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VA Health Care: Improvements Needed in Processes Used to Address Providers' Actions That Contribute to Adverse Events. | PSNet

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October 12, 2022 - Book/Report VA Health Care: Improvements Needed in Processes Used to Address Providers' Actions That Contribute to Adverse Events. Citation Text: VA Health Care: Improvements Needed in Processes Used to Address Providers' Actions That Contribute to Adverse Events. Draper D. Washington,…

Improving hospital systems for the care of women with major obstetric hemorrhage. | PSNet

psnet.ahrq.gov/issue/improving-hospital-systems-care-women-major-obstetric-hemorrhage

July 06, 2022 - Study Improving hospital systems for the care of women with major obstetric hemorrhage. Citation Text: Skupski DW, Lowenwirt IP, Weinbaum FI, et al. Improving hospital systems for the care of women with major obstetric hemorrhage. Obstet Gynecol. 2006;107(5):977-983. Copy Citation …

Enhanced free-text search for aggregated medication error report analysis and risk detection. | PSNet

psnet.ahrq.gov/issue/enhanced-free-text-search-aggregated-medication-error-report-analysis-and-risk-detection

April 12, 2019 - Study Enhanced free-text search for aggregated medication error report analysis and risk detection. Citation Text: Valkonen V, Saano S, Haatainen K, et al. Enhanced free-text search for aggregated medication error report analysis and risk detection. J Patient Saf. 2024;20(4):259-266. doi…

Use of the Second Victim Experience and Support Tool (SVEST) to assess the impact of a departmental peer support program on anesthesia professionals' second victim experiences (SVEs) and perceptions of support two years after implementation. | PSNet

psnet.ahrq.gov/issue/use-second-victim-experience-and-support-tool-svest-assess-impact-departmental-peer-support

December 23, 2020 - Study Use of the Second Victim Experience and Support Tool (SVEST) to assess the impact of a departmental peer support program on anesthesia professionals' second victim experiences (SVEs) and perceptions of support two years after implementation. Citation Text: Use of the Second Victim …

Patient safety in healthcare preregistration educational curricula: multiple case study-based investigations of eight medicine, nursing, pharmacy and physiotherapy university courses. | PSNet

psnet.ahrq.gov/issue/patient-safety-healthcare-preregistration-educational-curricula-multiple-case-study-based

January 19, 2014 - Study Patient safety in healthcare preregistration educational curricula: multiple case study-based investigations of eight medicine, nursing, pharmacy and physiotherapy university courses. Citation Text: Cresswell K, Howe A, Steven A, et al. Patient safety in healthcare preregistratio…

Heparin-containing medical devices and combination products: recommendations for labeling and safety testing. Draft guidance for industry and Food and Drug Administration staff. | PSNet

psnet.ahrq.gov/issue/heparin-containing-medical-devices-and-combination-products-recommendations-labeling-and

November 23, 2015 - Regulation Heparin-containing medical devices and combination products: recommendations for labeling and safety testing. Draft guidance for industry and Food and Drug Administration staff. Citation Text: Heparin-containing medical devices and combination products: recommendations for lab…

ASHP Guidelines on Preventing Diversion of Controlled Substances. | PSNet

psnet.ahrq.gov/issue/ashp-guidelines-preventing-diversion-controlled-substances

June 15, 2022 - Organizational Policy/Guidelines ASHP Guidelines on Preventing Diversion of Controlled Substances. Citation Text: Clark J, Fera T, Fortier CR, et al. ASHP Guidelines on Preventing Diversion of Controlled Substances. Am J Health Syst Pharm. 2022;79(24):2279-2306. doi:10.1093/ajhp/zxac246.…

The impact of electronic medical records data sources on an adverse drug event quality measure. | PSNet

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July 31, 2013 - Study The impact of electronic medical records data sources on an adverse drug event quality measure. Citation Text: Kahn MG, Ranade D. The impact of electronic medical records data sources on an adverse drug event quality measure. J Am Med Inform Assoc. 2010;17(2):185-91. doi:10.1136/…

Medication appropriateness in vulnerable older adults: healthy skepticism of appropriate polypharmacy. | PSNet

psnet.ahrq.gov/issue/medication-appropriateness-vulnerable-older-adults-healthy-skepticism-appropriate

October 04, 2023 - Review Medication appropriateness in vulnerable older adults: healthy skepticism of appropriate polypharmacy. Citation Text: Fried TR, Mecca MC. Medication Appropriateness in Vulnerable Older Adults: Healthy Skepticism of Appropriate Polypharmacy. J Am Geriatr Soc. 2019;67(6):1123-1127. …

Economic evaluation of the impact of medication errors reported by US clinical pharmacists. | PSNet

psnet.ahrq.gov/issue/economic-evaluation-impact-medication-errors-reported-us-clinical-pharmacists

February 02, 2011 - Study Economic evaluation of the impact of medication errors reported by US clinical pharmacists. Citation Text: Samp JC, Touchette DR, Marinac JS, et al. Economic evaluation of the impact of medication errors reported by U.S. clinical pharmacists. Pharmacotherapy. 2014;34(4):350-7. doi:…

Prevented harm and cost avoidance with pharmacist intervention while utilizing a discharge medication reconciliation tool. | PSNet

psnet.ahrq.gov/issue/prevented-harm-and-cost-avoidance-pharmacist-intervention-while-utilizing-discharge

October 19, 2022 - Study Prevented harm and cost avoidance with pharmacist intervention while utilizing a discharge medication reconciliation tool. Citation Text: Hoffman AM, Walls JL, Prusch A, et al. Prevented harm and cost avoidance with pharmacist intervention while utilizing a discharge medication rec…

Errors in surgery: a case control study. | PSNet

psnet.ahrq.gov/issue/errors-surgery-case-control-study

May 01, 2024 - Study Errors in surgery: a case control study. Citation Text: Marsh KM, Turrentine FE, Schenk WG, et al. Errors in surgery: a case control study. Ann Surg. 2022;276(5):e347-e352. doi:10.1097/sla.0000000000005664. Copy Citation Format: DOI Google Scholar BibTeX EndNote X3 XM…

Operating room traffic as a modifiable risk factor for surgical site infection. | PSNet

psnet.ahrq.gov/issue/operating-room-traffic-modifiable-risk-factor-surgical-site-infection

April 24, 2018 - Study Operating room traffic as a modifiable risk factor for surgical site infection. Citation Text: Wanta BT, Glasgow AE, Habermann EB, et al. Operating Room Traffic as a Modifiable Risk Factor for Surgical Site Infection. Surg Infect (Larchmt). 2016;17(6):755-760. Copy Citation F…

Investigating patient safety culture across a health system: multilevel modelling of differences associated with service types and staff demographics. | PSNet

psnet.ahrq.gov/issue/investigating-patient-safety-culture-across-health-system-multilevel-modelling-differences

November 12, 2014 - Study Investigating patient safety culture across a health system: multilevel modelling of differences associated with service types and staff demographics. Citation Text: Gallego B, Westbrook MT, Dunn AG, et al. Investigating patient safety culture across a health system: multilevel mod…

Physicians' practice of dispensing medicines: a qualitative study. | PSNet

psnet.ahrq.gov/issue/physicians-practice-dispensing-medicines-qualitative-study

November 16, 2022 - Study Physicians' practice of dispensing medicines: a qualitative study. Citation Text: Darbyshire D, Gordon M, Baker P, et al. Physicians' Practice of Dispensing Medicines: A Qualitative Study. J Patient Saf. 2016;12(2):82-8. doi:10.1097/PTS.0000000000000122. Copy Citation Format:…

What is safety leadership? A systematic review of definitions. | PSNet

psnet.ahrq.gov/issue/what-safety-leadership-systematic-review-definitions

October 26, 2022 - Review What is safety leadership? A systematic review of definitions. Citation Text: Adra I, Giga S, Hardy C, et al. What is safety leadership? A systematic review of definitions. J Safety Res. 2024;90:181-191. doi:10.1016/j.jsr.2024.04.001. Copy Citation Format: DOI Google…

A multidisciplinary team approach to retained foreign objects. | PSNet

psnet.ahrq.gov/issue/multidisciplinary-team-approach-retained-foreign-objects

June 10, 2010 - Study A multidisciplinary team approach to retained foreign objects. Citation Text: Cima RR, Kollengode A, Storsveen AS, et al. A multidisciplinary team approach to retained foreign objects. Jt Comm J Qual Saf. 2009;35(3):123-132. Copy Citation Format: Google Scholar PubMed…

Safe care for pediatric patients: a scoping review across multiple health care settings. | PSNet

psnet.ahrq.gov/issue/safe-care-pediatric-patients-scoping-review-across-multiple-health-care-settings

August 03, 2022 - Review Safe care for pediatric patients: a scoping review across multiple health care settings. Citation Text: Stang A, Thomson D, Hartling L, et al. Safe Care for Pediatric Patients: A Scoping Review Across Multiple Health Care Settings. Clin Pediatr (Phila). 2018;57(1):62-75. doi:10.11…

Patient safety: examining the adequacy of the 5 rights of medication administration. | PSNet

psnet.ahrq.gov/issue/patient-safety-examining-adequacy-5-rights-medication-administration

March 02, 2016 - Commentary Patient safety: examining the adequacy of the 5 rights of medication administration. Citation Text: Macdonald M. Patient safety: examining the adequacy of the 5 rights of medication administration. Clin Nurse Spec. 2010;24(4):196-201. doi:10.1097/NUR.0b013e3181e3605f. Copy…

The stories clinicians tell: achieving high reliability and improving patient safety. | PSNet

psnet.ahrq.gov/issue/stories-clinicians-tell-achieving-high-reliability-and-improving-patient-safety

April 24, 2018 - Commentary The stories clinicians tell: achieving high reliability and improving patient safety. Citation Text: Cohen DL, Stewart KO. The Stories Clinicians Tell: Achieving High Reliability and Improving Patient Safety. Perm J. 2016;20(1):85-90. doi:10.7812/TPP/15-039. Copy Citation …

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