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psnet.ahrq.gov/web-mm/bowel-prep
March 01, 2017 - Deprescribing as a Patient Safety Strategy
October 27, 2021
Crisis checklists for the operating
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psnet.ahrq.gov/web-mm/wrong-time-error-high-alert-medication
February 01, 2014 - the morning dose was scheduled to be given at 6 AM, but the patient was scheduled to leave for the operating
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psnet.ahrq.gov/web-mm/home-medications-contribute-unique-opportunity-error-discharge-hospital
May 16, 2022 - January 15, 2020
The effect of a checklist on the quality of patient handover from the operating
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psnet.ahrq.gov/web-mm/medication-reconciliation-pitfalls
May 01, 2006 - While being prepped on the operating room table several hours later, the patient developed asystole,
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psnet.ahrq.gov/web-mm/triage-time-bomb
September 01, 2008 - December 23, 2008
Practice advisory for the prevention and management of operating room
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psnet.ahrq.gov/perspective/how-does-infection-prevention-fit-safety-program
March 01, 2014 - How Does Infection Prevention Fit Into a Safety Program?
Susan S. Huang, MD, MPH | March 1, 2014
Also Read a Conversation
View more articles from the same authors.
Citation Text:
Huang SS. How Does Infection Prevention Fit Into a Safety Program?. PSNet [interne…
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psnet.ahrq.gov/sites/default/files/2021-09/spotlight_missed_sea_09.17.2021_-_final.pdf
January 01, 2021 - Spotlight
Spotlight
Dangers of Missing an Epidural Abscess:
Multiple Visits and Delayed Diagnosis with
a Severely Negative Outcome
Source and Credits
• This presentation is based on the June 2021 AHRQ WebM&M
Spotlight Case
o See the full article at https://psnet.ahrq.gov/webmm
o CME credit is available
o Comm…
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psnet.ahrq.gov/issue/work-life-balance-behaviours-cluster-work-settings-and-relate-burnout-and-safety-culture
September 14, 2022 - Study
Emerging Classic
Work–life balance behaviours cluster in work settings and relate to burnout and safety culture: a cross-sectional survey analysis.
Citation Text:
Schwartz SP, Adair KC, Bae J, et al. Work-life balance behaviours cluster in work settings an…
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psnet.ahrq.gov/issue/state-legal-restrictions-and-prescription-opioid-use-among-disabled-adults
May 31, 2023 - Study
Classic
State legal restrictions and prescription-opioid use among disabled adults.
Citation Text:
Meara E, Horwitz JR, Powell W, et al. State Legal Restrictions and Prescription-Opioid Use among Disabled Adults. N Engl J Med. 2016;375(1):44-53. doi:10.105…
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psnet.ahrq.gov/issue/mitigation-patient-harm-testing-errors-family-medicine-offices-report-american-academy-family
June 11, 2008 - Study
Mitigation of patient harm from testing errors in family medicine offices: a report from the American Academy of Family Physicians National Research Network.
Citation Text:
Graham DG, Harris DM, Elder NC, et al. Mitigation of patient harm from testing errors in family medicine of…
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psnet.ahrq.gov/issue/leapfrog-hospital-safety-score-magnet-designation-and-healthcare-associated-infections-united
July 27, 2022 - Study
Leapfrog Hospital Safety Score, Magnet designation, and healthcare-associated infections in United States hospitals.
Citation Text:
Pakyz AL, Wang H, Ozcan YA, et al. Leapfrog Hospital Safety Score, Magnet Designation, and Healthcare-Associated Infections in United States Hospitals…
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psnet.ahrq.gov/issue/association-between-complications-incidents-and-patient-experience-retrospective-linkage
February 20, 2019 - Study
The association between complications, incidents, and patient experience: retrospective linkage of routine patient experience surveys and safety data.
Citation Text:
de Vos MS, Hamming JF, Boosman H, et al. The Association Between Complications, Incidents, and Patient Experience: R…
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psnet.ahrq.gov/issue/communication-between-primary-and-secondary-care-deficits-and-danger
September 23, 2020 - Study
Communication between primary and secondary care: deficits and danger.
Citation Text:
Dinsdale E, Hannigan A, O’Connor R, et al. Communication between primary and secondary care: deficits and danger. Fam Pract. 2019;17(1):63-68. doi:10.1093/fampra/cmz037.
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Format…
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psnet.ahrq.gov/issue/effect-hospital-multifaceted-clinical-pharmacist-intervention-risk-readmission-randomized
September 13, 2023 - Study
Classic
Effect of an in-hospital multifaceted clinical pharmacist intervention on the risk of readmission: a randomized clinical trial.
Citation Text:
Ravn-Nielsen LV, Duckert M-L, Lund ML, et al. Effect of an In-Hospital Multifaceted Clinical Pharmacist I…
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psnet.ahrq.gov/issue/providing-feedback-following-leadership-walkrounds-associated-better-patient-safety-culture
February 01, 2023 - Study
Classic
Providing feedback following Leadership WalkRounds is associated with better patient safety culture, higher employee engagement and lower burnout.
Citation Text:
Sexton B, Adair KC, Leonard MW, et al. Providing feedback following Leadership WalkRou…
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psnet.ahrq.gov/issue/healthcare-failure-mode-and-effect-analysis-hfmea-effective-mechanism-preventing-infection
April 05, 2023 - Study
Healthcare failure mode and effect analysis (HFMEA) as an effective mechanism in preventing infection caused by accompanying caregivers during COVID-19-experience of a city medical center in Taiwan.
Citation Text:
Tiao C-H, Tsai L-C, Chen L-C, et al. Healthcare Failure Mode and Eff…
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psnet.ahrq.gov/issue/investigating-impact-pharmacist-intervention-inappropriate-prescribing-practices-hospital
November 30, 2022 - Study
Investigating the impact of a pharmacist intervention on inappropriate prescribing practices at hospital admission and discharge in older patients: a secondary outcome analysis from a randomized controlled trial.
Citation Text:
Garcia BH, Omma KK, Småbrekke L, et al. Investigating …
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psnet.ahrq.gov/issue/toward-zero-harm-mackenzie-healths-journey-toward-becoming-high-reliability-organization-and
September 14, 2022 - Study
Toward zero harm: Mackenzie Health's journey toward becoming a high reliability organization and eliminating avoidable harm.
Citation Text:
Wilson M-A, Sinno M, Hacker Teper M, et al. Toward zero harm: Mackenzie Health's journey toward becoming a high reliability organization and e…
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psnet.ahrq.gov/issue/quality-hospital-work-environments-and-missed-nursing-care-linked-heart-failure-readmissions
September 09, 2020 - Study
The quality of hospital work environments and missed nursing care is linked to heart failure readmissions: a cross-sectional study of US hospitals.
Citation Text:
Carthon MB, Lasater KB, Sloane DM, et al. The quality of hospital work environments and missed nursing care is linked t…
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psnet.ahrq.gov/issue/cost-quality-academic-health-centers-annual-costs-its-quality-and-patient-safety
October 14, 2020 - Study
The cost of quality: an academic health center's annual costs for its quality and patient safety infrastructure.
Citation Text:
Blanchfield BB, Demehin AA, Cummings CT, et al. The cost of quality: an academic health center's annual costs for its quality and patient safety infrastru…