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  1. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/851660/psn-pdf
    July 26, 2023 - From aviation to pediatric surgery. July 26, 2023 Arredondo Montero J, Bardají Pascual C. From aviation to pediatric surgery. Clin Pediatr (Phila). 2024;63(4):557-559. doi:10.1177/00099228231176631. https://psnet.ahrq.gov/issue/aviation-pediatric-surgery Human factors strategies are increasingly applied in health …
  2. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/42370/psn-pdf
    June 19, 2013 - Resident Projects for Improvement. June 19, 2013 Heilman J, ed. UNM CIR Journal of Quality Improvement in Healthcare. Albuquerque, NM: University of New Mexico; May 2013. https://psnet.ahrq.gov/issue/journal-quality-improvement-healthcare-second-edition This publication outlines quality and safety improvement proj…
  3. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/40677/psn-pdf
    August 10, 2011 - Board quality scorecards: measuring improvement. August 10, 2011 Goeschel CA, Berenholtz SM, Culbertson R, et al. Board quality scorecards: measuring improvement. Am J Med Qual. 2011;26(4):254-60. doi:10.1177/1062860610389324. https://psnet.ahrq.gov/issue/board-quality-scorecards-measuring-improvement Hospital boa…
  4. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/838184/psn-pdf
    September 28, 2022 - The hidden risk of wheelchair use. September 28, 2022 Quesenberry M. The hidden risk of wheelchair use. Patient Safety. 2022;4(3):6-9. doi:10.33940/alert/2022.9.1. https://psnet.ahrq.gov/issue/hidden-risk-wheelchair-use Medical devices intended to improve patient safety can unintentionally lead to patient harm. Th…
  5. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/73078/psn-pdf
    September 19, 2024 - Risky Business: Creating Connections. July 17, 2024 Joseph B. Martin Conference Center, Boston, MA; September 19, 2024. https://psnet.ahrq.gov/issue/risky-business-creating-connections A core tenant of the patient safety improvement drawing from the experiences of various high-risk industries to address system saf…
  6. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/37739/psn-pdf
    June 07, 2008 - Health-Care-Associated Infections in Hospitals: Leadership Needed from HHS to Prioritize Prevention Practices and Improve Data on these Infections. June 7, 2008 Washington, DC: United States Government Accountability Office; March 31, 2008. Publication GAO-08- 283. https://psnet.ahrq.gov/issue/health-care-associa…
  7. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/44481/psn-pdf
    September 09, 2015 - When doctors get it wrong: misdiagnoses are getting a closer look. September 9, 2015 Olsen J. Star Tribune. August 30, 2015. https://psnet.ahrq.gov/issue/when-doctors-get-it-wrong-misdiagnoses-are-getting-closer-look Diagnostic error is garnering increased attention as a patient safety problem. This news article r…
  8. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/837679/psn-pdf
    July 13, 2022 - Provider implicit bias: bringing awareness to clinical practice. July 13, 2022 Moss LD. Clinical Advisor. June 29, 2022. https://psnet.ahrq.gov/issue/provider-implicit-bias-bringing-awareness-clinical-practice Health disparities perpetuated by structural racism degrade patient safety. This article discusses the i…
  9. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/38582/psn-pdf
    May 22, 2023 - Serious Reportable Events in Massachusetts. May 22, 2023 Fillo KT, Saunders K. Bureau of Health Care Safety and Quality, Department of Public Health. Boston, MA: Commonwealth of Massachusetts; 2023. https://psnet.ahrq.gov/issue/serious-reportable-events-massachusetts This reoccurring report compiles patient safety…
  10. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/40439/psn-pdf
    July 31, 2012 - Medication error identification rates by pharmacy, medical, and nursing students. July 31, 2012 Warholak TL, Queiruga C, Roush R, et al. Medication error identification rates by pharmacy, medical, and nursing students. Am J Pharm Educ. 2011;75(2):24. https://psnet.ahrq.gov/issue/medication-error-identification-rat…
  11. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/37564/psn-pdf
    June 12, 2008 - The medical emergency team system: a two hospital comparison. June 12, 2008 Young L, Donald M, Parr M, et al. The Medical Emergency Team system: a two hospital comparison. Resuscitation. 2008;77(2):180-8. doi:10.1016/j.resuscitation.2007.11.016. https://psnet.ahrq.gov/issue/medical-emergency-team-system-two-hospit…
  12. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/40580/psn-pdf
    July 06, 2011 - Teaching medical error apologies: development of a multi-component intervention. July 6, 2011 Gillies RA, Speers SH, Young SE, et al. Teaching medical error apologies: development of a multi- component intervention. Fam Med. 2011;43(6):400-6. https://psnet.ahrq.gov/issue/teaching-medical-error-apologies-developmen…
  13. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/36746/psn-pdf
    August 02, 2011 - Patient safety event reporting in critical care: a study of three intensive care units. August 2, 2011 Harris CB, Krauss MJ, Coopersmith CM, et al. Patient safety event reporting in critical care: a study of three intensive care units. Crit Care Med. 2007;35(4):1068-76. https://psnet.ahrq.gov/issue/patient-safety-…
  14. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/836788/psn-pdf
    March 23, 2022 - A widow’s mission to change NC dental sedation rules. March 23, 2022 Blythe A. NC Health News. March 10, 2022 https://psnet.ahrq.gov/issue/widows-mission-change-nc-dental-sedation-rules Patient harm in dentistry is receiving increased attention and scrutiny. This story covers a medication incident and the lack of …
  15. www.ahrq.gov/evidencenow/heart-health/aspirin/facilitator-checklist.html
    August 01, 2018 - Aspirin Use Care: Tasks for the Practice Facilitator Resource title: Aspirin Use Care: Tasks for the Practice Facilitator Resource description: This checklist and associated materials are designed to be used with primary care practices to increase aspirin use for secondary prevention of cardiovascular dise…
  16. www.ahrq.gov/evidencenow/heart-health/smoking/facilitator-checklist.html
    August 01, 2018 - Smoking Cessation: Tasks for the Practice Facilitator Resource title: Smoking Cessation: Tasks for the Practice Facilitator Resource description: This two-page checklist and associated materials outline working with primary care practices to increase the rate of smoking cessation counseling for patients wh…
  17. www.ahrq.gov/evidencenow/heart-health/cholesterol/outreach.html
    September 01, 2018 - Automated Outreach & Adherence to Cholesterol-Lowering Medication Resource title: Automated Outreach to Increase Primary Adherence to Cholesterol-Lowering Medications . Resource description: This journal article summarizes findings from a randomized controlled trial that evaluated an automated system for im…
  18. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/35858/psn-pdf
    July 22, 2010 - How long and how much are nurses now working? July 22, 2010 Trinkoff AM, Geiger-Brown J, Brady B, et al. How long and how much are nurses now working? Am J Nurs. 2006;106(4):60-72. https://psnet.ahrq.gov/issue/how-long-and-how-much-are-nurses-now-working The authors analyzed results from a national survey and foun…
  19. www.uspreventiveservicestaskforce.org/home/getfilebytoken/EzrKKtG83uM-jEB3W3vkvm
    Clinical Summary: Ocular Prophylaxis for Gonococcal Ophthalmia Neonatorum Clinical Summary: Ocular Prophylaxis for Gonococcal Ophthalmia Neonatorum Population Newborns Recommendation Provide prophylactic ocular topical medication to prevent gonococcal ophthalmia neonatorum. Grade: A Preventi…
  20. digital.ahrq.gov/health-it-tools-and-resources/consumer-engagement-and-human-factors/designing-consumer-health-it-guide-developers-and-systems-designers
    January 01, 2023 - Designing Consumer Health IT: A Guide for Developers and Systems Designers This guide presents suggested recommendations for designers and developers of consumer health IT products.   Download the guide ( PDF , 3 MB)   Recommendations included in the guide are either g…