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  1. It is time to define antimicrobial never events. | PSNet

    psnet.ahrq.gov/issue/it-time-define-antimicrobial-never-events
    November 16, 2022 - Commentary It is time to define antimicrobial never events. Citation Text: Liu J, Kaye KS, Mercuro NJ, et al. It is time to define antimicrobial never events. Infect Control Hosp Epidemiol. 2019;40(2):206-207. doi:10.1017/ice.2018.313. Copy Citation Format: DOI Google Schol…

  2. Label design affects medication safety in an operating room crisis: a controlled simulation study. | PSNet

    psnet.ahrq.gov/issue/label-design-affects-medication-safety-operating-room-crisis-controlled-simulation-study
    April 24, 2018 - Study Label design affects medication safety in an operating room crisis: a controlled simulation study. Citation Text: Estock JL, Murray AW, Mizah MT, et al. Label Design Affects Medication Safety in an Operating Room Crisis: A Controlled Simulation Study. J Patient Saf. 2018;14(2):101-…

  3. Self-reported adverse events in health care that cause harm: a population-based survey. | PSNet

    psnet.ahrq.gov/issue/self-reported-adverse-events-health-care-cause-harm-population-based-survey
    September 20, 2011 - Study Self-reported adverse events in health care that cause harm: a population-based survey. Citation Text: Adams RJ, Tucker G, Price K, et al. Self-reported adverse events in health care that cause harm: a population-based survey. Med J Aust. 2009;190(9):484-8. Copy Citation Fo…

  4. Hospital safety scores: do grades really matter? | PSNet

    psnet.ahrq.gov/issue/hospital-safety-scores-do-grades-really-matter
    September 24, 2017 - Study Hospital safety scores: do grades really matter? Citation Text: Gonzalez AA, Ghaferi AA. Hospital Safety Scores: do grades really matter? JAMA Surg. 2014;149(5):413-4. Copy Citation Format: Google Scholar PubMed BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged PubMe…

  5. Task uncertainty and communication during nursing shift handovers. | PSNet

    psnet.ahrq.gov/issue/task-uncertainty-and-communication-during-nursing-shift-handovers
    August 20, 2018 - Study Task uncertainty and communication during nursing shift handovers. Citation Text: Mayor E, Bangerter A, Aribot M. Task uncertainty and communication during nursing shift handovers. J Adv Nurs. 2012;68(9):1956-66. doi:10.1111/j.1365-2648.2011.05880.x. Copy Citation Format: …

  6. Errors in the administration of intravenous medication in Brazilian hospitals. | PSNet

    psnet.ahrq.gov/issue/errors-administration-intravenous-medication-brazilian-hospitals
    October 05, 2022 - Study Errors in the administration of intravenous medication in Brazilian hospitals. Citation Text: Anselmi ML, Peduzzi M, dos Santos CB. Errors in the administration of intravenous medication in Brazilian hospitals. J Clin Nurs. 2007;16(10). doi:10.1111/j.1365-2702.2007.01834.x. Cop…

  7. Error in body weight estimation leads to inadequate parenteral anticoagulation. | PSNet

    psnet.ahrq.gov/issue/error-body-weight-estimation-leads-inadequate-parenteral-anticoagulation
    April 14, 2021 - Study Error in body weight estimation leads to inadequate parenteral anticoagulation. Citation Text: Macedo LG dos R, de Oliveira L, Pintão MC, et al. Error in body weight estimation leads to inadequate parenteral anticoagulation. Am J Emerg Med. 2011;29(6):613-7. doi:10.1016/j.ajem.20…

  8. EMS helicopter crashes: what influences fatal outcome? | PSNet

    psnet.ahrq.gov/issue/ems-helicopter-crashes-what-influences-fatal-outcome
    September 23, 2020 - Study EMS helicopter crashes: what influences fatal outcome? Citation Text: Baker SP, Grabowski JG, Dodd RS, et al. EMS helicopter crashes: what influences fatal outcome? Ann Emerg Med. 2006;47(4):351-356. Copy Citation Format: Google Scholar PubMed BibTeX EndNote X3 XML …

  9. Bar-code verification: reducing but not eliminating medication errors. | PSNet

    psnet.ahrq.gov/issue/bar-code-verification-reducing-not-eliminating-medication-errors
    September 27, 2016 - Study Bar-code verification: reducing but not eliminating medication errors. Citation Text: Henneman PL, Marquard J, Fisher DL, et al. Bar-code verification: reducing but not eliminating medication errors. J Nurs Adm. 2012;42(12):562-6. doi:10.1097/NNA.0b013e318274b545. Copy Citation…

  10. An inpatient fall prevention initiative in a tertiary care hospital. | PSNet

    psnet.ahrq.gov/issue/inpatient-fall-prevention-initiative-tertiary-care-hospital
    October 19, 2022 - Study An inpatient fall prevention initiative in a tertiary care hospital. Citation Text: Weinberg J, Proske D, Szerszen A, et al. An inpatient fall prevention initiative in a tertiary care hospital. Jt Comm J Qual Patient Saf. 2011;37(7):317-325. Copy Citation Format: Go…

  11. Latency of ECG displays of hospital telemetry systems: a science advisory from the American Heart Association. | PSNet

    psnet.ahrq.gov/issue/latency-ecg-displays-hospital-telemetry-systems-science-advisory-american-heart-association
    March 14, 2018 - Commentary Latency of ECG displays of hospital telemetry systems: a science advisory from the American Heart Association. Citation Text: Turakhia MP, Estes NAM, Drew BJ, et al. Latency of ECG displays of hospital telemetry systems: a science advisory from the American Heart Association.…

  12. The Schwartz Center Rounds: evaluation of an interdisciplinary approach to enhancing patient-centered communication, teamwork, and provider support. | PSNet

    psnet.ahrq.gov/issue/schwartz-center-rounds-evaluation-interdisciplinary-approach-enhancing-patient-centered
    October 14, 2020 - Study The Schwartz Center Rounds: evaluation of an interdisciplinary approach to enhancing patient-centered communication, teamwork, and provider support. Citation Text: Lown BA, Manning CF. The Schwartz Center Rounds: evaluation of an interdisciplinary approach to enhancing patient-ce…

  13. Near-miss medication errors provide a wake-up call. | PSNet

    psnet.ahrq.gov/issue/near-miss-medication-errors-provide-wake-call
    January 24, 2024 - Commentary Near-miss medication errors provide a wake-up call. Citation Text: Claffey C. Near-miss medication errors provide a wake-up call. Nursing (Brux). 2018;48(1):53-55. doi:10.1097/01.NURSE.0000527615.45031.9e. Copy Citation Format: DOI Google Scholar PubMed BibTeX En…

  14. Dental patient safety in the military health system: joining medicine in the journey to high reliability. | PSNet

    psnet.ahrq.gov/issue/dental-patient-safety-military-health-system-joining-medicine-journey-high-reliability
    October 19, 2022 - Study Dental patient safety in the military health system: joining medicine in the journey to high reliability. Citation Text: Stahl JM, Mack K, Cebula S, et al. Dental Patient Safety in the Military Health System: Joining Medicine in the Journey to High Reliability. Mil Med. 2019. doi:1…

  15. Chemotherapy safety and severe adverse events in cancer patients: strategies to efficiently avoid chemotherapy errors in in- and outpatient treatment. | PSNet

    psnet.ahrq.gov/issue/chemotherapy-safety-and-severe-adverse-events-cancer-patients-strategies-efficiently-avoid
    May 31, 2017 - Study Chemotherapy safety and severe adverse events in cancer patients: strategies to efficiently avoid chemotherapy errors in in- and outpatient treatment. Citation Text: Markert A, Thierry V, Kleber M, et al. Chemotherapy safety and severe adverse events in cancer patients: Strategi…

  16. Measures and measurement of high-performance work systems in health care settings: propositions for improvement. | PSNet

    psnet.ahrq.gov/issue/measures-and-measurement-high-performance-work-systems-health-care-settings-propositions
    December 21, 2017 - Commentary Measures and measurement of high-performance work systems in health care settings: propositions for improvement. Citation Text: Etchegaray J, St John C, Thomas EJ. Measures and measurement of high-performance work systems in health care settings: Propositions for improvement…

  17. Addressing delays in medication administration for patients transferred from the hospital to the nursing home: a pilot quality improvement project. | PSNet

    psnet.ahrq.gov/issue/addressing-delays-medication-administration-patients-transferred-hospital-nursing-home-pilot
    November 16, 2022 - Study Addressing delays in medication administration for patients transferred from the hospital to the nursing home: a pilot quality improvement project. Citation Text: Ward KT, Bates-Jensen B, Eslami MS, et al. Addressing delays in medication administration for patients transferred …

  18. Preventing medication errors in community pharmacy: root-cause analysis of transcription errors. | PSNet

    psnet.ahrq.gov/issue/preventing-medication-errors-community-pharmacy-root-cause-analysis-transcription-errors
    March 24, 2011 - Study Preventing medication errors in community pharmacy: root-cause analysis of transcription errors. Citation Text: Knudsen P, Herborg H, Mortensen AR, et al. Preventing medication errors in community pharmacy: root-cause analysis of transcription errors. Qual Saf Health Care. 2007;1…

  19. Anatomy and pathophysiology of errors occurring in clinical radiology practice. | PSNet

    psnet.ahrq.gov/issue/anatomy-and-pathophysiology-errors-occurring-clinical-radiology-practice
    February 01, 2011 - Commentary Anatomy and pathophysiology of errors occurring in clinical radiology practice. Citation Text: Brook OR, O'Connell AM, Thornton E, et al. Quality initiatives: anatomy and pathophysiology of errors occurring in clinical radiology practice. Radiographics. 2010;30(5):1401-10. d…

  20. Accident prevention in day-to-day clinical radiation therapy practice. | PSNet

    psnet.ahrq.gov/issue/accident-prevention-day-day-clinical-radiation-therapy-practice
    February 07, 2018 - Commentary Accident prevention in day-to-day clinical radiation therapy practice. Citation Text: Baeza M. Accident prevention in day-to-day clinical radiation therapy practice. Ann ICRP. 2012;41(3-4):179-87. doi:10.1016/j.icrp.2012.06.001. Copy Citation Format: DOI Google…
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