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psnet.ahrq.gov/node/73184/psn-pdf
April 28, 2021 - Interprofessional training and communication practices
among clinicians in the postoperative ICU handoff.
April 28, 2021
Massa S, Wu J, Wang C, et al. Interprofessional training and communication practices among clinicians in
the postoperative ICU handoff. Jt Comm J Qual Patient Saf. 2021;47(4):242-249.
doi:10.101…
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psnet.ahrq.gov/node/865703/psn-pdf
May 01, 2024 - Co-worker unprofessional behaviour and patient safety
risks: an analysis of co-worker reports across eight
Australian hospitals.
May 1, 2024
McMullan RD, Churruca K, Hibbert P, et al. Co-worker unprofessional behaviour and patient safety risks:
an analysis of co-worker reports across eight Australian hospitals. In…
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psnet.ahrq.gov/node/845071/psn-pdf
February 22, 2023 - Speaking up as an extension of socio-cultural dynamics
in hospital settings: a study of staff experiences of
speaking up across seven hospitals.
February 22, 2023
Pavithra A, Mannion R, Sunderland N, et al. Speaking up as an extension of socio-cultural dynamics
in hospital settings: a study of staff experiences of…
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psnet.ahrq.gov/node/61069/psn-pdf
October 28, 2020 - Exploring psychological safety in healthcare teams to
inform the development of interventions: combining
observational, survey and interview data.
October 28, 2020
O’Donovan R, McAuliffe E. Exploring psychological safety in healthcare teams to inform the development
of interventions: combining observational, surve…
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psnet.ahrq.gov/node/60725/psn-pdf
July 29, 2020 - The tradeoffs between safety and alert fatigue: data from
a national evaluation of hospital medication-related
clinical decision support.
July 29, 2020
Co Z, Holmgren AJ, Classen DC, et al. The tradeoffs between safety and alert fatigue: data from a national
evaluation of hospital medication-related clinical decis…
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psnet.ahrq.gov/node/74002/psn-pdf
October 27, 2021 - EMS non-conveyance: a safe practice to decrease ED
crowding or a threat to patient safety?
October 27, 2021
Paulin J, Kurola J, Koivisto M, et al. EMS non-conveyance: A safe practice to decrease ED crowding or a
threat to patient safety? BMC Emerg Med. 2021;21(1):115. doi:10.1186/s12873-021-00508-1.
https://psnet.…
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psnet.ahrq.gov/node/34651/psn-pdf
March 04, 2011 - Incidence and types of preventable adverse events in
elderly patients: population based review of medical
records.
March 4, 2011
Thomas EJ, Brennan TA. Incidence and types of preventable adverse events in elderly patients: population
based review of medical records. BMJ. 2000;320(7237):741-4.
https://psnet.ahrq.g…
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psnet.ahrq.gov/node/34888/psn-pdf
March 11, 2019 - "I wish I had seen this test result earlier!": dissatisfaction
with test result management systems in primary care.
March 11, 2019
Poon EG, Gandhi TK, Sequist TD, et al. "I wish I had seen this test result earlier!": Dissatisfaction with test
result management systems in primary care. Arch Intern Med. 2004;164(20):…
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psnet.ahrq.gov/node/61122/psn-pdf
January 01, 2022 - Implementing high-reliability organization principles into
practice: a rapid evidence review.
November 11, 2020
Veazie S, Peterson K, Bourne D, et al. Implementing high-reliability organization principles into practice: a
rapid evidence review. J Patient Saf. 2022;18(1):e320-e328. doi:10.1097/pts.0000000000000768.
…
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psnet.ahrq.gov/node/837145/psn-pdf
May 18, 2022 - Observational evidence of the prevalence and association
of polypharmacy and drug administration errors in
hospitalized adult patients.
May 18, 2022
Savva G, Papastavrou E, Charalambous A, et al. Observational evidence of the prevalence and
association of polypharmacy and drug administration errors in hospitalized…
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psnet.ahrq.gov/node/837663/psn-pdf
July 13, 2022 - Long-term risk of overdose or mental health crisis after
opioid dose tapering.
July 13, 2022
Fenton JJ, Magnan E, Tseregounis IE, et al. Long-term risk of overdose or mental health crisis after opioid
dose tapering. JAMA Netw Open. 2022;5(6):e2216726. doi:10.1001/jamanetworkopen.2022.16726.
https://psnet.ahrq.gov/…
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psnet.ahrq.gov/node/47846/psn-pdf
March 06, 2019 - Assessment of the FDA Risk Evaluation and Mitigation
Strategy for transmucosal immediate-release fentanyl
products.
March 6, 2019
Rollman JE, Heyward J, Olson L, et al. Assessment of the FDA Risk Evaluation and Mitigation Strategy for
Transmucosal Immediate-Release Fentanyl Products. JAMA. 2019;321(7):676-685.
do…
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psnet.ahrq.gov/node/845636/psn-pdf
March 08, 2023 - The effects of leadership for self-worth, inclusion, trust,
and psychological safety on medical error reporting.
March 8, 2023
Brimhall KC, Tsai C-Y, Eckardt R, et al. The effects of leadership for self-worth, inclusion, trust, and
psychological safety on medical error reporting. Health Care Manage Rev. 2023;48(2):…
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psnet.ahrq.gov/node/35551/psn-pdf
June 08, 2010 - Validity of unplanned admission to an intensive care unit
as a measure of patient safety in surgical patients.
June 8, 2010
Haller G, Myles PS, Wolfe R, et al. Validity of unplanned admission to an intensive care unit as a measure
of patient safety in surgical patients. Anesthesiology. 2005;103(6):1121-1129.
https…
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psnet.ahrq.gov/node/46121/psn-pdf
January 01, 2021 - Quality of handoffs in community pharmacies.
May 10, 2017
Abebe E, Stone JA, Lester CA, et al. Quality of Handoffs in Community Pharmacies. J Patient Saf.
2021;17(6):405-411. doi:10.1097/PTS.0000000000000382.
https://psnet.ahrq.gov/issue/quality-handoffs-community-pharmacies
Handoffs present a significant patient …
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psnet.ahrq.gov/node/45362/psn-pdf
January 23, 2017 - Capturing essential information to achieve safe
interoperability.
January 23, 2017
Weininger S, Jaffe MB, Rausch T, et al. Capturing Essential Information to Achieve Safe Interoperability.
Anesth Analg. 2017;124(1):83-94.
https://psnet.ahrq.gov/issue/capturing-essential-information-achieve-safe-interoperability
T…
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psnet.ahrq.gov/node/60637/psn-pdf
July 01, 2020 - Impact of a pharmacist-administered deprescribing
intervention on nursing home residents: a randomized
controlled trial.
July 1, 2020
Balsom C, Pittman N, King R, et al. Impact of a pharmacist-administered deprescribing intervention on
nursing home residents: a randomized controlled trial. Int J Clin Pharm. 2020;4…
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psnet.ahrq.gov/node/837025/psn-pdf
May 04, 2022 - Central venous catheter guidewire retention: lessons
from England's never event database.
May 4, 2022
Mariyaselvam MZA, Patel V, Young HE, et al. Central venous catheter guidewire retention: lessons from
England's never event database. J Patient Saf. 2022;18(2):e387-e392.
doi:10.1097/pts.0000000000000826.
https:/…
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psnet.ahrq.gov/node/60175/psn-pdf
April 01, 2020 - ACR Recommendations for the use of Chest Radiography
and Computed Tomography (CT) for Suspected COVID-19
Infection.
April 1, 2020
American College of Radiology. March 11, 2020.
https://psnet.ahrq.gov/issue/acr-recommendations-use-chest-radiography-and-computed-tomography-ct-
suspected-covid-19
As COVID-19 s…
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psnet.ahrq.gov/node/50866/psn-pdf
February 05, 2020 - Effectiveness of acute care remote triage systems: a
systematic review.
February 5, 2020
Boggan JC, Shoup JP, Whited JD, et al. Effectiveness of acute care remote triage systems: a systematic
review. J Gen Intern Med. 2020;35(7):2136-2145. doi:10.1007/s11606-019-05585-4.
https://psnet.ahrq.gov/issue/effectiveness-…