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Psn-Pdf (pdf file)
psnet.ahrq.gov/node/43459/psn-pdfAugust 27, 2014 - Serious Reportable Events. August 27, 2014 Nova Scotia Department of Health and Wellness. https://psnet.ahrq.gov/issue/serious-reportable-events Incident reporting systems are an important method for capturing, analyzing, and learning about a broad range of potential safety issues. This Web site provides access to… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/38747/psn-pdfSeptember 16, 2009 - Examination of how a survey can spur culture changes using a quality improvement approach: a region-wide approach to determining a patient safety culture. September 16, 2009 Pringle J, Weber RJ, Rice K, et al. Examination of how a survey can spur culture changes using a quality improvement approach: a region-wide … -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/844793/psn-pdfSeptember 11, 2019 - PC standards for maternal safety. September 11, 2019 The Joint Commission. R3 Report. August 21, 2019;24:1-6. https://psnet.ahrq.gov/issue/pc-standards-maternal-safety Maternal safety in the United States is gaining momentum as a system-level patient safety concern. This report reviews the new Joint Commission Pro… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/840163/psn-pdfNovember 16, 2022 - Deep Dive: Racial and Ethnic Disparities in Health and Healthcare. November 16, 2022 Plymouth Meeting, PA: ECRI and the Institute for Safe Medication Practices; 2022. https://psnet.ahrq.gov/issue/deep-dive-racial-and-ethnic-disparities-health-and-healthcare Racist behavior directed at either patients or clinicians… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/47544/psn-pdfDecember 12, 2018 - Using good catches to promote a just culture and perioperative patient safety. December 12, 2018 Monahan JJ. Using Good Catches to Promote a Just Culture and Perioperative Patient Safety. AORN J. 2018;108(5):548-552. doi:10.1002/aorn.12394. https://psnet.ahrq.gov/issue/using-good-catches-promote-just-culture-and-p… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/60963/psn-pdfSeptember 30, 2020 - Organisation and characteristics of out-of-hours primary care during a COVID-19 outbreak: a real-time observational study. September 30, 2020 Morreel S, Philips H, Verhoeven V. Organisation and characteristics of out-of-hours primary care during a COVID-19 outbreak: a real-time observational study. PLoS One. 2020;… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/43284/psn-pdfNovember 28, 2016 - Parental involvement in the preoperative surgical safety checklist is welcomed by both parents and staff. November 28, 2016 Corbally MT, Tierney E. Parental involvement in the preoperative surgical safety checklist is welcomed by both parents and staff. Int J Pediatr. 2014;2014:791490. doi:10.1155/2014/791490. htt… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/44265/psn-pdfJanuary 22, 2016 - How surgical trainees handle catastrophic errors: a qualitative study. January 22, 2016 Balogun JA, Bramall AN, Bernstein M. How Surgical Trainees Handle Catastrophic Errors: A Qualitative Study. J Surg Educ. 2015;72(6):1179-84. doi:10.1016/j.jsurg.2015.05.003. https://psnet.ahrq.gov/issue/how-surgical-trainees-ha… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/38735/psn-pdfJune 24, 2009 - Reflection and analysis of how pharmacy students learn to communicate about medication errors. June 24, 2009 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:10.1080/10410230902889399. https://psnet.ahrq.gov/… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/838025/psn-pdfSeptember 07, 2022 - Opportunities to mine EHRs for malpractice risk management and patient safety. September 7, 2022 Adler-Milstein J, Sarkar U, Wachter RM. Opportunities to mine EHRs for malpractice risk management and patient safety. J Patient Saf Risk Manag. 2022;27(4):160-162. doi:10.1177/25160435221097422. https://psnet.ahrq.gov… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/47804/psn-pdfJune 12, 2019 - Pediatric faculty knowledge and comfort discussing diagnostic errors: a pilot survey to understand barriers to an educational program. June 12, 2019 Grubenhoff JA, Ziniel SI, Bajaj L, et al. Pediatric faculty knowledge and comfort discussing diagnostic errors: a pilot survey to understand barriers to an educationa… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/60797/psn-pdfAugust 12, 2020 - Nonoperating room anaesthesia: safety, monitoring, cognitive aids and severe acute respiratory syndrome coronavirus 2. August 12, 2020 Borshoff DC, Sadleir P. Nonoperating room anaesthesia: safety, monitoring, cognitive aids and severe acute respiratory syndrome coronavirus 2. Curr Opin Anaesthesiol. 2020;33(4):55… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/34800/psn-pdfDecember 23, 2008 - A classification system for incidents and accidents in the health-care system. December 23, 2008 Runciman WB, Helps SC, Sexton EJ, et al. A classification for incidents and accidents in the health-care system. J Qual Clin Pract. 1998;18(3):199-211. https://psnet.ahrq.gov/issue/classification-system-incidents-and-a… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/47074/psn-pdfAugust 22, 2018 - Influences on the adoption of patient safety innovation in primary care: a qualitative exploration of staff perspectives. August 22, 2018 Litchfield I, Gill P, Avery T, et al. Influences on the adoption of patient safety innovation in primary care: a qualitative exploration of staff perspectives. BMC Fam Pract. 20… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/48005/psn-pdfMay 08, 2019 - Why your doctor's white coat can be a threat to your health. May 8, 2019 Haun N, Hooper-Lane C, Safdar N. Healthcare Personnel Attire and Devices as Fomites: A Systematic Review. Infect Control Hosp Epidemiol. 2016;37(11):1367-1373. https://psnet.ahrq.gov/issue/why-your-doctors-white-coat-can-be-threat-your-health… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/46298/psn-pdfOctober 18, 2017 - CVS taps a design legend to reinvent the prescription label. Next stop: the pharmacy. October 18, 2017 Kuang C. Fast Company. October 4, 2017. https://psnet.ahrq.gov/issue/cvs-taps-design-legend-reinvent-prescription-label-next-stop-pharmacy Complicated systems often require more than one change to improve their s… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/45297/psn-pdfJuly 13, 2016 - Evaluation of 12 strategies for obtaining second opinions to improve interpretation of breast histopathology: simulation study. July 13, 2016 Elmore JG, Tosteson AN, Pepe MS, et al. Evaluation of 12 strategies for obtaining second opinions to improve interpretation of breast histopathology: simulation study. BMJ. … -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/865346/psn-pdfMarch 27, 2024 - RaDonda Vaught says some system practices contributed to fatal mistake. March 27, 2024 Clark C. MedPage Today. March 14, 2024. https://psnet.ahrq.gov/issue/vaught-says-some-system-practices-contributed-fatal-mistake Stories from clinicians involved in errors provide unique insights into both the human an… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/61050/psn-pdfOctober 21, 2020 - Health care management during Covid-19: insights from complexity science. October 21, 2020 Begun JW, Jiang HJ. NEJM Catalyst. October 9, 2020. https://psnet.ahrq.gov/issue/health-care-management-during-covid-19-insights-complexity-science Complexity science provides a foundation to manage and learn from cris… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/44285/psn-pdfNovember 06, 2015 - Hospital board oversight of quality and safety: a stakeholder analysis exploring the role of trust and intelligence. November 6, 2015 Millar R, Freeman T, Mannion R. Hospital board oversight of quality and safety: a stakeholder analysis exploring the role of trust and intelligence. BMC Health Serv Res. 2015;15:196…
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