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9621. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/46768/psn-pdf
      March 07, 2018 - Dental Patient Safety Foundation. March 7, 2018 Dental Patient Safety Foundation; 16011 S. 108th Ave., Orland Park, IL 60467. https://psnet.ahrq.gov/issue/dental-patient-safety-foundation Dentistry, like other areas of health care, is intrinsically risky. This patient safety organization collects, analyzes, and sh…

9622. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/47125/psn-pdf
      July 11, 2018 - Teamwork in healthcare: key discoveries enabling safer, high-quality care. July 11, 2018 Rosen MA, DiazGranados D, Dietz AS, et al. Teamwork in healthcare: Key discoveries enabling safer, high-quality care. Am Psychol. 2018;73(4):433-450. doi:10.1037/amp0000298. https://psnet.ahrq.gov/issue/teamwork-healthcare-key…

9623. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/42491/psn-pdf
      September 18, 2013 - The incidence of diagnostic error in medicine. September 18, 2013 Graber ML. The incidence of diagnostic error in medicine. BMJ Qual Saf. 2013;22 Suppl 2:ii21-ii27. doi:10.1136/bmjqs-2012-001615. https://psnet.ahrq.gov/issue/incidence-diagnostic-error-medicine This review examines eight research methods used to es…

9624. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/48170/psn-pdf
      July 31, 2019 - Developing resilience to combat nurse burnout. July 31, 2019 Quick Safety. July 15, 2019;(50):1-4. https://psnet.ahrq.gov/issue/developing-resilience-combat-nurse-burnout This newsletter article discusses nurse burnout and how to reduce conditions that contribute to the problem . Recommendations focus on the role …

9625. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/43460/psn-pdf
      April 25, 2016 - Safety organizing, emotional exhaustion, and turnover in hospital nursing units. April 25, 2016 Vogus TJ, Cooil B, Sitterding M, et al. Safety organizing, emotional exhaustion, and turnover in hospital nursing units. Med Care. 2014;52(10):870-6. doi:10.1097/MLR.0000000000000169. https://psnet.ahrq.gov/issue/safety…

9626. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/866638/psn-pdf
      September 04, 2024 - The problem with 'never events'. September 4, 2024 Zaslow J, Fortier J, Garber G. The problem with ‘never events’. BMJ Qual Saf. 2024;33(9):613-616. doi:10.1136/bmjqs-2023-016981. https://psnet.ahrq.gov/issue/problem-never-events Never events are serious, but preventable, adverse events that result in serious pati…

9627. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/43646/psn-pdf
      January 01, 2021 - Patient Safety Systems Chapter. January 1, 2021 In: 2021 Comprehensive Accreditation Manual for Hospitals. CAMH. Oakbrook Terrace, IL: Joint Commission; January 2021:PS1-PS46. https://psnet.ahrq.gov/issue/patient-safety-systems-chapter This chapter provides information about how organizations can re-design existin…

9628. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/839830/psn-pdf
      November 09, 2022 - Walgreens will stop judging its pharmacy staffers by how fast they work. November 9, 2022 Kaplan A. NBC News. October 27, 2022.  https://psnet.ahrq.gov/issue/walgreens-will-stop-judging-its-pharmacy-staffers-how-fast-they-work Suboptimal working conditions are a known contributor to errors in retail pharmacie…

9629. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/39675/psn-pdf
      January 19, 2011 - A 5-year analysis of rapid response system activation at an in-hospital haemodialysis unit. January 19, 2011 Galhotra S, Devita MA, Dew MA, et al. A 5-year analysis of rapid response system activation at an in- hospital haemodialysis unit. Qual Saf Health Care. 2010;19(6):e38. doi:10.1136/qshc.2008.031666. https:/…

9630. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/45899/psn-pdf
      March 15, 2017 - Patient Safety: Investigating and Reporting Serious Clinical Incidents. March 15, 2017 Kelsey R. CRC Press: Boca Raton, FL; 2017. ISBN: 9781498781169. https://psnet.ahrq.gov/issue/patient-safety-investigating-and-reporting-serious-clinical-incidents Research is increasingly focusing on patient safety in primary ca…

9631. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/73098/psn-pdf
      September 07, 2021 - Achieving Excellence in the Diagnosis of Acute Cardiovascular Events: Proceedings of a Workshop–in Brief. September 7, 2021 National Academies of Sciences, Engineering, and Medicine. Washington, DC: The National Academies Press; 2021. https://psnet.ahrq.gov/issue/achieving-excellence-diagnosis-acute-cardiovascula…

9632. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/39371/psn-pdf
      April 05, 2017 - Patient safety research: an overview of the global evidence. April 5, 2017 Jha AK, Prasopa-Plaizier N, Larizgoitia I, et al. Patient safety research: an overview of the global evidence. Qual Saf Health Care. 2010;19(1):42-7. doi:10.1136/qshc.2008.029165. https://psnet.ahrq.gov/issue/patient-safety-research-overvie…

9633. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/35995/psn-pdf
      October 28, 2010 - FDA Guidance Document: Hospital Bed System Dimensional and Assessment Guidance to Reduce Entrapment. October 28, 2010 Rockville MD: Center for Devices and Radiological Health, Food and Drug Administration: March 10, 2006. https://psnet.ahrq.gov/issue/fda-guidance-document-hospital-bed-system-dimensional-and-assess…

9634. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/36075/psn-pdf
      September 28, 2010 - Sample to sample carryover: a source of analytical laboratory error and its relevance to integrated clinical chemistry/immunoassay systems. September 28, 2010 Armbruster DA, Alexander DB. Sample to sample carryover: a source of analytical laboratory error and its relevance to integrated clinical chemistry/immunoas…

9635. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/73991/psn-pdf
      October 20, 2021 - Digital Clinical Safety Strategy October 20, 2021 NHSX, NHS Digital, NHS England, et al. London, England: Crown Copyright; September 2021. https://psnet.ahrq.gov/issue/digital-clinical-safety-strategy Digital clinical technologies hold promise for care improvement while contributing to potential failures due to th…

9636. CHIPRA 240: Section 6, Tables 3 and 4 (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/chronic/chipra-240-section-6-tables-3-4.pdf
      June 02, 2025 - CHIPRA 240: Section 6, Tables 3 and 4 Table 3: Agreement and Kappa Statistics for Inter-Rater Reliability Variable Description Records Reviewed For IRR (N) N Agreed (%) Kappa Statistic Documentation that BMI percentile is >85th percentile 8 8 (100) 1 Documentation of height 4 4 (100) 1 Docume…

9637. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/37652/psn-pdf
      September 24, 2010 - Case study: getting boards on board at Allen Memorial Hospital, Iowa Health System. September 24, 2010 Slessor SR, Crandall JB, Nielsen GA. Case study: getting boards on board at Allen Memorial Hospital, Iowa Health System. Jt Comm J Qual Patient Saf. 2008;34(4):221-227. https://psnet.ahrq.gov/issue/case-study-get…

9638. Tool 3 Continued | Agency for Healthcare Research and Quality
      www.ahrq.gov/es/patient-safety/settings/hospital/red/toolkit/dxpages.html
      March 01, 2025 - Re-Engineered Discharge (RED) Toolkit Tool 3 Continued Previous Page Next Page Table of Contents Re-Engineered Discharge (RED) Toolkit Tool 1: Overview Tool 2: How To Begin the Re-engineered Discharge Implementation at Your Hospital How CMS Measures the "30-Day All Cause Rehospitalization Rate…

9639. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/39050/psn-pdf
      January 04, 2010 - Safety as a criterion for quality: The Critical Nursing Situation Index in paediatric critical care, an observational study. January 4, 2010 de Neef M, Bos AP, Tol D. Safety as a criterion for quality: the critical nursing situation index in paediatric critical care, an observational study. Intensive Crit Care Nur…

9640. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/40015/psn-pdf
      November 17, 2010 - Medication prescribing and monitoring errors in primary care: a report from the Practice Partner Research Network. November 17, 2010 Wessell AM, Litvin C, Jenkins RG, et al. Medication prescribing and monitoring errors in primary care: a report from the Practice Partner Research Network. Qual Saf Health Care. 2010…