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psnet.ahrq.gov/issue/impact-traditional-and-smart-pump-infusion-technology-nurse-medication-administration
May 18, 2022 - Study
The impact of traditional and smart pump infusion technology on nurse medication administration performance in a simulated inpatient unit.
Citation Text:
Trbovich PL, Pinkney S, Cafazzo JA, et al. The impact of traditional and smart pump infusion technology on nurse medication ad…
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psnet.ahrq.gov/issue/registration-errors-among-patients-receiving-blood-transfusions-national-analysis-2008-2017
March 18, 2020 - Study
Registration errors among patients receiving blood transfusions: a national analysis from 2008 to 2017.
Citation Text:
Vijenthira S, Armali C, Downie H, et al. Registration errors among patients receiving blood transfusions: a national analysis from 2008 to 2017. Vox Sang. 2021;116…
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psnet.ahrq.gov/issue/impact-errors-paper-based-and-computerized-diabetes-management-decision-support-hospitalized
April 03, 2024 - Study
Impact of errors in paper-based and computerized diabetes management with decision support for hospitalized patients with type 2 diabetes. A post-hoc analysis of a before and after study.
Citation Text:
Donsa K, Beck P, Höll B, et al. Impact of errors in paper-based and computerize…
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www.ahrq.gov/sites/default/files/wysiwyg/ncepcr/resources/job-aid-practice-assessments.pdf
June 02, 2025 - Job Aid: Practice Assessments and Surveys
Primary Care Practice Facilitator
Training Series
1
Job Aid: Practice Assessments and Surveys
Overview
Practice assessments and surveys are simple and non-threatening ways for a practice to gather
information, generate ideas for improvements, and test and…
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psnet.ahrq.gov/issue/report-information-technology-and-health-deficiencies-us-nursing-homes
October 28, 2020 - Study
A report of information technology and health deficiencies in U.S. nursing homes.
Citation Text:
Alexander GL, Madsen RW. A report of information technology and health deficiencies in U.S. nursing homes. J Patient Saf. 2021;17(6):e483-e489. doi:10.1097/pts.0000000000000390.
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psnet.ahrq.gov/issue/surgical-safety-and-hospital-volume-across-wide-range-interventions
April 04, 2011 - Study
Surgical safety and hospital volume across a wide range of interventions.
Citation Text:
Eggli Y, Halfon P, Meylan D, et al. Surgical safety and hospital volume across a wide range of interventions. Med Care. 2010;48(11):962-71. doi:10.1097/MLR.0b013e3181eaf9f6.
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psnet.ahrq.gov/issue/morning-handover-call-issues-opportunities-improvement
September 26, 2012 - Study
Morning handover of on-call issues: opportunities for improvement.
Citation Text:
Devlin MK, Kozij NK, Kiss A, et al. Morning handover of on-call issues: opportunities for improvement. JAMA Intern Med. 2014;174(9):1479-85. doi:10.1001/jamainternmed.2014.3033.
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Fo…
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www.ahrq.gov/teamstepps-program/curriculum/situation/tools/step.html
June 01, 2023 - Tool: STEP
STEP is a mnemonic tool that can help individuals monitor critical elements of a situation and the overall environment. It is suitable for use by teams supporting acutely ill patients in a hospital (e.g., an ICU patient the team hopes to wean off a ventilator as quickly as possible), for teams in lon…
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psnet.ahrq.gov/issue/risk-adjusted-morbidity-teaching-hospitals-correlates-reported-levels-communication-and
July 12, 2010 - Study
Classic
Risk-adjusted morbidity in teaching hospitals correlates with reported levels of communication and collaboration on surgical teams but not with scale measures of teamwork climate, safety climate, or working conditions.
Citation Text:
Davenport DL…
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psnet.ahrq.gov/issue/effects-electronic-nursing-handover-patient-safety-general-non-covid-19-and-covid-19
February 26, 2020 - Study
The effects of electronic nursing handover on patient safety in the general (non-COVID-19) and COVID-19 intensive care units: a quasi-experimental study.
Citation Text:
Tataei A, Rahimi B, Afshar HL, et al. The effects of electronic nursing handover on patient safety in the general…
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psnet.ahrq.gov/issue/identifying-hospital-wide-harm-set-icd-9-cm-coded-conditions-associated-increased-cost-length
September 07, 2016 - Study
Identifying hospital-wide harm: a set of ICD-9–CM-coded conditions associated with increased cost, length of stay, and risk of mortality.
Citation Text:
Bankowitz RA, Doyle B, Duan M, et al. Identifying hospital-wide harm: a set of ICD-9-CM-coded conditions associated with increase…
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psnet.ahrq.gov/issue/clinical-diagnoses-and-autopsy-findings-discrepancies-critically-ill-patients
March 09, 2022 - Study
Clinical diagnoses and autopsy findings: discrepancies in critically ill patients.
Citation Text:
Tejerina E, Esteban A, Fernández-Segoviano P, et al. Clinical diagnoses and autopsy findings: discrepancies in critically ill patients*. Crit Care Med. 2012;40(3):842-6. doi:10.1097/…
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psnet.ahrq.gov/issue/evaluation-and-comparison-errors-nursing-notes-created-online-and-offline-speech-recognition
April 13, 2022 - Study
Evaluation and comparison of errors on nursing notes created by online and offline speech recognition technology and handwritten: an interventional study.
Citation Text:
Peivandi S, Ahmadian L, Farokhzadian J, et al. Evaluation and comparison of errors on nursing notes created by o…
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psnet.ahrq.gov/issue/medical-errors-during-training-how-do-residents-cope-descriptive-study
October 13, 2021 - Study
Medical errors during training: how do residents cope?: a descriptive study.
Citation Text:
Fatima S, Soria S, Esteban- Cruciani N. Medical errors during training: how do residents cope?: a descriptive study. BMC Med Educ. 2021;21(1):408. doi:10.1186/s12909-021-02850-1.
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psnet.ahrq.gov/issue/comparing-variability-ingredient-strength-and-dose-form-information-electronic-prescriptions
March 20, 2024 - Study
Comparing the variability of ingredient, strength, and dose form information from electronic prescriptions with RxNorm drug product descriptions.
Citation Text:
Lester CA, Flynn AJ, Marshall VD, et al. Comparing the variability of ingredient, strength, and dose form information fro…
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www.ahrq.gov/hai/tools/ambulatory-surgery/sections/implementation/implementation-guide/app-p.html
May 01, 2017 - Appendix P. Evaluating and Selecting Hand Hygiene Products - Implementation Guide
Slide 1: Appendix P. Evaluating and Selecting Hand Hygiene Products
Timothy Landers, Ph.D., R.N., CNP, CIC
Assistant Professor, The Ohio State University College of Nursing
Slide 2: Disclosures
Dr. Landers receives sala…
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psnet.ahrq.gov/issue/using-failure-mode-and-effect-analysis-identify-potential-failures-psychiatric-hospital
June 22, 2017 - Study
Using failure mode and effect analysis to identify potential failures in a psychiatric hospital emergency department.
Citation Text:
Gur-Arieh S, Mendlovic S, Rozenblum R, et al. Using failure mode and effect analysis to identify potential failures in a psychiatric hospital emergen…
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psnet.ahrq.gov/issue/assessing-patient-safety-pediatric-telemedicine-setting-multi-methods-study
May 01, 2024 - Study
Emerging Classic
Assessing patient safety in a pediatric telemedicine setting: a multi-methods study.
Citation Text:
Haimi M, Brammli-Greenberg S, Baron-Epel O, et al. Assessing patient safety in a pediatric telemedicine setting: a multi-methods study. BMC…
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psnet.ahrq.gov/issue/surgical-patient-safety-outcomes-critical-access-hospitals-how-do-they-compare
June 05, 2019 - Study
Surgical patient safety outcomes in critical access hospitals: how do they compare?
Citation Text:
Natafgi N, Baloh J, Weigel P, et al. Surgical Patient Safety Outcomes in Critical Access Hospitals: How Do They Compare? J Rural Health. 2016;33(2):117-126. doi:10.1111/jrh.12176.
C…
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psnet.ahrq.gov/issue/identifying-risks-areas-related-medication-administrations-text-mining-analysis-using-free
December 18, 2019 - Study
Identifying risks areas related to medication administrations - text mining analysis using free-text descriptions of incident reports.
Citation Text:
Härkänen M, Paananen J, Murrells T, et al. Identifying risks areas related to medication administrations - text mining analysis usin…