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7401. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/37198/psn-pdf
      October 06, 2011 - Criminalization of medical error: who draws the line? October 6, 2011 Dekker SWA. Criminalization of medical error: who draws the line? ANZ J Surg. 2007;77(10):831-7. https://psnet.ahrq.gov/issue/criminalization-medical-error-who-draws-line The author discusses the complexities of defining and responding to health …

7402. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/35179/psn-pdf
      June 06, 2016 - Patient safety in cataract surgery. June 6, 2016 Kelly SP, Astbury NJ. Patient safety in cataract surgery. Eye (Lond). 2006;20(3):275-82. https://psnet.ahrq.gov/issue/patient-safety-cataract-surgery The authors evaluate patient safety issues involved with cataract surgery and provide several recommendations for sa…

7403. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/39151/psn-pdf
      October 02, 2017 - The challenges to transparency in reporting medical errors. October 2, 2017 Paterick ZR, Paterick BB, Waterhouse BE, et al. The Challenges to Transparency in Reporting Medical Errors. J Patient Saf. 2009;5(4). doi:10.1097/pts.0b013e3181be2a88. https://psnet.ahrq.gov/issue/challenges-transparency-reporting-medical-…

7404. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/37922/psn-pdf
      May 02, 2018 - Epidural-IV route mix-ups: reducing the risk of deadly errors. May 2, 2018 ISMP Medication Safety Alert! Acute Care Edition. July 3, 2008;13:1-3. https://psnet.ahrq.gov/issue/epidural-iv-route-mix-ups-reducing-risk-deadly-errors This article reports on the potentially fatal error of administering epidural medicati…

7405. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/37656/psn-pdf
      May 08, 2019 - Canadian Disclosure Guidelines: Being Open and Honest with Patients and Families. May 8, 2019 Disclosure Working Group. Edmonton, AB, Canada; Canadian Patient Safety Institute; 2011. ISBN 9781926541389. https://psnet.ahrq.gov/issue/canadian-disclosure-guidelines-being-open-and-honest-patients-and-families These n…

7406. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/41091/psn-pdf
      October 01, 2021 - ISMP List of High-Alert Medications in Community/Ambulatory Healthcare. October 1, 2021 Horsham, PA: Institute for Safe Medication Practices; 2021. https://psnet.ahrq.gov/issue/ismp-list-high-alert-medications-communityambulatory-healthcare This fact sheet provides a list of high-alert medications commonly used in…

7407. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/36846/psn-pdf
      March 03, 2011 - Information technology cannot guarantee patient safety. March 3, 2011 de Wildt SN, Verzijden R, van den Anker JN, et al. Information technology cannot guarantee patient safety. BMJ. 2007;334(7598):851-2. https://psnet.ahrq.gov/issue/information-technology-cannot-guarantee-patient-safety The authors provide a case …

7408. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/40389/psn-pdf
      July 31, 2012 - Getting Your Best Health Care: Real-World Stories for Patient Empowerment. July 31, 2012 Farbstein K. Rockville, MD: Access Intelligence, LLC; 2011. ISBN: 9781885461452. https://psnet.ahrq.gov/issue/getting-your-best-health-care-real-world-stories-patient-empowerment This book explores patient-centered care and pr…

7409. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/35257/psn-pdf
      June 25, 2009 - JCAHO's safety goals—the clock is ticking, will your ED be compliant? June 25, 2009 JCAHO's safety goals--the clock is ticking, will your ED be compliant? ED Manag. 2005;17(7):73-5. https://psnet.ahrq.gov/issue/jcahos-safety-goals-clock-ticking-will-your-ed-be-compliant This article provides practical advise for e…

7410. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/41595/psn-pdf
      May 28, 2019 - Luer Connector Misconnections: Under-Recognized but Potentially Dangerous Events. May 28, 2019 Medical Product Safety Network. Silver Spring, MD; US Food and Drug Administration. November 19, 2008. https://psnet.ahrq.gov/issue/luer-connector-misconnections-under-recognized-potentially-dangerous-events This Web si…

7411. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/35040/psn-pdf
      January 02, 2017 - Medication errors involving pediatric patients. January 2, 2017 Santell JP, Hicks RW. Medication errors involving pediatric patients. Jt Comm J Qual Patient Saf. 2005;31(6):348-53. https://psnet.ahrq.gov/issue/medication-errors-involving-pediatric-patients Using Medmarx data from 2001 through 2003, the authors ana…

7412. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/34598/psn-pdf
      November 15, 2011 - Complexity and the Adoption of Innovation in Health Care. November 15, 2011 Plsek P. Washington DC: National Institute for Health Care Management Foundation and National Committee for Quality Health Care; 2003. https://psnet.ahrq.gov/issue/complexity-and-adoption-innovation-health-care In discussing the complexit…

7413. EHR Copy and Paste and Patient Safety | PSNet
      psnet.ahrq.gov/perspective/ehr-copy-and-paste-and-patient-safety
      January 01, 2018 - EHR Copy and Paste and Patient Safety Shannon M. Dean, MD | January 1, 2018  Also Read a Conversation View more articles from the same authors. Citation Text: Dean SM. EHR Copy and Paste and Patient Safety. PSNet [internet]. Rockville (MD): Agency for Healthcare…

7414. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/836877/psn-pdf
      May 16, 2022 - In Conversation With... Remle P. Crowe, PhD May 16, 2022 In Conversation With.. Remle P. Crowe, PhD . PSNet [internet]. 2022. https://psnet.ahrq.gov/perspective/conversation-remle-p-crowe-phd Editor’s Note: Remle Crowe, PhD, NREMT, is the Director of Clinical and Operational Research at ESO. In her professional ro…

7415. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/41560/psn-pdf
      August 01, 2012 - Improving Medication Safety in High Risk Medicare Beneficiaries Toolkit. August 1, 2012 Touchette DR, Stubbings J, Schumock G. Effective Healthcare Research Report No. 38. Rockville, MD: Agency for Healthcare Research and Quality; July 2012. AHRQ Publication No. 12-EHC027-EF. https://psnet.ahrq.gov/issue/improving…

7416. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/40814/psn-pdf
      September 28, 2011 - Retained surgical items and minimally invasive surgery. September 28, 2011 Gibbs VC. Retained surgical items and minimally invasive surgery. World J Surg. 2011;35(7):1532-9. doi:10.1007/s00268-011-1060-4. https://psnet.ahrq.gov/issue/retained-surgical-items-and-minimally-invasive-surgery This commentary discusses …

7417. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/42480/psn-pdf
      August 07, 2013 - A multi-tiered approach to safety education. August 7, 2013 Oates K, Sammut J, Kennedy P. A multi-tiered approach to safety education. Clin Teach. 2013;10(4):214- 8. doi:10.1111/tct.12037. https://psnet.ahrq.gov/issue/multi-tiered-approach-safety-education This commentary describes an initiative that incorporated …

7418. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/37718/psn-pdf
      April 23, 2008 - Mistakes and disclosure. April 23, 2008 Winter RO, Birnberg BA. Mistakes and disclosure. Fam Med. 2008;40(4):245-7. https://psnet.ahrq.gov/issue/mistakes-and-disclosure This article describes a method for teaching residents about safety culture, medical errors, and disclosure by using a movie, magazine article, an…

7419. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/36310/psn-pdf
      January 05, 2017 - A statewide voluntary patient safety initiative: the Georgia experience. January 5, 2017 Rask KJ, Schuessler LD, Naylor DV. A statewide voluntary patient safety initiative: the Georgia experiene. Jt Comm J Qual Patient Saf. 2006;32(10):564-72. https://psnet.ahrq.gov/issue/statewide-voluntary-patient-safety-initiat…

7420. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/36286/psn-pdf
      September 20, 2006 - The Health Literacy of America's Adults: Results from the 2003 National Assessment of Adult Literacy.  September 20, 2006 Kutner M, Greenberg E, Jin Y, et al. Washington, DC: National Center for Education Statistics; 2006. https://psnet.ahrq.gov/issue/health-literacy-americas-adults-results-2003-national-assessment…