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psnet.ahrq.gov/node/46227/psn-pdf
October 30, 2017 - Patient engagement with surgical site infection
prevention: an expert panel perspective.
October 30, 2017
Tartari E, Weterings V, Gastmeier P, et al. Patient engagement with surgical site infection prevention: an
expert panel perspective. Antimicrob Resist Infect Control. 2017;6:45. doi:10.1186/s13756-017-0202-3.
…
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psnet.ahrq.gov/node/44941/psn-pdf
October 05, 2016 - An embedded checklist in the Anesthesia Information
Management System improves pre-anaesthetic induction
setup: a randomised controlled trial in a simulation
setting.
October 5, 2016
Wetmore D, Goldberg A, Gandhi N, et al. An embedded checklist in the Anesthesia Information
Management System improves pre-anaesthe…
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psnet.ahrq.gov/node/44947/psn-pdf
November 18, 2016 - Impact of the 2011 ACGME resident duty hour reform on
hospital patient experience and processes-of-care.
November 18, 2016
Rajaram R, Saadat L, Chung JW, et al. Impact of the 2011 ACGME resident duty hour reform on hospital
patient experience and processes-of-care. BMJ Qual Saf. 2016;25(12):962-970. doi:10.1136/bmj…
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psnet.ahrq.gov/node/60155/psn-pdf
March 25, 2020 - Analysis of patient-physician concordance in the
understanding of chemotherapy treatment plans among
patients with cancer.
March 25, 2020
Almalki H, Absi A, Alghamdi A, et al. Analysis of patient-physician concordance in the understanding of
chemotherapy treatment plans among patients with cancer. JAMA Netw Open. …
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psnet.ahrq.gov/node/44621/psn-pdf
February 10, 2016 - Young surgeons on speaking up: when and how surgical
trainees voice concerns about supervisors' clinical
decisions.
February 10, 2016
Sur MD, Schindler N, Singh P, et al. Young surgeons on speaking up: when and how surgical trainees
voice concerns about supervisors' clinical decisions. Am J Surg. 2016;211(2):437-4…
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psnet.ahrq.gov/node/47975/psn-pdf
May 29, 2019 - Surgical Innovation, New Techniques and Technologies:
A Guide to Good Practice.
May 29, 2019
London, UK: Royal College of Surgeons of England; 2019.
https://psnet.ahrq.gov/issue/surgical-innovation-new-techniques-and-technologies-guide-good-practice
Introducing innovations in practice involves taking calculated ri…
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psnet.ahrq.gov/node/43039/psn-pdf
August 24, 2016 - How Doctors Think.
August 24, 2016
Groopman J. Boston, MA: Houghton Mifflin; 2007. ISBN: 0618610030.
https://psnet.ahrq.gov/issue/how-doctors-think
In this book, the author presents several stories that illustrate the forces that shape physician decision-
making and may lead to diagnostic mistakes. Borrowing from …
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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:/…
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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…
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psnet.ahrq.gov/node/60577/psn-pdf
June 10, 2020 - Assuring safe patient care in a level III NICU in
anticipation of hospital closure.
June 10, 2020
Fleishman R, Anday E, Bhandari V. Assuring safe patient care in a level III NICU in anticipation of hospital
closure. J Perinatol. 2020. doi:10.1038/s41372-020-0648-7.
https://psnet.ahrq.gov/issue/assuring-safe-patien…
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psnet.ahrq.gov/node/43093/psn-pdf
August 12, 2014 - Identifying systems failures in the pathway to a
catastrophic event: an analysis of national incident report
data relating to vinca alkaloids.
August 12, 2014
Franklin BD, Panesar S, Vincent CA, et al. Identifying systems failures in the pathway to a catastrophic
event: an analysis of national incident report data…
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psnet.ahrq.gov/node/47013/psn-pdf
April 07, 2019 - An electronic intervention to improve safety for pain
patients co-prescribed chronic opioids and
benzodiazepines.
April 7, 2019
Zaman T, Rife TL, Batki SL, et al. An electronic intervention to improve safety for pain patients co-
prescribed chronic opioids and benzodiazepines. Subst Abus. 2018;39(4):441-448.
doi:…
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psnet.ahrq.gov/node/43511/psn-pdf
September 10, 2014 - Re-finding the 'human side' of human factors in nursing:
helping student nurses to combine person-centred care
with the rigours of patient safety.
September 10, 2014
Fawcett TJN, Rhynas SJ. Re-finding the 'human side' of human factors in nursing: helping student nurses
to combine person-centred care with the rigou…
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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…
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psnet.ahrq.gov/node/36088/psn-pdf
September 28, 2010 - Impact and implications of disruptive behavior in the
perioperative arena.
September 28, 2010
Rosenstein AH, O'Daniel M. Impact and implications of disruptive behavior in the perioperative arena. J Am
Coll Surg. 2006;203(1):96-105.
https://psnet.ahrq.gov/issue/impact-and-implications-disruptive-behavior-perioperat…
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psnet.ahrq.gov/node/860384/psn-pdf
January 10, 2024 - Aging stigma and the health of US adults over 65: what do
we know?
January 10, 2024
Allen J, Sikora N. Aging stigma and the health of US adults over 65: what do we know? Clin Interv Aging.
2023;18:2093-2116. doi:10.2147/cia.s396833.
https://psnet.ahrq.gov/issue/aging-stigma-and-health-us-adults-over-65-what-do-we-…
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psnet.ahrq.gov/node/60152/psn-pdf
March 25, 2020 - Errors during resuscitation: the impact of perceived
authority on delivery of care.
March 25, 2020
Delaloye NJ, Tobler K, O?Neill T, et al. Errors during resuscitation: the impact of perceived authority on
delivery of care. J Patient Saf. 2020;16(1). doi:10.1097/pts.0000000000000359.
https://psnet.ahrq.gov/issue/e…
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psnet.ahrq.gov/node/37277/psn-pdf
July 28, 2010 - Drug selection errors in relation to medication labels: a
simulation study.
July 28, 2010
Garnerin P, Perneger T, Chopard P, et al. Drug selection errors in relation to medication labels: a
simulation study. Anaesthesia. 2007;62(11):1090-4.
https://psnet.ahrq.gov/issue/drug-selection-errors-relation-medication-lab…
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psnet.ahrq.gov/node/47923/psn-pdf
April 17, 2019 - Improving employee voice about transgressive or
disruptive behavior: a case study.
April 17, 2019
Dixon-Woods M, Campbell A, Martin G, et al. Improving Employee Voice About Transgressive or Disruptive
Behavior: A Case Study. Acad Med. 2019;94(4):579-585. doi:10.1097/ACM.0000000000002447.
https://psnet.ahrq.gov/iss…
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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-…