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6941. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/39077/psn-pdf
      February 08, 2011 - Enhancing Patient Care: A Practical Guide to Improving Quality and Safety in Hospitals. February 8, 2011 Wolff A, Taylor S. Sydney, Australia: MJA Books; 2009. ISBN: 9780977578665. https://psnet.ahrq.gov/issue/enhancing-patient-care-practical-guide-improving-quality-and-safety-hospitals Authors from an Australian …

6942. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/36165/psn-pdf
      September 29, 2010 - Critical diagnoses (critical values) in anatomic pathology. September 29, 2010 Pathology A of D of A and S, Silverman JF, Fletcher CDM, et al. Critical diagnoses (critical values) in anatomic pathology. Hum Pathol. 2006;37(8):982-4. https://psnet.ahrq.gov/issue/critical-diagnoses-critical-values-anatomic-pathology …

6943. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/36989/psn-pdf
      June 18, 2013 - Medication Management: Detailed Use Case. June 18, 2013 Washington, DC: Office of the National Coordinator for Health Information Technology, US Department of Health and Human Services; 2007. https://psnet.ahrq.gov/issue/medication-management-detailed-use-case This report provides two example scenarios—inpatient m…

6944. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/40375/psn-pdf
      August 08, 2014 - Coordination Between Emergency and Primary Care Physicians. August 8, 2014 Carrier E, Yee T, Holtzwart RA. Washington, DC: National Institute for Health Care Reform; 2011. NIHCR Research Brief No. 3. https://psnet.ahrq.gov/issue/coordination-between-emergency-and-primary-care-physicians This report analyzes commu…

6945. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/38477/psn-pdf
      October 03, 2017 - Serious Adverse Events Reports. October 3, 2017 The Quality Improvement Committee. Wellington, New Zealand; 2006-2013. https://psnet.ahrq.gov/issue/serious-adverse-events-reports Considered a starting point for a national reporting initiative, this series of annual reports provides statistics on serious and sentin…

6946. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/36253/psn-pdf
      November 28, 2018 - Medication Reconciliation Handbook, 2nd edition. November 28, 2018 American Society of Health-System Pharmacists, Joint Commission on Accreditation of Healthcare Organizations. Oakbrook Terrace IL; Joint Commission Resources: 2009. ISBN 9781599403090. https://psnet.ahrq.gov/issue/medication-reconciliation-handbook-…

6947. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/38232/psn-pdf
      July 03, 2013 - Rx for medication errors. July 3, 2013 Friedley NJC. Rx for medication errors. A patient medication safety plan can help prevent the cascade of devastating and preventable complications from adverse drug events. Medical economics. 2008;85(20):34- 8. https://psnet.ahrq.gov/issue/rx-medication-errors This continuin…

6948. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/40688/psn-pdf
      November 16, 2016 - Guide to Infection Prevention for Outpatient Settings: Minimum Expectations for Safe Care. November 16, 2016 Atlanta, GA: Centers for Disease Control and Prevention; 2011. https://psnet.ahrq.gov/issue/guide-infection-prevention-outpatient-settings-minimum-expectations-safe-care This report suggests strategies to p…

6949. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/38315/psn-pdf
      October 24, 2018 - Defusing Disruptive Behavior. A Workbook for Health Care Leaders. October 24, 2018 Oakbrook, IL: Joint Commission Resources; 2007. ISBN: 9781599400846. https://psnet.ahrq.gov/issue/defusing-disruptive-behavior-workbook-health-care-leaders This workbook includes background on disruptive behaviors and provides tools…

6950. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/40717/psn-pdf
      August 24, 2011 - Revealing their medical errors: why three doctors went public. August 24, 2011 O'Reilly KB. https://psnet.ahrq.gov/issue/revealing-their-medical-errors-why-three-doctors-went-public This news article reports on health care providers who have publicly revealed direct involvement in cases of medical errors, with a …

6951. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/35646/psn-pdf
      December 16, 2008 - The National Report Card on the State of Emergency Medicine. December 16, 2008 American College of Emergency Physicians; ACEP https://psnet.ahrq.gov/issue/national-report-card-state-emergency-medicine This Web site provides access to emergency medical services evaluations in four categories: access, quality and p…

6952. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/50901/psn-pdf
      February 12, 2020 - Thinking fast and slow in medicine. February 12, 2020 Michel JB. Thinking fast and slow in medicine. Baylor U Med Center Proceed. 2019;33(1):123-125. doi:10.1080/08998280.2019.1674043. https://psnet.ahrq.gov/issue/thinking-fast-and-slow-medicine This commentary describes cognitive errors contributing to a patient’…

6953. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/35607/psn-pdf
      January 23, 2012 - The Patients' View: 2004 ISQSH National Survey. January 23, 2012 Dublin: Irish Society for Quality and Safety in Healthcare; 2004. https://psnet.ahrq.gov/issue/patients-view-2004-isqsh-national-survey This report provides results from a 26-hospital survey investigating areas of service and care weakness in Irish h…

6954. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/37611/psn-pdf
      February 15, 2011 - SBAR for patients. February 15, 2011 Denham CR. SBAR for Patients. J Patient Saf. 2008;4(1). doi:10.1097/pts.0b013e2181660c06. https://psnet.ahrq.gov/issue/sbar-patients This commentary presents information and background on the standardized communication process known as SBAR (situation, background, assessment, a…

6955. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/34023/psn-pdf
      April 12, 2008 - Safety in Critical Care Medicine. April 12, 2008 Fein AM, Heffner JE, eds. Crit Care Clin. 2005;21(1):1-176. https://psnet.ahrq.gov/issue/safety-critical-care-medicine Recognizing the complexity of the critical care environment, the editors provide access to expert thought in this special issue. Topics covered inc…

6956. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/34911/psn-pdf
      April 21, 2005 - Patient Safety Essentials for Health Care. 5th ed. April 21, 2005 Oakbrook Terrace, IL: Joint Commission Resources; 2009. https://psnet.ahrq.gov/issue/4th-ed-patient-safety-essentials-health-care This book provides a complete overview of the Joint Commission's National Patient Safety Goals and how to apply them in…

6957. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/37035/psn-pdf
      June 10, 2018 - Ongoing, preventable fatal events with fentanyl transdermal patches are alarming! June 10, 2018 ISMP Medication Safety Alert! Acute Care Edition. June 28, 2007;12:1-3. https://psnet.ahrq.gov/issue/ongoing-preventable-fatal-events-fentanyl-transdermal-patches-are-alarming This article discusses inappropriate prescr…

6958. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/37435/psn-pdf
      December 18, 2017 - Patient safety in the pediatric emergency care setting. December 18, 2017 Medicine AMERICANACADEMYOFPEDIATRICSC on PE, Krug SE, Frush K. Patient safety in the pediatric emergency care setting. Pediatrics. 2007;120(6):1367-1375. https://psnet.ahrq.gov/issue/patient-safety-pediatric-emergency-care-setting This polic…

6959. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/35586/psn-pdf
      March 15, 2021 - Healthcare Excellence Canada. March 15, 2021 150 Kent Street, Suite 200, Ottawa, Ontario, K1P 0E4 Canada. https://psnet.ahrq.gov/issue/canadian-patient-safety-institute This new organization fosters collaboration between governments and stakeholders in developing patient safety initiatives. This Web site provides …

6960. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/34608/psn-pdf
      March 28, 2005 - Center for Medical Simulation. March 28, 2005 https://psnet.ahrq.gov/issue/center-medical-simulation The Center for Medical Simulation (CMS) is a not-for-profit corporation founded by the anesthesia departments of the Harvard Medical School affiliated hospitals. CMS dedicates its efforts to provide medical educati…