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  1. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/840490/psn-pdf
    February 14, 2006 - Evidence of bias and variation in diagnostic accuracy studies. February 14, 2006 Rutjes AWS, Reitsma JB, Di Nisio M, et al. Evidence of bias and variation in diagnostic accuracy studies. CMAJ. 2006;174(4):469-476. doi:10.1503/cmaj.050090. https://psnet.ahrq.gov/issue/evidence-bias-and-variation-diagnostic-accuracy…

  2. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/60275/psn-pdf
    April 29, 2020 - Misreading injectable medications—causes and solutions: an integrative literature review. April 29, 2020 Borradale H, Andersen P, Wallis M, et al. Misreading injectable medications—causes and solutions: an integrative literature review. J Patient Saf. 2020. doi:10.1016/j.jcjq.2020.01.007. https://psnet.ahrq.gov/is…

  3. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/50910/psn-pdf
    February 19, 2020 - SEIPS 3.0: human-centered design of the patient journey for patient safety. February 19, 2020 Carayon P, Wooldridge AR, Hoonakker P, et al. SEIPS 3.0: human-centered design of the patient journey for patient safety. App Ergon. 2020;84:103033. doi:10.1016/j.apergo.2019.103033. https://psnet.ahrq.gov/issue/seips-30-…

  4. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/47564/psn-pdf
    December 05, 2018 - Challenges and opportunities for improving patient safety through human factors and systems engineering. December 5, 2018 Carayon P, Wooldridge A, Hose B-Z, et al. Challenges And Opportunities For Improving Patient Safety Through Human Factors And Systems Engineering. Health Aff (Millwood). 2018;37(11):1862-1869. …

  5. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/45274/psn-pdf
    July 20, 2016 - Medication safety in neonatal care: a review of medication errors among neonates. July 20, 2016 Krzyzaniak N, Bajorek B. Medication safety in neonatal care: a review of medication errors among neonates. Ther Adv Drug Saf. 2016;7(3):102-119. doi:10.1177/2042098616642231. https://psnet.ahrq.gov/issue/medication-safe…

  6. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/48157/psn-pdf
    August 21, 2019 - Recommendations for using the Revised Safer Dx instrument to help measure and improve diagnostic safety. August 21, 2019 Singh H, Khanna A, Spitzmueller C, et al. Recommendations for using the Revised Safer Dx Instrument to help measure and improve diagnostic safety. Diagnosis (Berl). 2019;6(4):315-323. doi:10.151…

  7. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/847724/psn-pdf
    April 19, 2023 - Defining avoidable healthcare-associated harm in prisons: a mixed-method development study. April 19, 2023 Keers RN, Wainwright V, McFadzean J, et al. Defining avoidable healthcare-associated harm in prisons: a mixed-method development study. PLOS One. 2023;18(3):e0282021. doi:10.1371/journal.pone.0282021. https:/…

  8. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/39277/psn-pdf
    August 22, 2018 - Preventing maternal death. August 22, 2018 Preventing maternal death. Sentinel Event Alert. 2010;44(44):1-4. https://psnet.ahrq.gov/issue/preventing-maternal-death The Joint Commission issues Sentinel Event Alerts to highlight areas of high risk and to promote the rapid adoption of risk reduction strategies. Adher…

  9. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/46096/psn-pdf
    May 31, 2017 - Guideline for opioid therapy and chronic noncancer pain. May 31, 2017 Busse JW, Craigie S, Juurlink DN, et al. Guideline for opioid therapy and chronic noncancer pain. CMAJ. 2017;189(18):E659-E666. doi:10.1503/cmaj.170363. https://psnet.ahrq.gov/issue/guideline-opioid-therapy-and-chronic-noncancer-pain Opioid pain…

  10. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/45276/psn-pdf
    September 29, 2017 - Clinicians' expectations of the benefits and harms of treatments, screening, and tests: a systematic review. September 29, 2017 Hoffmann TC, Del Mar C. Clinicians' Expectations of the Benefits and Harms of Treatments, Screening, and Tests: A Systematic Review. JAMA Intern Med. 2017;177(3):407-419. doi:10.1001/jama…

  11. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/45939/psn-pdf
    March 01, 2017 - Examining the Copy and Paste Function in the Use of Electronic Health Records. March 1, 2017 Lowry SZ, Ramaiah M, Prettyman SS, et al. Gaithersburg, MD: National Institute of Standards and Technology, United States Department of Commerce; January 19, 2017. NIST Interagency/Internal Report (NISTIR)-8166. https://p…

  12. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/837666/psn-pdf
    July 13, 2022 - Developing and aligning a safety event taxonomy for inpatient psychiatry. July 13, 2022 Barnes T, Fontaine T, Bautista C, et al. Developing and aligning a safety event taxonomy for inpatient psychiatry. J Patient Saf. 2022;18(4):e704-e713. doi:10.1097/pts.0000000000000935. https://psnet.ahrq.gov/issue/developing-a…

  13. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/34761/psn-pdf
    November 15, 2016 - The Girl Who Died Twice: Every Patient's Nightmare: the Libby Zion Case and the Hidden Hazards of Hospitals. November 15, 2016 Robins NS. New York NY: Delacorte Press; 1995. ISBN: 9780385308090.  https://psnet.ahrq.gov/issue/girl-who-died-twice-every-patients-nightmare-libby-zion-case-and-hidden- hazards-hosp…

  14. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/854389/psn-pdf
    October 11, 2023 - Alliance for Innovation on Maternal Health: Consensus Bundle on Sepsis in Obstetric Care. October 11, 2023 Bauer ME, Albright C, Prabhu M, et al. Alliance for Innovation on Maternal Health: Consensus Bundle on Sepsis in Obstetric Care. Obstet Gynecol. 2023;142(3):481-492. doi:10.1097/aog.0000000000005304. https://…

  15. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/46487/psn-pdf
    May 16, 2018 - High Reliability for a Highly Unreliable World: Preparing for Code Blue Through Daily Operations in Healthcare. May 16, 2018 van Stralen D, Byrum SL, Inozu B. North Charleston, SC: CreateSpace Publishing; 2018. ISBN: 1974506371. https://psnet.ahrq.gov/issue/high-reliability-highly-unreliable-world-preparing-code-b…

  16. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/44957/psn-pdf
    March 09, 2016 - Government and industry fail to protect the public when they suggest "carefully following instructions" is enough to prevent vaccine errors. March 9, 2016 ISMP Medication Safety Alert! Acute care edition. February 25, 2016;21(4):1-5. https://psnet.ahrq.gov/issue/government-and-industry-fail-protect-public-when-the…

  17. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/852282/psn-pdf
    August 09, 2023 - Implementation of medication reconciliation in outpatient cancer care. August 9, 2023 Powis M, Dara C, Macedo A, et al. Implementation of medication reconciliation in outpatient cancer care. BMJ Open Quality. 2023;12(2):e002211. doi:10.1136/bmjoq-2022-002211. https://psnet.ahrq.gov/issue/implementation-medication-…

  18. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/43698/psn-pdf
    November 19, 2014 - Alcohol and drug testing of health professionals following preventable adverse events: a bad idea. November 19, 2014 Banja J. Alcohol and drug testing of health professionals following preventable adverse events: a bad idea. Am J Bioeth. 2014;14(12):25-36. doi:10.1080/15265161.2014.964873. https://psnet.ahrq.gov/i…

  19. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/34814/psn-pdf
    January 01, 2015 - Prescribing for the elderly. Part I: Sensitivity of the elderly to adverse drug reactions. March 28, 2005 Nolan L, O'Malley K. Prescribing for the Elderly Part I: Sensitivity of the Elderly to Adverse Drug Reactions*. J Am Geriatr Soc. 2015;36(2):142-149. doi:10.1111/j.1532-5415.1988.tb01785.x. https://psnet.ahrq.…

  20. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/34760/psn-pdf
    March 28, 2005 - Managing the Risks of Organizational Accidents. March 28, 2005 Reason JT. Aldershot, Hants, England: Ashgate: 1997. ISBN: 9781840141047 https://psnet.ahrq.gov/issue/managing-risks-organizational-accidents Written 7 years after the publication of Human Error, this book demonstrates Reason's thinking at its finest a…
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