov/issue/parenteral-opioid-shortage-treating-pain-during-opioid-overdose-epidemic
January 31, 2024 - Commentary
Emerging Classic
Parenteral opioid shortage—treating pain during the opioid-overdose epidemic.
Citation Text:
Bruera E. Parenteral Opioid Shortage - Treating Pain during the Opioid-Overdose Epidemic. N Engl J Med. 2018;379(7):601-603. doi:10.1056/NEJM…
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psnet.ahrq.gov/issue/positive-deviance-new-tool-infection-prevention-and-patient-safety
March 09, 2022 - Commentary
Positive deviance: a new tool for infection prevention and patient safety.
Citation Text:
Marra AR, Santos OFPD, Neto MC, et al. Positive Deviance: A New Tool for Infection Prevention and Patient Safety. Curr Infect Dis Rep. 2013.
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psnet.ahrq.gov/issue/childrens-hospital-investigated-five-patient-deaths-deadly-fungal-disease-2009
June 14, 2017 - Newspaper/Magazine Article
Children's Hospital investigated five patient deaths from deadly fungal disease in 2009.
Citation Text:
Duffy J, Harris J, Gade L, et al. Mucormycosis outbreak associated with hospital linens. The Pediatric infectious disease journal. 2014;33(5):472-6. doi:10.1…
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psnet.ahrq.gov/issue/patient-safety-and-end-life-care-common-issues-perspectives-and-strategies-improving-care
June 30, 2021 - Review
Patient safety and end-of-life care: common issues, perspectives, and strategies for improving care.
Citation Text:
Dy SM. Patient Safety and End-of-Life Care: Common Issues, Perspectives, and Strategies for Improving Care. Am J Hosp Palliat Care. 2016;33(8):791-6. doi:10.1177/104…
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psnet.ahrq.gov/issue/when-medical-care-leads-harm-difficulty-finding-words-teachable-moment
September 23, 2017 - Commentary
When medical care leads to harm—difficulty finding words: a teachable moment.
Citation Text:
Chamberlain E, DiVeronica M, Segura R. When medical care leads to harm- difficulty finding words: a teachable moment. JAMA Intern Med. 2015;175(8):1271-1272. doi:10.1001/jamainternmed.…
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psnet.ahrq.gov/node/49529/psn-pdf
February 01, 2007 - Incidence of adverse drug events and potential adverse drug
events. Implications for prevention.
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psnet.ahrq.gov/node/49490/psn-pdf
September 01, 2005 - important, what can medical device
companies, health care organizations, and you do about reducing the incidence
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psnet.ahrq.gov/web-mm/right-electrocardiogram-wrong-patient
April 24, 2024 - : a mixed method study to identify incidence and risk factors for CPOE patient misidentification.
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psnet.ahrq.gov/perspective/context-intervention
August 05, 2020 - There are examples of the contribution these theories and methods have made to understanding the incidence
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psnet.ahrq.gov/issue/why-patient-safety-challenge-insights-professionalism-opinions-medical-students-research
January 26, 2022 - Study
Why is patient safety a challenge? Insights from the Professionalism Opinions of Medical Students' research.
Citation Text:
McGurgan PM, Calvert KL, Nathan EA, et al. Why is patient safety a challenge? Insights from the Professionalism Opinions of Medical Students' research. J Pati…
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psnet.ahrq.gov/issue/adverse-event-screening-tool-based-routinely-collected-hospital-acquired-diagnoses
July 23, 2008 - Study
An adverse event screening tool based on routinely collected hospital-acquired diagnoses.
Citation Text:
Brand CA, Tropea J, Gorelik A, et al. An adverse event screening tool based on routinely collected hospital-acquired diagnoses. Int J Qual Health Care. 2012;24(3):266-78. doi:10…
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psnet.ahrq.gov/issue/patterns-errors-contributing-trauma-mortality-lessons-learned-2594-deaths
March 24, 2021 - Study
Patterns of errors contributing to trauma mortality: lessons learned from 2,594 deaths.
Citation Text:
Gruen RL, Jurkovich GJ, McIntyre LK, et al. Patterns of Errors Contributing to Trauma Mortality. Transactions of the .. Meeting of the American Surgical Association. 2006;124. d…
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psnet.ahrq.gov/issue/whats-psychology-got-do-it-applying-psychological-theory-understanding-failures-modern
July 10, 2017 - Commentary
"What's psychology got to do with it?" Applying psychological theory to understanding failures in modern healthcare settings.
Citation Text:
Rydon-Grange M. 'What's Psychology got to do with it?' Applying psychological theory to understanding failures in modern healthcare sett…
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psnet.ahrq.gov/issue/framework-health-care-organizations-develop-and-evaluate-safety-scorecard
September 17, 2010 - Commentary
A framework for health care organizations to develop and evaluate a safety scorecard.
Citation Text:
Pronovost P, Berenholtz SM, Needham DM. A framework for health care organizations to develop and evaluate a safety scorecard. JAMA. 2007;298(17):2063-5.
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