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psnet.ahrq.gov/issue/promoting-patient-safety-one-companys-example
April 05, 2017 - Commentary
Promoting patient safety: one company's example.
Citation Text:
Babaie K. Promoting patient safety: one company's example. Case Manager. 2006;17(6):54-9.
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psnet.ahrq.gov/issue/personal-nursing-care-experiences-provide-lessons-patient-safety
March 01, 2023 - Commentary
Personal nursing care experiences provide lessons on patient safety.
Citation Text:
Pashley HS. Personal nursing care experiences provide lessons on patient safety. AORN J. 2011;94(2):194-8. doi:10.1016/j.aorn.2011.03.009.
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psnet.ahrq.gov/issue/medication-safety-moving-illusion-reality
July 29, 2020 - Commentary
Medication safety: moving from illusion to reality.
Citation Text:
Classen D. Medication safety. JAMA. 2003;289(9):1154-1156. doi:10.1001/jama.289.9.1154.
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psnet.ahrq.gov/node/49495/psn-pdf
December 01, 2005 - Low on the Totem Pole
December 1, 2005
Wachter R. Low on the Totem Pole. PSNet [internet]. 2005.
https://psnet.ahrq.gov/web-mm/low-totem-pole
Case Objectives
Understand the concept of authority gradient
List steps that can be taken to increase communication across an authority gradient
Consider the current cultu…
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psnet.ahrq.gov/node/33618/psn-pdf
September 01, 2005 - Playing Well with Others: "Translocational Research" in
Patient Safety
September 1, 2005
Wachter R. Playing Well with Others: "Translocational Research" in Patient Safety. PSNet [internet]. 2005.
https://psnet.ahrq.gov/perspective/playing-well-others-translocational-research-patient-safety
Perspective
Translation…
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psnet.ahrq.gov/web-mm/or
August 22, 2013 - On O.R. Off?
Citation Text:
Leonard M. On O.R. Off?. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2005.
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Do…
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psnet.ahrq.gov/node/49653/psn-pdf
May 01, 2012 - The Forgotten Line
May 1, 2012
Render ML. The Forgotten Line. PSNet [internet]. 2012.
https://psnet.ahrq.gov/web-mm/forgotten-line
The Case
An 81-year-old man with a history of coronary artery disease, hypertension, cerebrovascular accidents, and
chronic kidney disease was transferred to a referral hospital for p…
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psnet.ahrq.gov/node/49863/psn-pdf
May 01, 2019 - Good Catch in the Operating Room
May 1, 2019
Day J, Paige JT. Good Catch in the Operating Room. PSNet [internet]. 2019.
https://psnet.ahrq.gov/web-mm/good-catch-operating-room
The Case
A 46-year-old woman with extensive history of back pain from lumbar stenosis was scheduled for an
elective laminectomy and spinal…
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psnet.ahrq.gov/periodic-issue/periodic-issue-297
June 30, 2021 - to decrease in many areas in 2021, the authors recommend local, regional, and national public health leaders
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psnet.ahrq.gov/periodic-issue/periodic-issue-284
March 15, 2021 - A COVID-19 Resource for Hospital and Health System Leaders.
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psnet.ahrq.gov/periodic-issue/periodic-issue-281
March 15, 2021 - Commentary
How to do no harm: empowering local leaders to make care safer in low-resource
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psnet.ahrq.gov/periodic-issue/periodic-issue-287
April 28, 2021 - This article summarizes foundational concepts for leaders to adopt in order to enhance their work toward
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psnet.ahrq.gov/periodic-issue/periodic-issue-335
April 27, 2022 - Criminalization of medical mistakes typifies the blame-focused approach patient safety leaders
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psnet.ahrq.gov/periodic-issue/periodic-issue-333
March 31, 2022 - Based on qualitative interviews with organizational leaders and front-line supervisors, the researchers
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psnet.ahrq.gov/periodic-issue/periodic-issue-403
August 30, 2023 - This qualitative study with huddle leaders and participants at five sites found that huddles can enhance
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psnet.ahrq.gov/web-mm/medication-reconciliation-whose-job-it
May 01, 2018 - implementation of the process will require significant training, education, and support from clinical leaders
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psnet.ahrq.gov/perspective/conversation-withbarbara-blakeney-ms-rn
August 01, 2005 - Part of the reason probably relates to leaders' perceptions of an intractable nurse shortage, which has
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psnet.ahrq.gov/node/49454/psn-pdf
July 01, 2004 - that may prove useful and
which are reviewed elsewhere include academic detailing using local opinion leaders
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psnet.ahrq.gov/web-mm/weighty-mistake
September 01, 2016 - Development and evaluation of patient safety interventions: perspectives of operational safety leaders
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psnet.ahrq.gov/node/837791/psn-pdf
August 05, 2022 - implementation projects could further accelerate the application of lessons learned to help safety leaders