-
psnet.ahrq.gov/issue/outcomes-michigan-medicines-integrated-patient-safety-and-communication-and-resolution
April 24, 2018 - Study
Outcomes of Michigan Medicine's integrated patient safety and communication and resolution program, 2013–2022.
Citation Text:
Burney RE, Mckeown ES, Zhang Y, et al. Outcomes of Michigan Medicine's integrated patient safety and communication and resolution program, 2013–2022. J Pati…
-
psnet.ahrq.gov/issue/move-toward-full-use-metric-dosing-eliminate-dosage-cups-measure-liquids-fluid-drams-use-cups
April 01, 2015 - Press Release/Announcement
Move toward full use of metric dosing: eliminate dosage cups that measure liquids in fluid drams. Use cups that measure mL.
Citation Text:
Move toward full use of metric dosing: eliminate dosage cups that measure liquids in fluid drams. Use cups that measure mL…
-
psnet.ahrq.gov/issue/applying-hfmea-prevent-chemotherapy-errors
September 27, 2017 - Study
Applying HFMEA to prevent chemotherapy errors.
Citation Text:
Cheng C-H, Chou C-J, Wang P-C, et al. Applying HFMEA to prevent chemotherapy errors. J Med Syst. 2012;36(3):1543-51. doi:10.1007/s10916-010-9616-7.
Copy Citation
Format:
DOI Google Scholar PubMed BibTeX E…
-
psnet.ahrq.gov/issue/attitudes-nursing-students-and-clinical-instructors-towards-reporting-irregular-incidents
June 01, 2019 - Study
The attitudes of nursing students and clinical instructors towards reporting irregular incidents in the medical clinic.
Citation Text:
Halperin O, Bronshtein O. The attitudes of nursing students and clinical instructors towards reporting irregular incidents in the medical clinic. N…
-
psnet.ahrq.gov/issue/coronavirus-can-california-prison-save-itself-covid-19
July 01, 2020 - Newspaper/Magazine Article
Coronavirus: can this California prison save itself from Covid-19?
Citation Text:
Honderich H, Popat S. Coronavirus: Can this California prison save itself from Covid-19? BBC News, Washington. 2020;Jul 27.
Copy Citation
Format:
Google Scholar BibT…
-
psnet.ahrq.gov/issue/differences-between-human-error-risk-behavior-and-reckless-behavior-are-key-just-culture
September 23, 2020 - Newspaper/Magazine Article
The differences between human error, at-risk behavior, and reckless behavior are key to a just culture.
Citation Text:
The differences between human error, at-risk behavior, and reckless behavior are key to a just culture. ISMP Medication Safety Alert! Acute Ca…
-
psnet.ahrq.gov/issue/does-physicians-training-induce-overconfidence-hampers-disclosing-errors
October 21, 2009 - Study
Does physician's training induce overconfidence that hampers disclosing errors?
Citation Text:
Brezis M, Orkin-Bedolach Y, Fink D, et al. Does Physician's Training Induce Overconfidence That Hampers Disclosing Errors? J Patient Saf. 2019;15(4):296-298. doi:10.1097/PTS.0000000000000…
-
psnet.ahrq.gov/node/38894/psn-pdf
August 26, 2009 - Negotiating medical virtues: toward the development of a
physician mistake disclosure model.
August 26, 2009
Hannawa AF. Negotiating medical virtues: toward the development of a physician mistake disclosure
model. Health Comm. 2009;24(5):391-399. doi:10.1080/10410230903023279.
https://psnet.ahrq.gov/issue/negotiat…
-
psnet.ahrq.gov/node/39296/psn-pdf
January 22, 2017 - Applying Lean Sigma solutions to mistake-proof the
chemotherapy preparation process.
January 22, 2017
Aboumatar HJ, Winner L, Davis RO, et al. Applying Lean Sigma solutions to mistake-proof the
chemotherapy preparation process. Jt Comm J Qual Patient Saf. 2010;36(2):79-86.
https://psnet.ahrq.gov/issue/applying-lea…
-
psnet.ahrq.gov/node/39964/psn-pdf
January 04, 2011 - Fatal consequences of a simple mistake: how can a
patient be saved from inadvertent intrathecal vincristine?
January 4, 2011
Reddy K, Brown B, Nanda A. Fatal consequences of a simple mistake: how can a patient be saved from
inadvertent intrathecal vincristine? Clin Neurol Neurosurg. 2011;113(1):68-71.
doi:10.1016/…
-
psnet.ahrq.gov/node/841774/psn-pdf
December 21, 2022 - The prosecution of RaDonda Vaught: an ethical and legal
mistake.
December 21, 2022
Vogelstein E. The prosecution of RaDonda Vaught: An ethical and legal mistake. Nurs Forum.
2022;57(6):1571-1574. doi:10.1111/nuf.12838.
https://psnet.ahrq.gov/issue/prosecution-radonda-vaught-ethical-and-legal-mistake
The criminal …
-
psnet.ahrq.gov/node/60717/psn-pdf
July 22, 2020 - The U.S. is repeating its deadliest pandemic mistake.
July 22, 2020
KHAZAN OLGA. The U.S. is repeating its deadliest pandemic mistake. The Atlantic. 2020;July 6.
https://psnet.ahrq.gov/issue/us-repeating-its-deadliest-pandemic-mistake
Residential care facilities have been particularly challenged by COVID-19. This a…
-
psnet.ahrq.gov/node/46037/psn-pdf
April 16, 2018 - 'If no-one stops me, I'll make the mistake again': changing
prescribing behaviours through feedback; a Perceptual
Control Theory perspective.
April 16, 2018
Ferguson J, Keyworth C, Tully MP. 'If no-one stops me, I'll make the mistake again': Changing prescribing
behaviours through feedback; A Perceptual Control Th…
-
psnet.ahrq.gov/node/39241/psn-pdf
March 05, 2010 - Dealing honestly with an honest mistake.
March 5, 2010
Liang NL, Herring ME, Bush RL. Dealing honestly with an honest mistake. J Vasc Surg. 2010;51(2):494-5.
doi:10.1016/j.jvs.2009.11.001.
https://psnet.ahrq.gov/issue/dealing-honestly-honest-mistake
This case report describes a near miss involving a potential hepa…
-
psnet.ahrq.gov/node/39771/psn-pdf
August 18, 2010 - Bearing witness to the ethics of practice: storying
physicians' medical mistake narratives.
August 18, 2010
Carmack HJ. Bearing witness to the ethics of practice: storying physicians' medical mistake narratives.
Health Commun. 2010;25(5):449-58. doi:10.1080/10410236.2010.484876.
https://psnet.ahrq.gov/issue/bearin…
-
psnet.ahrq.gov/node/37148/psn-pdf
March 11, 2009 - CMS: your mistake, your problem.
March 11, 2009
Lubell J. CMS: your mistake, your problem. Eight hospital-acquired conditions won't be paid for. Modern
healthcare. 2007;37(33):10-1.
https://psnet.ahrq.gov/issue/cms-your-mistake-your-problem
This article discusses the challenges hospitals face in responding to rece…
-
psnet.ahrq.gov/node/37044/psn-pdf
September 05, 2007 - Make no mistake about it: chain pharmacies are finding
innovative ways to combat medication errors.
September 5, 2007
Levy S. Drug Topics. July 9, 2007
https://psnet.ahrq.gov/issue/make-no-mistake-about-it-chain-pharmacies-are-finding-innovative-ways-
combat-medication
This article reports on ways in which chain …
-
psnet.ahrq.gov/node/42753/psn-pdf
November 20, 2013 - Dealing with a medical mistake: should physicians
apologize to patients?
November 20, 2013
Tabler NG Jr.
https://psnet.ahrq.gov/issue/dealing-medical-mistake-should-physicians-apologize-patients
This article discusses how apologies address patients' needs when a medical mistake has occurred and
how such disclosur…
-
psnet.ahrq.gov/node/39344/psn-pdf
March 03, 2010 - Mistake-proofing healthcare: why stopping processes
may be a good start.
March 3, 2010
Grout JR, Toussaint JS. Mistake-proofing healthcare: Why stopping processes may be a good start. Bus
Horiz. 2009;53(2):149-156. doi:10.1016/j.bushor.2009.10.007.
https://psnet.ahrq.gov/issue/mistake-proofing-healthcare-why-stopp…
-
psnet.ahrq.gov/node/39634/psn-pdf
December 04, 2016 - We meant no harm, yet we made a mistake; why not
apologize for it? A student's view.
December 4, 2016
Sanford DE, Fleming DA. We meant no harm, yet we made a mistake; why not apologize for it? A student's
view. HEC Forum. 2010;22(2):159-69. doi:10.1007/s10730-010-9131-8.
https://psnet.ahrq.gov/issue/we-meant-no-ha…