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psnet.ahrq.gov/issue/clarifying-adverse-drug-events-clinicians-guide-terminology-documentation-and-reporting
February 03, 2011 - Study
Clarifying adverse drug events: a clinician's guide to terminology, documentation, and reporting.
Citation Text:
Nebeker JR, Barach P, Samore MH. Clarifying adverse drug events: a clinician's guide to terminology, documentation, and reporting. Ann Intern Med. 2004;140(10):795-801…
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psnet.ahrq.gov/issue/why-dont-we-know-whether-care-safe
January 14, 2014 - Commentary
Why don't we know whether care is safe?
Citation Text:
Pham JC, Frick KD, Pronovost P. Why don't we know whether care is safe? Am J Med Qual. 2013;28(6):457-63. doi:10.1177/1062860613479397.
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digital.ahrq.gov/track-6-using-reporting-systems-safety-and-quality-improvement
January 01, 2023 - This information is for reference purposes only. It was current when produced and may now be outdated. Archive material is no longer maintained, and some links may not work. Persons with disabilities having difficulty accessing this information should contact us at: https://digital.ahrq.gov/contact-us . Let us know th…
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psnet.ahrq.gov/issue/effect-computerisation-quality-and-safety-chemotherapy-prescription
December 29, 2014 - Study
Effect of computerisation on the quality and safety of chemotherapy prescription.
Citation Text:
Voeffray M, Pannatier A, Stupp R, et al. Effect of computerisation on the quality and safety of chemotherapy prescription. Qual Saf Health Care. 2006;15(6):418-21.
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psnet.ahrq.gov/issue/factors-influencing-patient-safety-during-postoperative-handover
March 03, 2021 - Review
Factors influencing patient safety during postoperative handover.
Citation Text:
Factors influencing patient safety during postoperative handover. Rose M, Newman SD. AANA J. 2016;84:329-338.
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psnet.ahrq.gov/issue/effective-approaches-control-non-actionable-alarms-and-alarm-fatigue
January 15, 2025 - Commentary
Effective approaches to control non-actionable alarms and alarm fatigue.
Citation Text:
Winters BD. Effective approaches to control non-actionable alarms and alarm fatigue. J Electrocardiol. 2018;51(6S):S49-S51. doi:10.1016/j.jelectrocard.2018.07.007.
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psnet.ahrq.gov/issue/tapping-front-line-knowledge-identifying-problems-they-occur-helps-enhance-patient-safety
July 21, 2009 - Newspaper/Magazine Article
Tapping front-line knowledge: identifying problems as they occur helps enhance patient safety.
Citation Text:
Luther K, Resar RK. Tapping front-line knowledge: identifying problems as they occur helps enhance patient safety. Healthcare executive. 2013;28(1):84-…
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psnet.ahrq.gov/issue/patient-safety-planting-seed
February 09, 2011 - Commentary
Patient safety: planting the seed.
Citation Text:
Poe SS. Patient safety: planting the seed. J Nurs Care Qual. 2005;20(3):198-202.
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psnet.ahrq.gov/issue/meaning-justice-safety-incident-reporting
April 11, 2011 - Commentary
The meaning of justice in safety incident reporting.
Citation Text:
Weiner BJ, Hobgood C, Lewis MA. The meaning of justice in safety incident reporting. Soc Sci Med. 2008;66(2):403-13.
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www.ahrq.gov/policymakers/chipra/demoeval/what-we-learned/finalsummary/finalsummary7.html
September 01, 2015 - Key Lessons from the National Evaluation of the CHIPRA Quality Demonstration Grant Program
Using Federal grants to build intellectual capital at the State level
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Key Lessons from the National Evaluation of the CHIPRA Quality Demonstration Grant Program
Intr…
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psnet.ahrq.gov/issue/patient-safety-rounds-description-inexpensive-important-strategy-improve-safety-culture
December 15, 2008 - Commentary
Patient safety rounds: description of an inexpensive but important strategy to improve the safety culture.
Citation Text:
Campbell D, Thompson M. Patient safety rounds: description of an inexpensive but important strategy to improve the safety culture. Am J Med Qual. 2007;22…
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psnet.ahrq.gov/issue/cost-serious-fall-related-injuries-three-midwestern-hospitals
January 03, 2017 - Study
The cost of serious fall-related injuries at three midwestern hospitals.
Citation Text:
Wong CA, Recktenwald AJ, Jones ML, et al. The cost of serious fall-related injuries at three Midwestern hospitals. Jt Comm J Qual Patient Saf. 2011;37(2):81-87.
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psnet.ahrq.gov/issue/patient-safety-during-anaesthesia-incorporation-who-safe-surgery-guidelines-clinical-practice
September 20, 2011 - Review
Patient safety during anaesthesia: incorporation of the WHO safe surgery guidelines into clinical practice.
Citation Text:
Schlack WS, Boermeester MA. Patient safety during anaesthesia: incorporation of the WHO safe surgery guidelines into clinical practice. Curr Opin Anaesthesi…
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psnet.ahrq.gov/issue/edgeware-insights-complexity-science-health-care-leaders
June 23, 2021 - Book/Report
Edgeware: Insights from Complexity Science for Health Care Leaders. Second ed.
Citation Text:
Edgeware: Insights from Complexity Science for Health Care Leaders. Second ed. Zimmerman B, Lindberg C, Plsek P. Irving, TX: VHA Incorporated; 2008. ISBN: 9780966782806
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psnet.ahrq.gov/issue/avoiding-medical-emergencies
April 07, 2021 - Commentary
Avoiding medical emergencies.
Citation Text:
Omar Y. Avoiding medical emergencies. Br Dent J. 2013;214(5):255-9. doi:10.1038/sj.bdj.2013.217.
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www.ahrq.gov/practiceimprovement/systemdesign/leancasestudies/lean-exhibit5-4.html
November 01, 2014 - Improving Care Delivery Through Lean: Implementation Case Studies
Exhibit 5.4. Chronology of Quality Improvement (QI) and Lean at Heights Hospital
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Improving Care Delivery Through Lean: Implementation Case Studies
Introduction to the Case Studies
Case 1. …
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psnet.ahrq.gov/issue/clinical-decision-support-and-malpractice-risk
September 24, 2017 - Commentary
Clinical decision support and malpractice risk.
Citation Text:
Greenberg MD, Ridgely MS. Clinical Decision Support and Malpractice Risk. JAMA. 2011;306(1). doi:10.1001/jama.2011.929.
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psnet.ahrq.gov/issue/alcohol-based-surgical-prep-solution-and-risk-fire-operating-room-case-report
February 02, 2022 - Commentary
Alcohol based surgical prep solution and the risk of fire in the operating room: a case report.
Citation Text:
Batra S, Gupta R. Alcohol based surgical prep solution and the risk of fire in the operating room: a case report. Patient Saf Surg. 2008;2(1):10. doi:10.1186/1754-9…
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psnet.ahrq.gov/issue/rapid-response-systems-should-we-still-question-their-implementation
January 06, 2017 - Commentary
Rapid response systems: should we still question their implementation?
Citation Text:
Winters BD, Pronovost P. Rapid response systems: should we still question their implementation? J Hosp Med. 2013;8(5):278-81. doi:10.1002/jhm.2050.
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psnet.ahrq.gov/issue/rapid-response-teams-whats-latest
December 12, 2012 - Commentary
Rapid response teams: what's the latest?
Citation Text:
Jackson SA. Rapid response teams: What's the latest? Nursing (Brux). 2017;47(12):34-41. doi:10.1097/01.NURSE.0000526885.10306.21.
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