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  1. Understanding procedural violations using Safety-I and Safety-II: the case of community pharmacies. | PSNet

    psnet.ahrq.gov/issue/understanding-procedural-violations-using-safety-i-and-safety-ii-case-community-pharmacies
    February 06, 2019 - Study Understanding procedural violations using Safety-I and Safety-II: the case of community pharmacies. Citation Text: Jones CEL, Phipps D, Ashcroft DM. Understanding procedural violations using Safety-I and Safety-II: The case of community pharmacies. Saf Sci. 2018;105:114-120. doi:10…

  2. Creating a culture of safety around bar-code medication administration: an evidence-based evaluation framework. | PSNet

    psnet.ahrq.gov/issue/creating-culture-safety-around-bar-code-medication-administration-evidence-based-evaluation
    July 14, 2010 - Commentary Creating a culture of safety around bar-code medication administration: an evidence-based evaluation framework. Citation Text: Kelly K, Harrington L, Matos P, et al. Creating a Culture of Safety Around Bar-Code Medication Administration: An Evidence-Based Evaluation Framework.…

  3. A structured judgement method to enhance mortality case note review: development and evaluation. | PSNet

    psnet.ahrq.gov/issue/structured-judgement-method-enhance-mortality-case-note-review-development-and-evaluation
    May 27, 2011 - Study A structured judgement method to enhance mortality case note review: development and evaluation. Citation Text: Hutchinson A, Coster JE, Cooper KL, et al. A structured judgement method to enhance mortality case note review: development and evaluation. BMJ Qual Saf. 2013;22(12). do…

  4. The effectiveness of integrated health information technologies across the phases of medication management: a systematic review of randomized controlled trials. | PSNet

    psnet.ahrq.gov/issue/effectiveness-integrated-health-information-technologies-across-phases-medication-management
    October 19, 2022 - Review The effectiveness of integrated health information technologies across the phases of medication management: a systematic review of randomized controlled trials. Citation Text: McKibbon A, Lokker C, Handler S, et al. The effectiveness of integrated health information technologies a…

  5. Competencies for patient safety and quality improvement: a synthesis of recommendations in influential position papers. | PSNet

    psnet.ahrq.gov/issue/competencies-patient-safety-and-quality-improvement-synthesis-recommendations-influential
    March 31, 2022 - Review Competencies for patient safety and quality improvement: a synthesis of recommendations in influential position papers. Citation Text: Moran KM, Harris IB, Valenta AL. Competencies for Patient Safety and Quality Improvement: A Synthesis of Recommendations in Influential Position P…

  6. Automated identification of extreme-risk events in clinical incident reports. | PSNet

    psnet.ahrq.gov/issue/automated-identification-extreme-risk-events-clinical-incident-reports
    November 03, 2015 - Study Automated identification of extreme-risk events in clinical incident reports. Citation Text: Ong M-S, Magrabi F, Coiera E. Automated identification of extreme-risk events in clinical incident reports. J Am Med Inform Assoc. 2012;19(e1):e110-8. Copy Citation Format: Go…

  7. Handoff practices in emergency medicine: are we making progress? | PSNet

    psnet.ahrq.gov/issue/handoff-practices-emergency-medicine-are-we-making-progress
    September 23, 2020 - Study Handoff practices in emergency medicine: are we making progress? Citation Text: Hern G, Gallahue FE, Burns BD, et al. Handoff Practices in Emergency Medicine: Are We Making Progress? Acad Emerg Med. 2016;23(2):197-201. doi:10.1111/acem.12867. Copy Citation Format: DOI…

  8. Safety culture and care: a program to prevent surgical errors. | PSNet

    psnet.ahrq.gov/issue/safety-culture-and-care-program-prevent-surgical-errors
    March 25, 2020 - Commentary Safety culture and care: a program to prevent surgical errors. Citation Text: Hemingway MW, O'Malley C, Silvestri S. Safety culture and care: a program to prevent surgical errors. AORN J. 2015;101(4):404-12; quiz 413-5. doi:10.1016/j.aorn.2015.01.002. Copy Citation Forma…

  9. Predictors of treatment error for children with uncomplicated malaria seen as outpatients in Blantyre district, Malawi. | PSNet

    psnet.ahrq.gov/issue/predictors-treatment-error-children-uncomplicated-malaria-seen-outpatients-blantyre-district
    May 18, 2022 - Study Predictors of treatment error for children with uncomplicated malaria seen as outpatients in Blantyre district, Malawi. Citation Text: Osterholt DM, Rowe AK, Hamel MJ, et al. Predictors of treatment error for children with uncomplicated malaria seen as outpatients in Blantyre dis…

  10. Exploring how nursing schools handle student errors and near misses. | PSNet

    psnet.ahrq.gov/issue/exploring-how-nursing-schools-handle-student-errors-and-near-misses
    May 28, 2014 - Study Exploring how nursing schools handle student errors and near misses. Citation Text: Disch J, Barnsteiner J, Connor S, et al. CE: Original Research: Exploring How Nursing Schools Handle Student Errors and Near Misses. Am J Nurs. 2017;117(10):24-31. doi:10.1097/01.NAJ.0000525849.3553…

  11. Anticoagulation-associated adverse drug events. | PSNet

    psnet.ahrq.gov/issue/anticoagulation-associated-adverse-drug-events
    July 26, 2023 - Study Anticoagulation-associated adverse drug events. Citation Text: Piazza G, Nguyen TN, Cios D, et al. Anticoagulation-associated Adverse Drug Events. Am J Med. 2011;124(12). doi:10.1016/j.amjmed.2011.06.009. Copy Citation Format: DOI Google Scholar BibTeX EndNote X3 XM…

  12. Critical incidents related to cardiac arrests reported to the Danish Patient Safety Database. | PSNet

    psnet.ahrq.gov/issue/critical-incidents-related-cardiac-arrests-reported-danish-patient-safety-database
    February 18, 2015 - Study Critical incidents related to cardiac arrests reported to the Danish Patient Safety Database. Citation Text: Andersen PO, Maaløe R, Andersen HB. Critical incidents related to cardiac arrests reported to the Danish Patient Safety Database. Resuscitation. 2010;81(3):312-316. doi:10.…

  13. Simulation-based education to ensure provider competency within the healthcare system. | PSNet

    psnet.ahrq.gov/issue/simulation-based-education-ensure-provider-competency-within-healthcare-system
    May 02, 2018 - Commentary Simulation-based education to ensure provider competency within the healthcare system. Citation Text: Griswold S, Fralliccardi A, Boulet J, et al. Simulation-based Education to Ensure Provider Competency Within the Health Care System. Acad Emerg Med. 2018;25(2):168-176. doi:10…

  14. Lost, mislabeled, and mishandled surgical and clinical pathology specimens: a systematic review of published literature. | PSNet

    psnet.ahrq.gov/issue/lost-mislabeled-and-mishandled-surgical-and-clinical-pathology-specimens-systematic-review
    September 23, 2020 - Review Lost, mislabeled, and mishandled surgical and clinical pathology specimens: a systematic review of published literature. Citation Text: Carmack HJ, Lazenby BS, Wilson KJ, et al. Lost, mislabeled, and mishandled surgical and clinical pathology specimens: a systematic review of publ…

  15. Reflection and analysis of how pharmacy students learn to communicate about medication errors. | PSNet

    psnet.ahrq.gov/issue/reflection-and-analysis-how-pharmacy-students-learn-communicate-about-medication-errors
    April 12, 2011 - Study Reflection and analysis of how pharmacy students learn to communicate about medication errors. Citation Text: Noland CM, Rickles NM. Reflection and analysis of how pharmacy students learn to communicate about medication errors. Health Commun. 2009;24(4):351-60. doi:10.1080/104102…

  16. The impact of major intraoperative adverse events on hospital readmissions. | PSNet

    psnet.ahrq.gov/issue/impact-major-intraoperative-adverse-events-hospital-readmissions
    July 01, 2017 - Study The impact of major intraoperative adverse events on hospital readmissions. Citation Text: Nandan AR, Bohnen JD, Chang DC, et al. The impact of major intraoperative adverse events on hospital readmissions. Am J Surg. 2017;213(1):10-17. doi:10.1016/j.amjsurg.2016.03.018. Copy Cita…

  17. Using performance improvement to enhance time-out compliance and prevent wrong-site surgery. | PSNet

    psnet.ahrq.gov/issue/using-performance-improvement-enhance-time-out-compliance-and-prevent-wrong-site-surgery
    October 06, 2021 - Commentary Using performance improvement to enhance time-out compliance and prevent wrong-site surgery. Citation Text: Vance ME, Proctor T, Schmidt KA. Using performance improvement to enhance time-out compliance and prevent wrong-site surgery. AORN J. 2021;113(6):635-642. doi:10.1002/ao…

  18. From battles to burnout: investigating the role of interphysician conflict in physician burnout. | PSNet

    psnet.ahrq.gov/issue/battles-burnout-investigating-role-interphysician-conflict-physician-burnout
    August 23, 2023 - Study From battles to burnout: investigating the role of interphysician conflict in physician burnout. Citation Text: Amick AE, Schrepel C, Bann M, et al. From battles to burnout: investigating the role of interphysician conflict in physician burnout. Acad Med. 2023;98(9):1076-1082. doi:…

  19. The effect of medication reconciliation in elderly patients at hospital discharge. | PSNet

    psnet.ahrq.gov/issue/effect-medication-reconciliation-elderly-patients-hospital-discharge
    February 04, 2009 - Study The effect of medication reconciliation in elderly patients at hospital discharge. Citation Text: Midlöv P, Bahrani L, Seyfali M, et al. The effect of medication reconciliation in elderly patients at hospital discharge. Int J Clin Pharm. 2012;34(1):113-9. doi:10.1007/s11096-011-9…

  20. The compliance with a patient safety bundle for management of placenta accreta spectrum. | PSNet

    psnet.ahrq.gov/issue/compliance-patient-safety-bundle-management-placenta-accreta-spectrum
    October 19, 2022 - Study The compliance with a patient safety bundle for management of placenta accreta spectrum. Citation Text: Quist-Nelson J, Crank A, Oliver EA, et al. The compliance with a patient-safety bundle for management of placenta accreta spectrum†. J Matern Fetal Neonatal Med. 2021;34(17):2880…
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