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psnet.ahrq.gov/node/46255/psn-pdf
September 06, 2017 - Patient Safety in the Home: Assessment of Issues,
Challenges, and Opportunities.
September 6, 2017
Carpenter D, Famolaro T, Hassell S, et al. Cambridge, MA: Institute for Healthcare Improvement; 2017.
https://psnet.ahrq.gov/issue/patient-safety-home-assessment-issues-challenges-and-opportunities
The ambulatory env…
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psnet.ahrq.gov/node/46133/psn-pdf
May 24, 2017 - Implementing smart infusion pumps with dose-error
reduction software: real-world experiences.
May 24, 2017
Heron C. Implementing smart infusion pumps with dose-error reduction software: real-world experiences.
Br J Nurs. 2017;26(8):S13-S16. doi:10.12968/bjon.2017.26.8.S13.
https://psnet.ahrq.gov/issue/implementing…
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psnet.ahrq.gov/node/46084/psn-pdf
February 21, 2018 - The effect of facility characteristics on patient safety,
patient experience, and service availability for procedures
in non–hospital-affiliated outpatient settings: a systematic
review.
February 21, 2018
Berglas NF, Battistelli MF, Nicholson WK, et al. The effect of facility characteristics on patient safety,
pa…
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psnet.ahrq.gov/node/43710/psn-pdf
October 06, 2016 - Improving medication administration safety: using naïve
observation to assess practice and guide improvements
in process and outcomes.
October 6, 2016
Donaldson N, Aydin C, Fridman M, et al. Improving medication administration safety: using naïve
observation to assess practice and guide improvements in process and…
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psnet.ahrq.gov/node/73062/psn-pdf
January 01, 2022 - Description of the role of pharmacist independent double
checks during cognitive order verification of outpatient
parenteral anti-cancer therapy.
March 25, 2021
Booth JP, Kennerly-Shah JM, Hartman AD. Description of the role of pharmacist independent double
checks during cognitive order verification of outpatient …
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psnet.ahrq.gov/node/846760/psn-pdf
March 29, 2023 - Electronic health record-based prediction models for in-
hospital adverse drug event diagnosis or prognosis: a
systematic review.
March 29, 2023
Yasrebi-de Kom IAR, Dongelmans DA, de Keizer NF, et al. Electronic health record-based prediction
models for in-hospital adverse drug event diagnosis or prognosis: a syst…
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psnet.ahrq.gov/node/34694/psn-pdf
February 10, 2011 - Computerized surveillance of adverse drug events in
hospital patients.
February 10, 2011
Classen DC, Pestotnik SL, Evans RS, et al. Computerized surveillance of adverse drug events in hospital
patients. JAMA. 1991;266(20):2847-51.
https://psnet.ahrq.gov/issue/computerized-surveillance-adverse-drug-events-hospital-…
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psnet.ahrq.gov/node/867047/psn-pdf
October 30, 2024 - Therapeutic errors involving diabetes medications
reported to United States poison centers.
October 30, 2024
Thurgood Giarman A, Hays HL, Badeti J, et al. Therapeutic errors involving diabetes medications reported
to United States poison centers. Inj Epidemiol. 2024;11(1):51. doi:10.1186/s40621-024-00536-y.
https:…
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psnet.ahrq.gov/node/867388/psn-pdf
December 18, 2024 - Secure messaging use and wrong-patient ordering errors
among inpatient clinicians.
December 18, 2024
Lou SS, Lew D, Xia L, et al. Secure messaging use and wrong-patient ordering errors among inpatient
clinicians. JAMA Netw Open. 2024;7(12):e2447797. doi:10.1001/jamanetworkopen.2024.47797.
https://psnet.ahrq.gov/is…
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psnet.ahrq.gov/node/859343/psn-pdf
December 20, 2023 - Reducing retained foreign objects in the operating room:
a quality improvement initiative.
December 20, 2023
Keane OA, Chambers C, Brady CM, et al. Reducing retained foreign objects in the operating room: a
quality improvement initiative. J Am Coll Surg. 2023;237(6):864-872. doi:10.1097/xcs.0000000000000847.
https…
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psnet.ahrq.gov/node/35448/psn-pdf
September 18, 2009 - Relationship between performance measurement and
accreditation: implications for quality of care and patient
safety.
September 18, 2009
Miller MR, Pronovost P, Donithan M, et al. Relationship between performance measurement and
accreditation: implications for quality of care and patient safety. Am J Med Qual. 2005…
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psnet.ahrq.gov/node/48040/psn-pdf
July 24, 2019 - Potentially inappropriate prescribing among older
persons: a meta-analysis of observational studies.
July 24, 2019
Liew TM, Lee CS, Shawn KLG, et al. Potentially Inappropriate Prescribing Among Older Persons: A Meta-
Analysis of Observational Studies. Ann Fam Med. 2019;17(3):257-266. doi:10.1370/afm.2373.
https://…
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psnet.ahrq.gov/node/850165/psn-pdf
June 07, 2023 - Adolescents identifying errors and omissions in their
electronic health records: a national survey.
June 7, 2023
Hagström J, Blease CR, Kharko A, et al. Adolescents identifying errors and omissions in their electronic
health records: a national survey. Stud Health Technol Inform. 2023;302:242-246. doi:10.3233/shti2…
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psnet.ahrq.gov/node/843324/psn-pdf
February 01, 2023 - Cost of inpatient falls and cost-benefit analysis of
implementation of an evidence-based fall prevention
program.
February 1, 2023
Dykes PC, Curtin-Bowen M, Lipsitz S, et al. Cost of inpatient falls and cost-benefit analysis of
implementation of an evidence-based fall prevention program. JAMA Health Forum. 2023;4(…
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psnet.ahrq.gov/node/838244/psn-pdf
October 05, 2022 - Standardization of pediatric noncardiac operating room to
intensive care unit handoffs improves communication
and patient care.
October 5, 2022
Hebballi NB, Gupta VS, Sheppard K, et al. Standardization of pediatric noncardiac operating room to
intensive care unit handoffs improves communication and patient care. J…
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psnet.ahrq.gov/node/74202/psn-pdf
December 22, 2021 - Prevalence of potentially harmful multidrug interactions
on medication lists of elderly ambulatory patients.
December 22, 2021
Anand TV, Wallace BK, Chase HS. Prevalence of potentially harmful multidrug interactions on medication
lists of elderly ambulatory patients. BMC Geriatr. 2021;21(1):648. doi:10.1186/s12877-…
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psnet.ahrq.gov/node/74012/psn-pdf
January 01, 2022 - Should electronic differential diagnosis support be used
early or late in the diagnostic process? A multicentre
experimental study of Isabel.
October 27, 2021
Sibbald M, Monteiro SD, Sherbino J, et al. Should electronic differential diagnosis support be used early or
late in the diagnostic process? A multicentre e…
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psnet.ahrq.gov/node/73571/psn-pdf
August 04, 2021 - "My whole room went into chaos because of that thing in
the corner": unintended consequences of a central fetal
monitoring system.
August 4, 2021
Small K, Sidebotham M, Gamble J, et al. “My whole room went into chaos because of that thing in the
corner”: unintended consequences of a central fetal monitoring system…
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psnet.ahrq.gov/node/61045/psn-pdf
October 21, 2020 - Association of electronic health record use above
meaningful use thresholds with hospital quality and
safety outcomes.
October 21, 2020
Murphy ZR, Wang J, Boland MV. Association of electronic health record use above meaningful use
thresholds with hospital quality and safety outcomes. JAMA Netw Open. 2020;3(9):e201…
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psnet.ahrq.gov/node/45685/psn-pdf
January 01, 2021 - The effects of the second victim phenomenon on work-
related outcomes: connecting self-reported caregiver
distress to turnover intentions and absenteeism.
December 21, 2016
Burlison JD, Quillivan RR, Scott SD, et al. The Effects of the Second Victim Phenomenon on Work-Related
Outcomes: Connecting Self-Reported Car…