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psnet.ahrq.gov/issue/longitudinal-evaluation-programme-safety-culture-change-mental-health-service
January 24, 2018 - Study
Longitudinal evaluation of a programme for safety culture change in a mental health service.
Citation Text:
Dickens GL, Salamonson Y, Johnson A, et al. Longitudinal evaluation of a programme for safety culture change in a mental health service. J Nurs Manag. 2021;29(4):690-698. doi…
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psnet.ahrq.gov/issue/shifting-supervision-implications-safe-administration-medication-nursing-students
January 27, 2021 - Study
Shifting supervision: implications for safe administration of medication by nursing students.
Citation Text:
Reid-Searl K, Moxham L, Walker S, et al. Shifting supervision: implications for safe administration of medication by nursing students. J Clin Nurs. 2008;17(20):2750-7. doi…
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psnet.ahrq.gov/issue/impact-preoperative-briefings-operating-room-delays
July 28, 2010 - Study
Impact of preoperative briefings on operating room delays.
Citation Text:
Nundy S, Mukherjee A, Sexton B, et al. Impact of preoperative briefings on operating room delays: a preliminary report. Arch Surg. 2008;143(11):1068-72. doi:10.1001/archsurg.143.11.1068.
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psnet.ahrq.gov/issue/cognitive-error-most-frequent-contributory-factor-cases-medical-injury-study-verdicts
September 25, 2013 - Study
Cognitive error as the most frequent contributory factor in cases of medical injury: a study on verdict's judgment among closed claims in Japan.
Citation Text:
Tokuda Y, Kishida N, Konishi R, et al. Cognitive error as the most frequent contributory factor in cases of medical inju…
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psnet.ahrq.gov/issue/safe-home-care-intervention-study-implementation-methods-and-effectiveness-evaluation
July 19, 2023 - Study
The Safe Home Care Intervention Study: implementation methods and effectiveness evaluation.
Citation Text:
Sama SR, Quinn MM, Gore RJ, et al. The Safe Home Care Intervention Study: implementation methods and effectiveness evaluation. J Appl Gerontol. 2024;43(11):1595-1604. doi:10.1…
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psnet.ahrq.gov/issue/learning-mistakes-and-near-mistakes-using-root-cause-analysis-risk-management-tool
June 19, 2024 - Commentary
Learning from mistakes and near mistakes: using root cause analysis as a risk management tool.
Citation Text:
Cerniglia-Lowensen J. Learning From Mistakes and Near Mistakes: Using Root Cause Analysis as a Risk Management Tool. J Radiol Nurs. 2015;34(1). doi:10.1016/j.jradnu.20…
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psnet.ahrq.gov/issue/parental-involvement-preoperative-surgical-safety-checklist-welcomed-both-parents-and-staff
April 12, 2011 - Study
Parental involvement in the preoperative surgical safety checklist is welcomed by both parents and staff.
Citation Text:
Corbally MT, Tierney E. Parental involvement in the preoperative surgical safety checklist is welcomed by both parents and staff. Int J Pediatr. 2014;2014:791490…
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psnet.ahrq.gov/issue/exploring-factors-drive-clinical-negligence-claims-stated-preferences-those-who-have
April 08, 2020 - Study
Exploring the factors that drive clinical negligence claims: stated preferences of those who have experienced unintended harm.
Citation Text:
Wickramasekera N, Hole AR, Rowen D, et al. Exploring the factors that drive clinical negligence claims: stated preferences of those who have…
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psnet.ahrq.gov/issue/speaking-about-dangers-hidden-curriculum
September 30, 2020 - Commentary
Speaking up about the dangers of the hidden curriculum.
Citation Text:
Liao JM, Thomas EJ, Bell SK. Speaking up about the dangers of the hidden curriculum. Health Aff (Millwood). 2014;33(1):168-171. doi:10.1377/hlthaff.2013.1073.
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psnet.ahrq.gov/issue/intensive-care-unit-alarms-how-many-do-we-need
March 01, 2011 - Study
Intensive care unit alarms—how many do we need?
Citation Text:
Siebig S, Kuhls S, Imhoff M, et al. Intensive care unit alarms--how many do we need? Crit Care Med. 2010;38(2):451-6. doi:10.1097/CCM.0b013e3181cb0888.
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psnet.ahrq.gov/issue/passing-yo-mama-test
February 15, 2023 - Commentary
Passing the "Yo' Mama" test.
Citation Text:
Blair R. Passing the "Yo' Mama" test. Atlanta healthcare organization follows the beat of a different drummer in achieving 100 percent CPOE adoption. Health Manag Technol. 2006;27(6):14, 16, 18.
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psnet.ahrq.gov/issue/fractures-fingers-missed-or-misdiagnosed-poorly-positioned-or-poorly-taken-radiographs
September 07, 2022 - Study
Fractures of the fingers missed or misdiagnosed on poorly positioned or poorly taken radiographs: a retrospective study.
Citation Text:
Tuncer S, Aksu N, Dilek H, et al. Fractures of the fingers missed or misdiagnosed on poorly positioned or poorly taken radiographs: a retrospect…
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psnet.ahrq.gov/issue/improving-alarm-performance-medical-intensive-care-unit-using-delays-and-clinical-context
December 31, 2014 - Study
Improving alarm performance in the medical intensive care unit using delays and clinical context.
Citation Text:
Görges M, Markewitz BA, Westenskow DR. Improving alarm performance in the medical intensive care unit using delays and clinical context. Anesth Analg. 2009;108(5):1546…
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psnet.ahrq.gov/issue/overriding-drug-safety-alerts-computerized-physician-order-entry
March 04, 2011 - Review
Overriding of drug safety alerts in computerized physician order entry.
Citation Text:
van der Sijs H, Aarts J, Vulto A, et al. Overriding of drug safety alerts in computerized physician order entry. J Am Med Inform Assoc. 2006;13(2):138-47.
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psnet.ahrq.gov/issue/effect-pharmacist-led-educational-intervention-inappropriate-medication-prescriptions-older
February 14, 2017 - Study
Classic
Effect of a pharmacist-led educational intervention on inappropriate medication prescriptions in older adults: the D-PRESCRIBE randomized clinical trial.
Citation Text:
Martin P, Tamblyn R, Benedetti A, et al. Effect of a Pharmacist-Led Educational…
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psnet.ahrq.gov/issue/human-factors-and-quality-improvement-emergency-department-reducing-potential-errors-blood
October 14, 2011 - Study
Human factors and quality improvement in the emergency department: reducing potential errors in blood collection.
Citation Text:
Bashkin O, Caspi S, Swissa A, et al. Human Factors and Quality Improvement in the Emergency Department: Reducing Potential Errors in Blood Collection. J …
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psnet.ahrq.gov/issue/ins-and-outs-change-shift-handoffs-between-nurses-communication-challenge
October 19, 2022 - Study
The ins and outs of change of shift handoffs between nurses: a communication challenge.
Citation Text:
Carroll JS, Williams M, Gallivan TM. The ins and outs of change of shift handoffs between nurses: a communication challenge. BMJ Qual Saf. 2012;21(7):586-93. doi:10.1136/bmjqs-2…
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psnet.ahrq.gov/issue/development-medication-safety-and-quality-survey-small-rural-hospitals
July 15, 2010 - Study
Development of a medication safety and quality survey for small rural hospitals.
Citation Text:
Winterstein AG, Johns TE, Campbell KN, et al. Development of a Medication Safety and Quality Survey for Small Rural Hospitals. J Patient Saf. 2017;13(4):249-254. doi:10.1097/PTS.00000000…
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psnet.ahrq.gov/issue/impact-antiretroviral-stewardship-strategy-medication-error-rates
August 04, 2021 - Study
Impact of an antiretroviral stewardship strategy on medication error rates.
Citation Text:
Shea KM, Hobbs AL, Shumake JD, et al. Impact of an antiretroviral stewardship strategy on medication error rates. Am J Health Syst Pharm. 2018;75(12):876-885. doi:10.2146/ajhp170420.
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psnet.ahrq.gov/issue/incidence-potentially-avoidable-urgent-readmissions-and-their-relation-all-cause-urgent
April 22, 2011 - Study
Incidence of potentially avoidable urgent readmissions and their relation to all-cause urgent readmissions.
Citation Text:
van Walraven C, Jennings A, Taljaard M, et al. Incidence of potentially avoidable urgent readmissions and their relation to all-cause urgent readmissions. Ca…