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psnet.ahrq.gov/node/844543/psn-pdf
February 15, 2023 - The evolving curriculum in quality improvement and
patient safety in undergraduate and graduate medical
education: a scoping review.
February 15, 2023
Li CJ, Nash DB. The evolving curriculum in quality improvement and patient safety in undergraduate and
graduate medical education: a scoping review. Am J Med Qual. …
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psnet.ahrq.gov/node/38033/psn-pdf
September 24, 2010 - Implementing online medication reconciliation at a large
academic medical center.
September 24, 2010
Bails D, Clayton K, Roy K, et al. Implementing online medication reconciliation at a large academic medical
center. Jt Comm J Qual Patient Saf. 2008;34(9):499-508.
https://psnet.ahrq.gov/issue/implementing-online-m…
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psnet.ahrq.gov/node/45322/psn-pdf
July 20, 2016 - RN assessments of excellent quality of care and patient
safety are associated with significantly lower odds of 30-
day inpatient mortality: a national cross-sectional study
of acute-care hospitals.
July 20, 2016
Smeds-Alenius L, Tishelman C, Lindqvist R, et al. RN assessments of excellent quality of care and patie…
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psnet.ahrq.gov/node/863749/psn-pdf
March 06, 2024 - Improving situation awareness to advance patient
outcomes: a systematic literature review.
March 6, 2024
Alqarrain Y, Roudsari A, Courtney KL, et al. Improving situation awareness to advance patient outcomes: a
systematic literature review. Comput Inform Nurs. 2024;42(4):277-288.
doi:10.1097/cin.0000000000001112.
…
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psnet.ahrq.gov/node/45374/psn-pdf
April 24, 2018 - Two-year longitudinal assessment of physicians'
perceptions after replacement of a longstanding
homegrown electronic health record: does a J-curve of
satisfaction really exist?
April 24, 2018
Hanauer DA, Branford GL, Greenberg G, et al. Two-year longitudinal assessment of physicians'
perceptions after replacement…
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psnet.ahrq.gov/node/843460/psn-pdf
February 01, 2023 - Persisting high rates of omissions during anesthesia
induction are decreased by utilization of a pre- & post-
induction checklist.
February 1, 2023
Krombach JW, Zürcher C, Simon SG, et al. Persisting high rates of omissions during anesthesia induction
are decreased by utilization of a pre- & post-induction checkli…
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psnet.ahrq.gov/node/851055/psn-pdf
June 28, 2023 - How do we learn about error? A cross-sectional study of
urology trainees.
June 28, 2023
Browne C, Crone L, O'Connor E. How do we learn about error? A cross-sectional study of urology trainees.
J Surg Educ. 2023;80(6):864-872. doi:10.1016/j.jsurg.2023.03.007.
https://psnet.ahrq.gov/issue/how-do-we-learn-about-error…
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psnet.ahrq.gov/node/43662/psn-pdf
November 05, 2014 - A crack in our best armor: "wrong patient" injections from
insulin pens alarmingly frequent even with barcode
scanning.
November 5, 2014
ISMP Medication Safety Alert! Acute Care Edition. October 23, 2014;19:1-5.
https://psnet.ahrq.gov/issue/crack-our-best-armor-wrong-patient-injections-insulin-pens-alarmingly-
fr…
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psnet.ahrq.gov/node/47251/psn-pdf
July 25, 2018 - Fail-safe patient ID matching remains just out of reach.
July 25, 2018
Arndt RZ. Mod Healthc. July 14, 2018.
https://psnet.ahrq.gov/issue/fail-safe-patient-id-matching-remains-just-out-reach
Similarities in patient names and clinical situations can result in medical errors. Discussing how digital
technologies can …
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psnet.ahrq.gov/node/850170/psn-pdf
June 07, 2023 - A scoping review of distributed cognition in acute care
clinical decision-making.
June 7, 2023
Wilson E, Daniel M, Rao A, et al. A scoping review of distributed cognition in acute care clinical decision-
making. Diagnosis (Berl). 2023;10(2):68-88. doi:10.1515/dx-2022-0095.
https://psnet.ahrq.gov/issue/scoping-revi…
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psnet.ahrq.gov/node/865920/psn-pdf
May 22, 2024 - Role of knowledge and reasoning processes as
predictors of resident physicians' susceptibility to
anchoring bias in diagnostic reasoning: a randomised
controlled experiment.
May 22, 2024
Mamede S, Zandbergen A, de Carvalho-Filho MA, et al. Role of knowledge and reasoning processes as
predictors of resident physic…
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psnet.ahrq.gov/node/43169/psn-pdf
May 07, 2014 - Copy, paste, and cloned notes in electronic health
records: prevalence, benefits, risks, and best practice
recommendations.
May 7, 2014
Weis JM, Levy PC. Copy, paste, and cloned notes in electronic health records: prevalence, benefits, risks,
and best practice recommendations. Chest. 2014;145(3):632-8. doi:10.1378…
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psnet.ahrq.gov/node/46300/psn-pdf
August 16, 2017 - Prioritizing medication safety in care of people with
cancer: clinicians' views on main problems and solutions.
August 16, 2017
Car LT, Papachristou N, Urch C, et al. Prioritizing medication safety in care of people with cancer:
clinicians' views on main problems and solutions. J Glob Health. 2017;7(1):011001.
doi…
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psnet.ahrq.gov/node/39872/psn-pdf
February 25, 2013 - The Essential Guide for Patient Safety Officers, Second
Edition.
February 25, 2013
Leonard M, Frankel A, Federico F, et al, eds. Oakbrook Terrace, IL: Joint Commission Resources, Institute
for Healthcare Improvement; 2013. ISBN: 9781599407036.
https://psnet.ahrq.gov/issue/essential-guide-patient-safety-officers-se…
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psnet.ahrq.gov/node/46849/psn-pdf
May 23, 2018 - 1,300 days and counting: a risk model approach to
preventing retained foreign objects (RFOs).
May 23, 2018
Duggan EG, Fernandez J, Saulan MM, et al. 1,300 Days and Counting: A Risk Model Approach to
Preventing Retained Foreign Objects (RFOs). Jt Comm J Qual Patient Saf. 2018;44(5):260-269.
doi:10.1016/j.jcjq.2017.…
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psnet.ahrq.gov/node/44047/psn-pdf
September 09, 2015 - Linking acknowledgement to action: closing the loop on
non-urgent, clinically significant test results in the
electronic health record.
September 9, 2015
Dalal A, Pesterev BM, Eibensteiner K, et al. Linking acknowledgement to action: closing the loop on non-
urgent, clinically significant test results in the elect…
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psnet.ahrq.gov/node/50745/psn-pdf
December 18, 2019 - Medication errors during simulated paediatric
resuscitations: a prospective, observational human
reliability analysis.
December 18, 2019
Appelbaum N, Clarke J, Feather C, et al. Medication errors during simulated paediatric resuscitations: a
prospective, observational human reliability analysis. BMJ Open. 2019;9(1…
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psnet.ahrq.gov/node/72574/psn-pdf
December 16, 2020 - Transitions from one electronic health record to another:
challenges, pitfalls, and recommendations.
December 16, 2020
Huang C, Koppel R, McGreevey JD, et al. Transitions from one electronic health record to another:
challenges, pitfalls, and recommendations. Appl Clin Inform. 2020;11(05):742-754. doi:10.1055/s-004…
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psnet.ahrq.gov/node/851350/psn-pdf
July 12, 2023 - A scoping review of legibility of hand-written
prescriptions and drug-orders: the writing on the wall.
July 12, 2023
Ariaga A, Balzan D, Falzon S, et al. A scoping review of legibility of hand-written prescriptions and drug-
orders: the writing on the wall. Expert Rev Clin Pharmacol. 2023;16(7):617-621.
doi:10.108…
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psnet.ahrq.gov/node/41920/psn-pdf
October 08, 2013 - Review of computerized physician handoff tools for
improving the quality of patient care.
October 8, 2013
Li P, Ali S, Tang C, et al. Review of computerized physician handoff tools for improving the quality of
patient care. J Hosp Med. 2013;8(8):456-63. doi:10.1002/jhm.1988.
https://psnet.ahrq.gov/issue/review-com…