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psnet.ahrq.gov/node/844988/psn-pdf
February 22, 2023 - Assessment of patient retention of inpatient care
information post-hospitalization.
February 22, 2023
Townshend R, Grondin C, Gupta A, et al. Assessment of patient retention of inpatient care information
post-hospitalization. Jt Comm J Qual Patient Saf. 2023;49(2):70-78. doi:10.1016/j.jcjq.2022.11.002.
https://psn…
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psnet.ahrq.gov/node/45266/psn-pdf
January 01, 2020 - Learning from lawsuits: using malpractice claims data to
develop care transitions planning tools.
August 31, 2016
Arbaje AI, Werner NE, Kasda EM, et al. Learning From Lawsuits: Using Malpractice Claims Data to
Develop Care Transitions Planning Tools. J Patient Saf. 2020;16(1):52-57.
doi:10.1097/pts.000000000000023…
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psnet.ahrq.gov/node/61118/psn-pdf
January 01, 2021 - Bracing for the storm: one health care system's planning
for the COVID-19 surge.
November 11, 2020
Kim CS, Meo N, Little D, et al. Bracing for the storm: one health care system's planning for the COVID-19
surge. Jt Comm J Qual Patient Saf. 2021;47(1):60-68. doi:10.1016/j.jcjq.2020.09.007.
https://psnet.ahrq.gov/is…
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psnet.ahrq.gov/issue/rates-serious-surgical-errors-california-and-plans-prevent-recurrence
March 09, 2022 - Study
Rates of serious surgical errors in California and plans to prevent recurrence.
Citation Text:
Cohen AJ, Lui H, Zheng M, et al. Rates of serious surgical errors in California and plans to prevent recurrence. JAMA Netw Open. 2021;4(5):e217058. doi:10.1001/jamanetworkopen.2021.7058. …
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psnet.ahrq.gov/node/841467/psn-pdf
December 14, 2022 - A framework for assessing reasoning about controversial
end-of-life clinical decisions.
December 14, 2022
Fedyk M, Fairman N, Romano PS, et al. A framework for assessing reasoning about controversial end-of-
life clinical decisions. PSNet [internet]. 2022.
https://psnet.ahrq.gov/web-mm/framework-assessing-reasonin…
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psnet.ahrq.gov/node/50447/psn-pdf
October 09, 2019 - Patient safety incidents in advance care planning for
serious illness: a mixed-methods analysis
October 9, 2019
Dinnen T, Williams H, Yardley S, et al. Patient safety incidents in advance care planning for serious illness:
a mixed-methods analysis. BMJ Support Palliat Care. 2019. doi:10.1136/bmjspcare-2019-001824.
…
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psnet.ahrq.gov/issue/solicitation-written-comments-draft-national-action-plan-adverse-drug-event-prevention
October 21, 2016 - Government Resource
Solicitation for written comments on draft National Action Plan for Adverse Drug Event Prevention.
Citation Text:
Solicitation for written comments on draft National Action Plan for Adverse Drug Event Prevention. Federal Register. Washington, DC: Office of Disease…
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psnet.ahrq.gov/node/60167/psn-pdf
April 12, 2024 - Discharge Planning and Transitions of Care
March 25, 2020
Bajorek SA, McElroy V. Discharge Planning and Transitions of Care. PSNet [internet]. 2020.
https://psnet.ahrq.gov/primer/discharge-planning-and-transitions-care
Background
Transitions of care refer to the movement of patients between different healthcare se…
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psnet.ahrq.gov/node/836841/psn-pdf
June 01, 2020 - uses a unique staffing structure consisting of APRNs partnered with paramedics to provide ad hoc
and planned
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psnet.ahrq.gov/node/50949/psn-pdf
February 26, 2020 - pre-analytical-pitfalls-missing-and-mislabeled-specimens
The Case
Case #1:
A 56-year-old man was admitted to the same-day surgery center for a planned
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psnet.ahrq.gov/web-mm/navigating-complications-unintended-journey-guidewire-during-dialysis-catheter-placement
February 23, 2022 - two guidewires were used, either because initial attempts to thread the catheter failed or because of planned
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psnet.ahrq.gov/web-mm/when-taking-sglt2-inhibitor-remember-sstop-stop-sglt2-inhibitor-three-days-bef-o-re
February 01, 2023 - guidelines should consider the patient's medical history, the type of surgery being performed, and the planned
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psnet.ahrq.gov/web-mm/nurse-staffing-ratios-crucible-money-policy-research-and-patient-care
June 01, 2003 - The budgeted staffing ratios must be planned with staff nurse input and support, and their decision making
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psnet.ahrq.gov/node/849592/psn-pdf
May 31, 2023 - Preventing Falls Through Patient and Family Engagement
to Create Customized Prevention Plans
May 31, 2023
https://psnet.ahrq.gov/innovation/preventing-falls-through-patient-and-family-engagement-create-
customized-prevention
Summary
Patient falls in hospitals are common and debilitating adverse events that persis…
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psnet.ahrq.gov/issue/promoting-medication-safety-older-adults-upon-hospital-discharge-guiding-principles
July 31, 2019 - Study
Promoting medication safety for older adults upon hospital discharge: guiding principles for a medication discharge plan.
Citation Text:
Zhang FH, Lauzon J, Payette J, et al. Promoting medication safety for older adults upon hospital discharge: guiding principles for a medication d…
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psnet.ahrq.gov/issue/advancing-medication-safety-establishing-national-action-plan-adverse-drug-event-prevention
September 29, 2017 - Commentary
Advancing medication safety: establishing a National Action Plan for Adverse Drug Event Prevention.
Citation Text:
Harris Y, Hu DJ, Lee C, et al. Advancing Medication Safety: Establishing a National Action Plan for Adverse Drug Event Prevention. Jt Comm J Qual Patient Saf. 201…
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psnet.ahrq.gov/node/60929/psn-pdf
September 16, 2020 - Safer Together: A National Action Plan to Advance Patient
Safety.
September 16, 2020
Boston, MA: Institute for Healthcare Improvement: September 2020.
https://psnet.ahrq.gov/issue/national-action-plan-advance-patient-safety
This National Action Plan developed by the National Steering Committee for Pati…
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psnet.ahrq.gov/node/49777/psn-pdf
December 01, 2016 - ensure their safety by asking patients to promise that they
won't self-harm and will follow up as planned
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psnet.ahrq.gov/node/74102/psn-pdf
January 01, 2022 - Workforce planning and safe workload in sterile
compounding hospital pharmacy services.
November 24, 2021
Chaker A, Omair I, Mohamed WH, et al. Workforce planning and safe workload in sterile compounding
hospital pharmacy services. Am J Health Syst Pharm. 2022;79(3):187–192. doi:10.1093/ajhp/zxab379.
https://psnet…
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psnet.ahrq.gov/issue/failure-engage-hospitalized-elderly-patients-and-their-families-advance-care-planning
November 21, 2016 - Study
Classic
Failure to engage hospitalized elderly patients and their families in advance care planning.
Citation Text:
Heyland DK, Barwich D, Pichora D, et al. Failure to engage hospitalized elderly patients and their families in advance care planning. JAMA I…