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psnet.ahrq.gov/issue/reducing-risk-and-promoting-patient-safety-nih-intramural-clinical-research-draft-report
November 18, 2020 - Book/Report
Reducing Risk and Promoting Patient Safety for NIH Intramural Clinical Research—Final Report.
Citation Text:
Reducing Risk and Promoting Patient Safety for NIH Intramural Clinical Research—Final Report. The Clinical Center Working Group Report to the Advisory Committee to the…
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psnet.ahrq.gov/issue/application-iv-medication-harm-index-assess-nature-harm-averted-smart-infusion-safety-systems
January 23, 2017 - Study
Application of the IV Medication Harm Index to assess the nature of harm averted by "smart" infusion safety systems.
Citation Text:
Williams CK, Maddox RR, Heape E, et al. Application of the IV Medication Harm Index to Assess the Nature of Harm Averted by "Smart" Infusion Safety …
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psnet.ahrq.gov/issue/research-improve-diagnosis-time-study-real-world
February 12, 2020 - Commentary
Research to improve diagnosis: time to study the real world.
Citation Text:
Ranji SR, Thomas EJ. Research to improve diagnosis: time to study the real world. BMJ Qual Saf. 2022;31(4):255-258. doi:10.1136/bmjqs-2021-014071.
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psnet.ahrq.gov/issue/impact-interruptions-distractions-and-cognitive-load-procedure-failures-and-medication
March 02, 2012 - Study
Impact of interruptions, distractions, and cognitive load on procedure failures and medication administration errors.
Citation Text:
Thomas L, Donohue-Porter P, Fishbein JS. Impact of Interruptions, Distractions, and Cognitive Load on Procedure Failures and Medication Administratio…
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psnet.ahrq.gov/issue/measurement-performance-driver-case-national-measurement-system-improve-patient-safety
September 01, 2018 - Review
Measurement as a performance driver: the case for a national measurement system to improve patient safety.
Citation Text:
Krause TR, Bell KJ, Pronovost P, et al. Measurement as a Performance Driver: The Case for a National Measurement System to Improve Patient Safety. J Patient Sa…
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psnet.ahrq.gov/issue/patient-safety-adoption-framework-practical-framework-bridge-know-do-gap
May 26, 2021 - Commentary
The Patient Safety Adoption Framework: a practical framework to bridge the know-do gap.
Citation Text:
The Patient Safety Adoption Framework: a practical framework to bridge the know-do gap. Moyal-Smith R, Margo J, Maloney FL, et al. J Patient Saf. 2023;19(4):243-248.
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psnet.ahrq.gov/issue/selecting-indicators-patient-safety-health-system-level-oecd-countries
June 28, 2011 - Study
Selecting indicators for patient safety at the health system level in OECD countries.
Citation Text:
McLoughlin V, Millar J, Mattke S, et al. Selecting indicators for patient safety at the health system level in OECD countries. Int J Qual Health Care. 2006;18 Suppl 1:14-20.
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psnet.ahrq.gov/issue/safe-administration-medication-school-policy-statement
May 31, 2023 - Organizational Policy/Guidelines
Safe Administration of Medication in School: Policy Statement.
Citation Text:
Miotto MB, Balchan B, Combe L, et al. Safe Administration of Medication in School: Policy Statement. Pediatrics. 2024;153(6):2024066839. doi:10.1542/peds.2024-066839.
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psnet.ahrq.gov/issue/computerised-provider-order-entry-and-residency-education-academic-medical-centre
June 09, 2015 - Study
Computerised provider order entry and residency education in an academic medical centre.
Citation Text:
Wong BM, Kuper A, Robinson N, et al. Computerised provider order entry and residency education in an academic medical centre. Med Educ. 2012;46(8):795-806. doi:10.1111/j.1365-2…
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psnet.ahrq.gov/issue/costs-adverse-drug-events-community-hospitals
February 18, 2011 - Study
The costs of adverse drug events in community hospitals.
Citation Text:
Hug BL, Keohane C, Seger DL, et al. The costs of adverse drug events in community hospitals. Jt Comm J Qual Patient Saf. 2012;38(3):120-6.
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psnet.ahrq.gov/issue/economic-evaluation-patient-safety-literature-review-methods
March 05, 2025 - Review
Economic evaluation in patient safety: a literature review of methods.
Citation Text:
de Rezende BA, Or Z, Com-Ruelle L, et al. Economic evaluation in patient safety: a literature review of methods. BMJ Qual Saf. 2012;21(6):457-65. doi:10.1136/bmjqs-2011-000191.
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psnet.ahrq.gov/issue/communication-training-adverse-events-and-quality-measures-2-retrospective-database-analyses
August 04, 2021 - Study
Communication training, adverse events, and quality measures: 2 retrospective database analyses in Washington State hospitals.
Citation Text:
Slade IR, Beck SJ, Kramer B, et al. Communication Training, Adverse Events, and Quality Measures: 2 Retrospective Database Analyses in Washi…
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psnet.ahrq.gov/issue/communication-discrepancies-between-physicians-and-hospitalized-patients
October 12, 2022 - Study
Classic
Communication discrepancies between physicians and hospitalized patients.
Citation Text:
Olson DP, Windish DM. Communication discrepancies between physicians and hospitalized patients. Arch Intern Med. 2010;170(15):1302-1307. doi:10.1001/archintern…
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psnet.ahrq.gov/issue/rapid-response-systems-systematic-review-and-meta-analysis
January 29, 2018 - Review
Rapid response systems: a systematic review and meta-analysis.
Citation Text:
Maharaj R, Raffaele I, Wendon J. Rapid response systems: a systematic review and meta-analysis. Crit Care. 2015;19(1). doi:10.1186/s13054-015-0973-y.
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psnet.ahrq.gov/issue/development-patient-safety-measures-identify-inappropriate-diagnosis-common-infections
April 10, 2024 - Study
Development of patient safety measures to identify inappropriate diagnosis of common infections.
Citation Text:
White AT, Vaughn VM, Petty LA, et al. Development of patient safety measures to identify inappropriate diagnosis of common infections. Clin Infect Dis. 2024;78(6):1403-14…
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psnet.ahrq.gov/issue/evidence-based-toolkit-development-effective-and-sustainable-root-cause-analysis-system
June 01, 2019 - Study
An evidence-based toolkit for the development of effective and sustainable root cause analysis system safety solutions.
Citation Text:
Hettinger Z, Fairbanks RJ, Hegde S, et al. An evidence-based toolkit for the development of effective and sustainable root cause analysis syste…
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psnet.ahrq.gov/issue/teamstepps-long-term-care-academic-partnership-part-1-and-part-2
July 05, 2017 - Commentary
TeamSTEPPS in long-term care- an academic partnership: part 1 and part 2.
Citation Text:
Roman TC, Abraham K, Dever K. TeamSTEPPS in Long-Term Care-An Academic Partnership: Part I. J Contin Educ Nurs. 2016;47(11):490-492. doi:10.3928/00220124-20161017-06.
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psnet.ahrq.gov/issue/stop-line-interventions-prevent-retained-surgical-items
July 10, 2024 - Commentary
Stop the line: interventions to prevent retained surgical items.
Citation Text:
Angelilli S. Stop the line: interventions to prevent retained surgical items. AORN J. 2024;120(2):71-81. doi:10.1002/aorn.14190.
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psnet.ahrq.gov/issue/framing-family-conversation-after-early-diagnosis-iatrogenic-injury-and-incidental-findings
November 14, 2011 - Study
Framing family conversation after early diagnosis of iatrogenic injury and incidental findings.
Citation Text:
Barrios L, Tsuda S, Derevianko A, et al. Framing family conversation after early diagnosis of iatrogenic injury and incidental findings. Surg Endosc. 2009;23(11):2535-42…
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psnet.ahrq.gov/issue/safer-healthcare-home-detecting-correcting-and-learning-incidents-involving-infusion-devices
October 18, 2018 - Study
Safer healthcare at home: detecting, correcting and learning from incidents involving infusion devices.
Citation Text:
Lyons I, Blandford A. Safer healthcare at home: detecting, correcting and learning from incidents involving infusion devices. App Ergon. 2018;67(Feb):104-114. doi:…