-
psnet.ahrq.gov/issue/texting-debate-beneficial-means-communication-or-safety-and-security-risk
July 12, 2023 - Adopting new technologies in health care can have unintended consequences that diminish patient safety … patients. … July 2, 2014
View More
Related Resources
Patient Safety … Technology as a Tool for Improving Patient Safety
March 29, 2023 … Cybersecurity is Patient Safety: Policy Options in the Health Care Sector.
-
psnet.ahrq.gov/issue/preventing-adverse-drug-events
June 15, 2011 - August 2, 2016
Promoting Patient Safety Through Effective Health Information Technology … Reporting System for Patient Safety Events. … , and patient outcomes. … May 2, 2018
Medication governance: preventing errors and promoting patient safety. … January 27, 2016
Continuing education in patient safety: massive open online courses
-
psnet.ahrq.gov/issue/impact-use-employee-functional-flexibility-patient-safety
January 12, 2022 - Study
The impact of the use of employee functional flexibility on patient safety. … The impact of the use of employee functional flexibility on patient safety. … The impact of the use of employee functional flexibility on patient safety. … January 12, 2022
Learning and mindfulness: improving perioperative patient safety. … during handovers when nurses are away from patients?
-
psnet.ahrq.gov/issue/care-quality-patient-safety-and-nurse-outcomes-hospitals-serving-economically-disadvantaged
December 09, 2020 - Study
Care quality, patient safety, and nurse outcomes at hospitals serving economically … Care quality, patient safety, and nurse outcomes at hospitals serving economically disadvantaged patients … safety , and patient outcomes. … Care quality, patient safety, and nurse outcomes at hospitals serving economically disadvantaged patients … in patient safety transformation.
-
psnet.ahrq.gov/web-mm/premature-closure-was-it-just-syncope
February 10, 2021 - In a study of patients with a hemorrhage secondary to anticoagulation, 76% of patients with intracranial … Approach to Improving Safety and Systems Change Needed
To help clinicians avoid similar errors, hospitals … like checklists and forcing functions, when integrated into the EHR, provide additional measures of safety … A surgical safety checklist to reduce morbidity and mortality in a global population. … Sections
Learning Objectives
The Case
The Commentary
Background
Approach to Improving Safety
-
psnet.ahrq.gov/node/39786/psn-pdf
August 25, 2010 - trend-analysis-radiation-therapy-incidents-over-seven-years
Analysis of voluntary error reports indicated a decrease in safety … trend-analysis-radiation-therapy-incidents-over-seven-years
https://psnet.ahrq.gov/primer/reporting-patient-safety-events
-
psnet.ahrq.gov/node/60242/psn-pdf
March 01, 2021 - 1994 and 1996 found that they
received indicated care less than two-thirds of the time for 16 of 40 indicators … In addition, the team performs a home safety evaluation. … what impact the program had on Assessing Care of Vulnerable Elders quality
indicators, which have been … Innovation Patient Safety Focus
The GRACE program provides services to low-income seniors to help ensure … A
review of key quality indicators showed an improvement in falls, depression, medication management
-
psnet.ahrq.gov/node/44131/psn-pdf
May 13, 2015 - -
study-general
A delayed or missed diagnosis of cancer can have profound ramifications for patients … The researchers used a large reliable
dataset for patients with a diagnosis of breast, colorectal, or … The longest
delays for diagnosis occurred after patients had been referred for consultation, indicating … delivering-high-quality-cancer-care-charting-new-course-system-crisis
https://psnet.ahrq.gov/issue/gaps-continuity-care-and-progress-patient-safety … https://psnet.ahrq.gov/primer/ambulatory-care-safety
-
psnet.ahrq.gov/issue/supplemental-item-set-nursing-home-sops-call-pilot-participants
December 24, 2008 - The potential for workplace violence degrades patient and staff safety. … December 18, 2008
AHRQ-Funded Patient Safety Project Highlights: Improving Patient Safety … February 28, 2025
Nursing Home Survey on Patient Safety Culture. … December 20, 2023
Challenge Competition: Impact of Patient Safety Tools. … Safety by Engaging Patients and Families.
-
psnet.ahrq.gov/perspective/reducing-safety-hazards-monitor-alert-and-alarm-fatigue
May 01, 2016 - The recent Joint Commission National Patient Safety Goal on clinical alarm safety highlighted the complexities … Default settings are useful when patients first arrive on a unit; they can act as a safety net by detecting … The Joint Commission announces 2014 National Patient Safety Goal. … Many of those patients are also on cardiac monitors, and there are fewer nurses per patient. … Barbara Drew, RN, PhD
May 1, 2016
Alarm fatigue: impacts on patient safety.
-
psnet.ahrq.gov/issue/unintended-consequences-new-problems-and-new-solutions
June 27, 2018 - Eisenberg Patient Safety and Quality Awards. … April 19, 2017
Patient Safety and Adverse Events. … February 27, 2019
Patient Safety and Adverse Events. … May 3, 2017
The Economics of Patient Safety: Strengthening a Value-based Approach to … December 7, 2016
Special Section on Patient Safety and Quality in Healthcare.
-
psnet.ahrq.gov/issue/safety-issues-combined-gynecologic-and-plastic-surgical-procedures
January 06, 2018 - for these patients. … March 12, 2025
Effects of a team-based assessment and intervention on patient safety … December 1, 2021
Patient safety in the office-based setting. … April 9, 2013
Patient safety in the operating room—part 1 and part 2. … November 21, 2012
Patient safety in plastic surgery.
-
psnet.ahrq.gov/issue/hospital-safety-scores-do-grades-really-matter
September 24, 2017 - This editorial examines whether The Leapfrog Group's Hospital Safety Score accurately directs patients … June 18, 2019
Rapid response teams as a patient safety practice for failure to rescue … April 4, 2011
Optimizing Pediatric Patient Safety in the Emergency Care Setting. … September 26, 2017
Patient-safety–related hospital deaths in England: thematic analysis … Professionals
Safety Scientists
Patients
Hospital Medicine
View More
-
psnet.ahrq.gov/issue/human-factors-and-systems-engineering-approach-patient-safety-radiotherapy
August 07, 2013 - Commentary
Human factors and systems engineering approach to patient safety for radiotherapy … Citation Text:
Human factors and systems engineering approach to patient safety for radiotherapy. … This article describes how systems engineering concepts can be applied to improve patient safety. … 13, 2022
Nursing guidelines for comprehensive harm prevention strategies for adult patients … safety improvements.
-
psnet.ahrq.gov/node/33585/psn-pdf
March 15, 2025 - UC Davis PSNet Editorial Team to ensure that
they reflect current research and practice in the patient … https://psnet.ahrq.gov/primer/radiation-safety
Approximately 40% of patients diagnosed with cancer … This Patient Safety Primer will discuss the
safety issues associated with the use of radiation, both … 20008690
https://psnet.ahrq.gov/primer/systems-approach
https://psnet.ahrq.gov/issue/international-review-patient-safety-measures-radiotherapy-practice … ; cases
of wrong-patient and wrong-site errors have also been reported.
-
psnet.ahrq.gov/issue/quality-and-safety-nursing-competency-approach-improving-outcomes-second-edition
May 13, 2009 - December 5, 2018
Patient Safety, 2nd edition. … May 13, 2015
Improving Usability, Safety and Patient Outcomes With Health Information … December 6, 2017
Medication governance: preventing errors and promoting patient safety … November 5, 2013
Using the ABCs of situational awareness for patient safety. … June 6, 2012
Keeping Patients Safe: Transforming the Work Environment of Nurses.
-
psnet.ahrq.gov/node/33666/psn-pdf
October 01, 2008 - From a patient safety perspective, the single most effective method to avoid the adverse outcomes
associated … Like most patient safety interventions, successful control of MRSA requires a combination of interventions … Certainly, the impact on patient safety is paramount, but there are potential financial implications … Like most
patient safety activities, this requires a comprehensive approach focusing on the system and … Safety of patients isolated for infection control. JAMA.
2003;290:1899-1905.
-
psnet.ahrq.gov/issue/comments-common-formats-event-reporting-hospital-version-03-beta
September 06, 2011 - Patient safety organizations collect data across various systems and states. … safety organizations. … Safety Tools. … September 11, 2023
National Steering Committee for Patient Safety. … June 28, 2018
SOPS Health Information Technology Patient Safety Supplemental Item Set
-
psnet.ahrq.gov/node/866343/psn-pdf
December 31, 2024 - outcomes in patients with non-cardiac conditions.1 However, the
patient in this case presented with … Approaches to Improving Patient Safety
Fluid and volume management
The patient may have benefited from … safety. … Conclusion
Implementing these approaches to improving patient safety may not have changed the outcome … with end-organ injury, and emphasizing patient safety-centered disposition from the ED may help to
-
psnet.ahrq.gov/periodic-issue/periodic-issue-471
December 31, 2024 - January 22, 2025 Weekly Issue
PSNet highlights the latest patient safety literature, news … Maintaining hand hygiene is a critical safety activity for patients, families, and healthcare workers … Commentary
AI: promise or peril for patient safety. … Patients for Patient Safety US (PFPS-US) is a patient- and family-led organization to improve healthcare … safety, equitable healthcare, and patient outcomes.