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psnet.ahrq.gov/issue/comparison-quality-care-patients-veterans-health-administration-and-patients-national-sample
February 24, 2011 - Study
Comparison of quality of care for patients in the Veterans Health Administration and patients in a national sample.
Citation Text:
Asch SM, McGlynn EA, Hogan MM, et al. Comparison of quality of care for patients in the Veterans Health Administration and patients in a national sam…
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psnet.ahrq.gov/issue/improving-safety-culture-results-rhode-island-icus-lessons-learned-development-action
September 17, 2010 - Study
Improving safety culture results in Rhode Island ICUs: lessons learned from the development of action-oriented plans.
Citation Text:
Vigorito MC, McNicoll L, Adams L, et al. Improving safety culture results in Rhode Island ICUs: lessons learned from the development of action-orie…
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psnet.ahrq.gov/issue/developing-team-performance-framework-intensive-care-unit
December 01, 2011 - Review
Developing a team performance framework for the intensive care unit.
Citation Text:
Reader TW, Flin R, Mearns K, et al. Developing a team performance framework for the intensive care unit. Crit Care Med. 2009;37(5):1787-1793. doi:10.1097/CCM.0b013e31819f0451.
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psnet.ahrq.gov/issue/errors-associated-oxytocin-use-multi-organization-analysis-ismp-and-ismp-canada
February 23, 2022 - Newspaper/Magazine Article
Errors associated with oxytocin use: a multi-organization analysis by ISMP and ISMP Canada.
Citation Text:
Errors associated with oxytocin use: a multi-organization analysis by ISMP and ISMP Canada. ISMP Medication Safety Alert! Acute care edition. Februar…
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psnet.ahrq.gov/issue/patient-safety-and-collaboration-intensive-care-unit-team
February 17, 2010 - Commentary
Patient safety and collaboration of the intensive care unit team.
Citation Text:
Despins LA. Patient safety and collaboration of the intensive care unit team. Crit Care Nurse. 2009;29(2):85-91. doi:10.4037/ccn2009281.
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psnet.ahrq.gov/issue/risk-adverse-drug-events-and-hospital-related-morbidity-and-mortality-among-older-adults
October 10, 2012 - Study
The risk of adverse drug events and hospital-related morbidity and mortality among older adults with potentially inappropriate medication use.
Citation Text:
Page RL, Ruscin M. The risk of adverse drug events and hospital-related morbidity and mortality among older adults with po…
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psnet.ahrq.gov/issue/roadmap-patient-safety-research-approaches-and-roadforks
July 17, 2019 - Review
Roadmap for patient safety research: approaches and roadforks.
Citation Text:
Hofoss D, Deilkås E. Roadmap for patient safety research: approaches and roadforks. Scand J Public Health. 2008;36(8):812-7. doi:10.1177/1403494808096168.
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psnet.ahrq.gov/issue/pediatric-antidepressant-medication-errors-national-error-reporting-database
September 21, 2008 - Study
Pediatric antidepressant medication errors in a national error reporting database.
Citation Text:
Rinke ML, Bundy DG, Shore AD, et al. Pediatric antidepressant medication errors in a national error reporting database. J Dev Behav Pediatr. 2010;31(2):129-36. doi:10.1097/DBP.0b013e…
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psnet.ahrq.gov/issue/enhancing-safety-reporting-adult-ambulatory-oncology-clinician-champion-practice-innovation
January 05, 2017 - Study
Enhancing safety reporting in adult ambulatory oncology with a clinician champion: a practice innovation.
Citation Text:
Weingart SN, Price J, Duncombe D, et al. Enhancing safety reporting in adult ambulatory oncology with a clinician champion: a practice innovation. J Nurs Care …
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psnet.ahrq.gov/issue/iv-push-gap-analysis-tool-gat-helps-uncover-national-priorities-safe-injection-practices
August 14, 2019 - Newspaper/Magazine Article
IV Push Gap Analysis Tool (GAT) helps uncover national priorities for safe injection practices.
Citation Text:
IV Push Gap Analysis Tool (GAT) helps uncover national priorities for safe injection practices. ISMP Medication Safety Alert! Acute Care Edition. Augu…
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psnet.ahrq.gov/issue/advancing-medication-safety-establishing-national-action-plan-adverse-drug-event-prevention
September 29, 2017 - Commentary
Advancing medication safety: establishing a National Action Plan for Adverse Drug Event Prevention.
Citation Text:
Harris Y, Hu DJ, Lee C, et al. Advancing Medication Safety: Establishing a National Action Plan for Adverse Drug Event Prevention. Jt Comm J Qual Patient Saf. 201…
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psnet.ahrq.gov/issue/notes-healing-after-missed-diagnosis
May 18, 2022 - Commentary
Notes on healing after a missed diagnosis.
Citation Text:
Fleming EA. Notes on healing after a missed diagnosis. JAMA. 2022;328(13):1297-1298. doi:10.1001/jama.2022.15724.
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psnet.ahrq.gov/issue/human-cognition-and-dynamics-failure-rescue-lewis-blackman-case
April 24, 2018 - Commentary
Human cognition and the dynamics of failure to rescue: the Lewis Blackman case.
Citation Text:
Acquaviva K, Haskell H, Johnson J. Human cognition and the dynamics of failure to rescue: the Lewis Blackman case. J Prof Nurs. 2013;29(2):95-101. doi:10.1016/j.profnurs.2012.12.009.…
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psnet.ahrq.gov/issue/why-even-good-physicians-do-not-wash-their-hands
September 21, 2022 - Commentary
Why even good physicians do not wash their hands.
Citation Text:
Redelmeier DA, Shafir E. Why even good physicians do not wash their hands. BMJ Qual Saf. 2015;24(12):744-7. doi:10.1136/bmjqs-2015-004319.
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psnet.ahrq.gov/issue/err-human-what-happens-when-surgeons-err
August 04, 2021 - Study
To err is human, but what happens when surgeons err?
Citation Text:
Lin JS, Olutoye OO, Samora JB. To err is human, but what happens when surgeons err? J Pediatr Surg. 2023;58(3):496-502. doi:10.1016/j.jpedsurg.2022.06.019.
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psnet.ahrq.gov/issue/changing-patient-safety-mindset-can-safety-cases-help
July 14, 2021 - Commentary
Changing the patient safety mindset: can safety cases help?
Citation Text:
Sujan M, Habli I. Changing the patient safety mindset: can safety cases help? BMJ Qual Saf. 2024;33(3):145-148. doi:10.1136/bmjqs-2023-016652.
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psnet.ahrq.gov/issue/missed-diagnoses-urologists-resulting-malpractice-payment
November 21, 2021 - Study
Missed diagnoses by urologists resulting in malpractice payment.
Citation Text:
Badger WJ, Moran ME, Abraham C, et al. Missed diagnoses by urologists resulting in malpractice payment. J Urol. 2007;178(6):2537-9.
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psnet.ahrq.gov/issue/sterile-cockpit-effective-approach-reducing-medication-errors
April 24, 2018 - Commentary
The sterile cockpit: an effective approach to reducing medication errors?
Citation Text:
Federwisch M, Ramos H, Adams S' C. The sterile cockpit: an effective approach to reducing medication errors? Am J Nurs. 2014;114(2):47-55. doi:10.1097/01.NAJ.0000443777.80999.5c.
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psnet.ahrq.gov/issue/10-years-why-time-out-still-matters
November 08, 2013 - Commentary
10 years in, why time out still matters.
Citation Text:
Guglielmi CL, Canacari EG, DuPree ES, et al. 10 years in, why time out still matters. AORN J. 2014;99(6):783-794. doi:10.1016/j.aorn.2014.04.009.
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psnet.ahrq.gov/issue/investigation-relationship-between-safety-climate-and-medication-errors-well-other-nurse-and
June 26, 2019 - Study
An investigation of the relationship between safety climate and medication errors as well as other nurse and patient outcomes.
Citation Text:
Hofmann DA, Mark BA. AN INVESTIGATION OF THE RELATIONSHIP BETWEEN SAFETY CLIMATE AND MEDICATION ERRORS AS WELL AS OTHER NURSE AND PATIENT …