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psnet.ahrq.gov/node/44649/psn-pdf
November 11, 2015 - Seven (potentially) deadly prescribing errors.
November 11, 2015
Graham LR, Scudder L, Stokowski L. Medscape. October 22, 2015.
https://psnet.ahrq.gov/issue/seven-potentially-deadly-prescribing-errors
Errors in the prescribing process can lead to adverse drug events. This slide set provides information about
commo…
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psnet.ahrq.gov/node/45039/psn-pdf
September 27, 2016 - Deaths following prehospital safety incidents: an analysis
of a national database.
September 27, 2016
Yardley I, Donaldson LJ. Deaths following prehospital safety incidents: an analysis of a national database.
Emerg Med J. 2016;33(10):716-721. doi:10.1136/emermed-2015-204724.
https://psnet.ahrq.gov/issue/deaths-fo…
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psnet.ahrq.gov/node/39559/psn-pdf
December 17, 2010 - Understanding vs. competency: the case of accuracy
checking dispensed medicines in pharmacy.
December 17, 2010
James L, Davies G, Kinchin I, et al. Understanding vs. competency: the case of accuracy checking
dispensed medicines in pharmacy. Adv Health Sci Educ Theory Pract. 2010;15(5):735-47.
doi:10.1007/s10459-01…
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psnet.ahrq.gov/node/74188/psn-pdf
December 15, 2021 - Semantically ambiguous language in the teaching
operating room.
December 15, 2021
Liu C, McKenzie A, Sutkin G. Semantically ambiguous language in the teaching operating room. J Surg
Edu. 2021;78(6):1938-1947. doi:10.1016/j.jsurg.2021.03.020.
https://psnet.ahrq.gov/issue/semantically-ambiguous-language-teaching-ope…
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psnet.ahrq.gov/node/34805/psn-pdf
November 07, 2017 - Medication errors in neonatal and paediatric intensive-
care units.
November 7, 2017
Raju TN, Kecskes S, Thornton JP, et al. Medication errors in neonatal and paediatric intensive-care units.
Lancet. 1989;2(8659):374-6.
https://psnet.ahrq.gov/issue/medication-errors-neonatal-and-paediatric-intensive-care-units
Th…
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psnet.ahrq.gov/node/38551/psn-pdf
April 15, 2009 - Harm caused by adverse events in primary care: a clinical
observational study.
April 15, 2009
Wetzels R, Wolters R, van Weel C, et al. Harm caused by adverse events in primary care: a clinical
observational study. J Eval Clin Pract. 2009;15(2):323-7. doi:10.1111/j.1365-2753.2008.01005.x.
https://psnet.ahrq.gov/iss…
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psnet.ahrq.gov/node/43700/psn-pdf
November 19, 2014 - Appropriate use of medical interpreters.
November 19, 2014
Juckett G, Unger K. Appropriate use of medical interpreters. Am Fam Physician. 2014;90(7):476-80.
https://psnet.ahrq.gov/issue/appropriate-use-medical-interpreters
Language barriers between patients and providers can contribute to misunderstandings and lead…
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psnet.ahrq.gov/node/43118/psn-pdf
April 16, 2014 - NCPDP Recommendations and Guidance for
Standardizing the Dosing Designations on Prescription
Container Labels of Oral Liquid Medications Version 1.0.
April 16, 2014
Scottsdale, AZ: National Council for Prescription Drug Programs; March 2014.
https://psnet.ahrq.gov/issue/ncpdp-recommendations-and-guidance-standardi…
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psnet.ahrq.gov/node/73586/psn-pdf
January 01, 2022 - 'More than words' - interpersonal communication,
cognitive bias and diagnostic errors.
August 11, 2021
Dahm MR, Williams M, Crock C. ‘More than words’ – Interpersonal communication, cognitive bias and
diagnostic errors. Patient Educ Couns. 2022;105(1):252-256. doi:10.1016/j.pec.2021.05.012.
https://psnet.ahrq.gov/…
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psnet.ahrq.gov/node/46329/psn-pdf
September 06, 2017 - Risk factors of missed colorectal lesions after
colonoscopy.
September 6, 2017
Lee J, Park SW, Kim YS, et al. Risk factors of missed colorectal lesions after colonoscopy. Medicine
(Baltimore). 2017;96(27):e7468. doi:10.1097/MD.0000000000007468.
https://psnet.ahrq.gov/issue/risk-factors-missed-colorectal-lesions-af…
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psnet.ahrq.gov/node/40130/psn-pdf
January 12, 2011 - Patient safety culture: factors that influence clinician
involvement in patient safety behaviours.
January 12, 2011
Wakefield JG, McLaws M-L, Whitby M, et al. Patient safety culture: factors that influence clinician
involvement in patient safety behaviours. Qual Saf Health Care. 2010;19(6):585-91.
doi:10.1136/qshc…
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psnet.ahrq.gov/node/853971/psn-pdf
September 27, 2023 - Unconscious bias among health professionals: a scoping
review.
September 27, 2023
Meidert U, Dönnges G, Bucher T, et al. Unconscious bias among health professionals: a scoping review.
Int J Environ Res Public Health. 2023;20(16):6569. doi:10.3390/ijerph20166569.
https://psnet.ahrq.gov/issue/unconscious-bias-among-…
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psnet.ahrq.gov/node/46701/psn-pdf
December 20, 2017 - The other big drug problem: older people taking too many
pills.
December 20, 2017
Boodman SG. Washington Post. December 9, 2017.
https://psnet.ahrq.gov/issue/other-big-drug-problem-older-people-taking-too-many-pills
The prevalence of polypharmacy among older patients represents an important concern for health care…
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psnet.ahrq.gov/node/73885/psn-pdf
September 29, 2021 - Reporting of unsafe conditions at an academic women
and children's hospital.
September 29, 2021
Grabinski ZG, Babineau J, Jamal N, et al. Reporting of unsafe conditions at an academic women and
children's hospital. Jt Comm J Qual Patient Saf. 2021;47(11):731-738. doi:10.1016/j.jcjq.2021.08.004.
https://psnet.ahrq.…
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psnet.ahrq.gov/node/74100/psn-pdf
November 24, 2021 - Pediatric medication errors and reduction strategies in
the perioperative period.
November 24, 2021
Bekes JL, Sackash CR, Voss AL, et al. AANA J. 2021;89(4):319-324.
https://psnet.ahrq.gov/issue/pediatric-medication-errors-and-reduction-strategies-perioperative-period
Pediatric medication errors during anesthesia …
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psnet.ahrq.gov/node/35101/psn-pdf
November 04, 2015 - Hospital finances and patient safety outcomes.
November 4, 2015
Encinosa W, Bernard DM. Hospital finances and patient safety outcomes. Inquiry. 2005;42(1):60-72.
https://psnet.ahrq.gov/issue/hospital-finances-and-patient-safety-outcomes
This AHRQ–funded study examined the relationship between hospital profit margin…
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psnet.ahrq.gov/node/47709/psn-pdf
August 07, 2019 - Medication histories in critically ill patients completed by
pharmacy personnel.
August 7, 2019
Kram BL, Trammel MA, Kram SJ, et al. Medication histories in critically ill patients completed by pharmacy
personnel. Ann Pharmacother. 2019;53(6):596-602. doi:10.1177/1060028018825483.
https://psnet.ahrq.gov/issue/medi…
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psnet.ahrq.gov/node/867650/psn-pdf
January 01, 2022 - Opioid deprescribing toolkit.
January 1, 2022
Health Innovation East, National Health Service. Opioid deprescribing toolkit.
https://psnet.ahrq.gov/issue/opioid-deprescribing-toolkit
Sudden discontinuation of long-term prescription opioid use can lead to adverse outcomes for patients.
Based on research and clinici…
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psnet.ahrq.gov/node/42212/psn-pdf
April 17, 2013 - Reducing the risk of adverse drug events in older adults.
April 17, 2013
Pretorius RW, Gataric G, Swedlund SK, et al. Reducing the risk of adverse drug events in older adults. Am
Fam Physician. 2013;87(5):331-6.
https://psnet.ahrq.gov/issue/reducing-risk-adverse-drug-events-older-adults
This commentary outlines ty…
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psnet.ahrq.gov/node/47112/psn-pdf
May 09, 2018 - 34 ways to survive your next trip to the hospital.
May 9, 2018
Crouch M. Reader's Digest. April 2018.
https://psnet.ahrq.gov/issue/34-ways-survive-your-next-trip-hospital
Involving patients in their care can help improve safety. This magazine article provides 34 tips from leading
patient safety experts to assist p…