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  1. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/39353/psn-pdf
    March 10, 2010 - The impact of a pharmacist's participation on hospitalists' rounds. March 10, 2010 Patel R, Butler K, Garrett D, et al. The Impact of a Pharmacist's Participation on Hospitalists' Rounds. Hosp Pharm. 2010;45(2). doi:10.1310/hpj4502-129. https://psnet.ahrq.gov/issue/impact-pharmacists-participation-hospitalists-rou…
  2. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/40134/psn-pdf
    February 17, 2011 - Sleep deprivation, elective surgical procedures, and informed consent. February 17, 2011 Nurok M, Czeisler CA, Lehmann LS. Sleep deprivation, elective surgical procedures, and informed consent. N Engl J Med. 2010;363(27):2577-9. doi:10.1056/NEJMp1007901. https://psnet.ahrq.gov/issue/sleep-deprivation-elective-surg…
  3. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/40312/psn-pdf
    June 10, 2018 - Oops, sorry, wrong patient! A patient verification process is needed everywhere, not just at the bedside. June 10, 2018 ISMP Medication Safety Alert! Acute care edition. March 10, 2011;16:1-4. https://psnet.ahrq.gov/issue/oops-sorry-wrong-patient-patient-verification-process-needed-everywhere-not- just-bedside Th…
  4. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/38017/psn-pdf
    May 02, 2018 - Proper positioning of pharmacy label on Hospira PCA vials will avoid interference with scanning. May 2, 2018 ISMP Medication Safety Alert! Acute Care Edition. August 14, 2008;13:1-3. https://psnet.ahrq.gov/issue/proper-positioning-pharmacy-label-hospira-pca-vials-will-avoid-interference- scanning This article rep…
  5. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/46552/psn-pdf
    October 25, 2017 - The power of regret. October 25, 2017 Groopman J, Hartzband P. The Power of Regret. N Engl J Med. 2017;377(16):1507-1509. doi:10.1056/NEJMp1709917. https://psnet.ahrq.gov/issue/power-regret Clinicians may feel regret when the care they provide falls short of their expectations. This commentary explores how regret…
  6. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/39669/psn-pdf
    July 07, 2010 - ASHP guidelines on remote medication order processing. July 7, 2010 Processing ASHPEP on RMO, Thompson B, Conrad G, et al. ASHP guidelines on remote medication order processing. Am J Health Syst Pharm. 2010;67(8):672-7. doi:10.2146/sp100003. https://psnet.ahrq.gov/issue/ashp-guidelines-remote-medication-order-proce…
  7. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/50777/psn-pdf
    January 08, 2020 - Safety culture across cultures. January 8, 2020 Yorio PL, Edwards J, Hoeneveld D. Safety culture across cultures. Safety Sci. 2019;120:402-410. doi:10.1016/j.ssci.2019.07.021. https://psnet.ahrq.gov/issue/safety-culture-across-cultures This paper discusses the relationship between national culture and safety cultu…
  8. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/46442/psn-pdf
    October 04, 2017 - Handoff Communication. October 4, 2017 APSF Newsletter. October 2017;32:29-56. https://psnet.ahrq.gov/issue/handoff-communication Handoff processes are known to carry risks of communication errors. This special issue focuses on transfers involving anesthesia care. Articles review different types of handoffs, chara…
  9. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/39094/psn-pdf
    June 09, 2011 - Human factors in surgery: from Three Mile Island to the operating room. June 9, 2011 D'Addessi A, Bongiovanni L, Volpe A, et al. Human factors in surgery: from Three Mile Island to the operating room. Urol Int. 2009;83(3):249-57. doi:10.1159/000241662. https://psnet.ahrq.gov/issue/human-factors-surgery-three-mile-…
  10. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/34576/psn-pdf
    May 27, 2015 - An Agenda for Research in Ambulatory Patient Safety. May 27, 2015 Hammons T; Piland NF; Small SD; Hatlie MJ; Burstin HR; Medical Group Management Association; MGMA https://psnet.ahrq.gov/issue/agenda-research-ambulatory-patient-safety This summarizes a multidisciplinary conference (November 30 and December 1, 2000)…
  11. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/37696/psn-pdf
    October 13, 2022 - How To Create a My Medicines List. October 13, 2022 Rockville, MD: Agency for Healthcare Research and Quality; October 2022. https://psnet.ahrq.gov/issue/how-create-my-medicines-list This tool provides a printable template and step-by-step instructions for patients to create a visual reference for keeping track of…
  12. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/46998/psn-pdf
    August 01, 2019 - 10 Facts on Patient Safety. June 27, 2018 Patient Safety and Risk Management Service Delivery and Safety. Geneva, Switzerland; World Health Organization: August 2019. https://psnet.ahrq.gov/issue/10-facts-patient-safety This publication highlights statistics that illustrate the global impact of patient harm. The i…
  13. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/39340/psn-pdf
    March 17, 2010 - Adverse Events in Hospitals: Methods for Identifying Events. March 17, 2010 Levinson DR. Washington, DC: US Department of Health and Human Services, Office of the Inspector General; March 2010. Report No. OEI-06-08-00221. https://psnet.ahrq.gov/issue/adverse-events-hospitals-methods-identifying-events This report…
  14. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/43564/psn-pdf
    January 15, 2019 - Are hospitals in a med safety standard slump? January 15, 2019 Wild D. Pharmacy Practice News. September 8, 2014. https://psnet.ahrq.gov/issue/are-hospitals-med-safety-standard-slump Highlighting how hospital compliance rates with Joint Commission medication–related standards have remained mostly unchanged from 20…
  15. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/39079/psn-pdf
    June 06, 2018 - Oral syringes: a crucial and economical risk-reduction strategy that has not been fully utilized. June 6, 2018 ISMP Medication Safety Alert! Acute Care Edition. October 22, 2009;14:1-3. https://psnet.ahrq.gov/issue/oral-syringes-crucial-and-economical-risk-reduction-strategy-has-not-been- fully-utilized This arti…
  16. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/47805/psn-pdf
    May 29, 2019 - Better Health for Mothers and Babies. May 29, 2019 American Hospital Association. https://psnet.ahrq.gov/issue/better-health-mothers-and-babies Maternal harm is a patient safety concern that is increasingly prioritized in regulatory and care delivery environments. This website provides tools, policies, news articl…
  17. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/35514/psn-pdf
    April 03, 2009 - Information Design for Patient Safety: A Guide to the Graphic Design of Medication Packaging. 2nd edition. April 3, 2009 Swayne T. London, UK: National Patient Safety Agency, The Helen Hamlyn Research Centre; 2007. https://psnet.ahrq.gov/issue/information-design-patient-safety-guide-graphic-design-medication-p…
  18. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/38287/psn-pdf
    February 06, 2009 - Teamwork and patient safety in dynamic domains of healthcare: a review of the literature. February 6, 2009 Manser T. Teamwork and patient safety in dynamic domains of healthcare: a review of the literature. Acta Anaesthesiol Scand. 2009;53(2):143-51. doi:10.1111/j.1399-6576.2008.01717.x. https://psnet.ahrq.gov/iss…
  19. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/39326/psn-pdf
    July 31, 2012 - Initiative to Reduce Unnecessary Radiation Exposure from Medical Imaging. July 31, 2012 Center for Devices and Radiological Health; CDRH; US Food and Drug Administration; FDA. https://psnet.ahrq.gov/issue/initiative-reduce-unnecessary-radiation-exposure-medical-imaging This Web site provides information on an init…
  20. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/34923/psn-pdf
    February 27, 2009 - Failure mode and effects analysis application to critical care medicine. February 27, 2009 Duwe B, Fuchs BD, Hansen-Flaschen J. Failure mode and effects analysis application to critical care medicine. Crit Care Clin. 2005;21(1):21-30, vii. https://psnet.ahrq.gov/issue/failure-mode-and-effects-analysis-application-…

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