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  1. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/44996/psn-pdf
    June 29, 2016 - Residents' numeric inputting error in computerized physician order entry prescription. June 29, 2016 Wu X, Wu C, Zhang K, et al. Residents' numeric inputting error in computerized physician order entry prescription. Int J Med Inform. 2016;88:25-33. doi:10.1016/j.ijmedinf.2016.01.002. https://psnet.ahrq.gov/issue/r…
  2. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/41606/psn-pdf
    February 01, 2019 - Safe use of opioids in hospitals. December 23, 2016 Sentinel Event Alert. 2012;49:1-5. https://psnet.ahrq.gov/issue/safe-use-opioids-hospitals Opioid pain medications are considered high-risk medications due to the potential for respiratory depression and other adverse effects. Because these medications are freque…
  3. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/46094/psn-pdf
    July 11, 2017 - Hiding in plain sight—resurrecting the power of inspecting the patient. July 11, 2017 Gupta S, Saint S, Detsky AS. Hiding in Plain Sight-Resurrecting the Power of Inspecting the Patient. JAMA Intern Med. 2017;177(6):757-758. doi:10.1001/jamainternmed.2017.0634. https://psnet.ahrq.gov/issue/hiding-plain-sight-resur…
  4. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/837597/psn-pdf
    June 29, 2022 - Patient safety informatics: criteria development for assessing the maturity of digital patient safety in hospitals. June 29, 2022 Kutza J-O, Hübner U, Holmgren AJ, et al. Patient safety informatics: criteria development for assessing the maturity of digital patient safety in hospitals. Stud Health Technol Inform. …
  5. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/47279/psn-pdf
    July 23, 2018 - No Place Like Home: Advancing the Safety of Care in the Home. July 23, 2018 Boston, MA: Institute for Healthcare Improvement; 2018. https://psnet.ahrq.gov/issue/no-place-home-advancing-safety-care-home The home care setting harbors unique challenges to patient safety. This report builds on a previous evidence ass…
  6. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/37277/psn-pdf
    July 28, 2010 - Drug selection errors in relation to medication labels: a simulation study. July 28, 2010 Garnerin P, Perneger T, Chopard P, et al. Drug selection errors in relation to medication labels: a simulation study. Anaesthesia. 2007;62(11):1090-4. https://psnet.ahrq.gov/issue/drug-selection-errors-relation-medication-lab…
  7. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/35838/psn-pdf
    March 28, 2011 - Unscheduled returns to the emergency department: an outcome of medical errors? March 28, 2011 Nuñez S, Hexdall A, Aguirre-Jaime A. Unscheduled returns to the emergency department: an outcome of medical errors? Qual Saf Health Care. 2006;15(2):102-8. https://psnet.ahrq.gov/issue/unscheduled-returns-emergency-depart…
  8. psnet.ahrq.gov/perspective/conversation-andrew-bindman-md
    June 15, 2024 - In Conversation With… Andrew Bindman, MD November 1, 2016  Citation Text: In Conversation With… Andrew Bindman, MD. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2016. Copy Citation For…
  9. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49858/psn-pdf
    April 01, 2019 - What Happened on Telemetry? April 1, 2019 Sandau KE, Funk M. What Happened on Telemetry? PSNet [internet]. 2019. https://psnet.ahrq.gov/web-mm/what-happened-telemetry Case Objectives Describe current hospital practices for continuous telemetry monitoring. Appreciate key recommendations from the Update to Practice…
  10. psnet.ahrq.gov/innovation/us-department-veterans-affairs-medical-center-houston-tx-and-baylor-college-medicine
    February 26, 2025 - U.S. Department of Veterans Affairs Medical Center, Houston, TX, and Baylor College of Medicine Revised Safer Diagnosis (Safer Dx) Instrument Save Save to your library Print Download PDF Share Facebook Twitter Linkedin Copy URL January …
  11. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49771/psn-pdf
    July 01, 2016 - Unintended Consequences of CPOE October 1, 2016 Wears RL. Unintended Consequences of CPOE. PSNet [internet]. 2016. https://psnet.ahrq.gov/web-mm/unintended-consequences-cpoe Case Objectives Explain how technology, including computerized provider order entry, can transform, rather than eliminate, hazards. Recogni…
  12. psnet.ahrq.gov/curated-library/artificial-intelligence-system-level-considerations
    March 27, 2024 - Breadcrumb Home The PSNet Collection Curated Libraries Subscribed Artificial Intelligence: System-Level Considerations  Download  Share Facebook Twitter Linkedin Copy URL Subscribe Created By: Lorri Zipper…
  13. psnet.ahrq.gov/perspective/conversation-amy-j-starmer-md-mph
    May 31, 2023 - In Conversation With… Amy J. Starmer, MD, MPH April 1, 2016  Citation Text: In Conversation With… Amy J. Starmer, MD, MPH. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2016. Copy Citation …
  14. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/850675/psn-pdf
    June 14, 2023 - Patient and Family Roles in Safety June 14, 2023 Johnson B, Lee M, Mossburg S. Patient and Family Roles in Safety. PSNet [internet]. 2023. https://psnet.ahrq.gov/perspective/patient-and-family-roles-safety Moving From Engagement to Partnership Involving patients and families in healthcare decisions about patient c…
  15. psnet.ahrq.gov/toolkits
    March 01, 2025 - Toolkits Patient safety toolkits provide practical applications of PSNet research and concepts for front line providers to use in their day to day work. These toolkits contain resources necessary to implement patient safety systems and protocols. Want to submit a Toolkit? Has your organization deve…
  16. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49819/psn-pdf
    February 01, 2018 - Signout Fallout February 1, 2018 Starmer AJ, Landrigan CP. Signout Fallout. PSNet [internet]. 2018. https://psnet.ahrq.gov/web-mm/signout-fallout Case Objectives Understand the role of communication failures in medical errors and preventable adverse events. Review the evidence in support of handoff improvement pr…
  17. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/33818/psn-pdf
    November 01, 2016 - In Conversation With… Andrew Bindman, MD November 1, 2016 In Conversation With… Andrew Bindman, MD. PSNet [internet]. 2016. https://psnet.ahrq.gov/perspective/conversation-andrew-bindman-md Editor's note: Dr. Bindman was appointed as Director of the Agency for Healthcare Research and Quality (AHRQ) in May 2016. P…
  18. psnet.ahrq.gov/web-mm/techno-trip
    May 01, 2005 - Techno Trip Citation Text: Cook RI. Techno Trip. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2005. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged PubMedId RIS Downlo…
  19. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/60826/psn-pdf
    August 19, 2020 - Variation in electronic test results management and its implications for patient safety: a multisite investigation. August 19, 2020 Thomas J, Dahm MR, Li J, et al. Variation in electronic test results management and its implications for patient safety: a multisite investigation. J Am Med Inform Assoc. 2020;27(8):12…
  20. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/73063/psn-pdf
    March 24, 2021 - Clinical data sharing improves quality measurement and patient safety. March 24, 2021 D’Amore JD, McCrary LK, Denson J, et al. Clinical data sharing improves quality measurement and patient safety. J Am Med Inform Assoc. 2021;28(7):1534-1542. doi:10.1093/jamia/ocab039. https://psnet.ahrq.gov/issue/clinical-data-sh…

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