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8401. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/45062/psn-pdf
      May 18, 2016 - Opioid Epidemic & Health IT May 18, 2016 Section 4. Health IT Playbook. Office of the National Coordinator for Health Information Technology. https://psnet.ahrq.gov/issue/attacking-opioid-crisis-head-health-it Overdoses of opioid medications are considered an epidemic in the United States. This website provides ac…

8402. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/764409/psn-pdf
      March 02, 2022 - She was headed to a locked psych ward. Then an ER doctor made a startling discovery. March 2, 2022 Boodman SG. Washington Post. February 12, 2022. https://psnet.ahrq.gov/issue/she-was-headed-locked-psych-ward-then-er-doctor-made-startling-discovery Misdiagnosis over a long period of time can be exacerbated by stig…

8403. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/863221/psn-pdf
      February 28, 2024 - Using artificial intelligence to improve primary care for patients and clinicians. February 28, 2024 Sarkar U, Bates DW. Using artificial intelligence to improve primary care for patients and clinicians. JAMA Intern Med. 2024;184(4):343-344. doi:10.1001/jamainternmed.2023.7965. https://psnet.ahrq.gov/issue/using-a…

8404. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/43840/psn-pdf
      January 28, 2015 - A qualitative study of systemic influences on paramedic decision making: care transitions and patient safety. January 28, 2015 O'Hara R, Johnson M, Siriwardena N, et al. A qualitative study of systemic influences on paramedic decision making: care transitions and patient safety. J Health Serv Res Policy. 2015;20(1 …

8405. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/46352/psn-pdf
      October 15, 2018 - Optimal Resources for Surgical Quality and Safety. October 15, 2018 Hoyt DB, Ko CY, eds. Chicago, IL: American College of Surgeons; 2017. ISBN: 9780996826242. https://psnet.ahrq.gov/issue/optimal-resources-surgical-quality-and-safety Surgery is complex and involves a wide range of possibilities for error that can r…

8406. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/39356/psn-pdf
      April 08, 2011 - Team training in the neonatal resuscitation program for interns: teamwork and quality of resuscitations. April 8, 2011 Thomas EJ, Williams AL, Reichman EF, et al. Team training in the neonatal resuscitation program for interns: teamwork and quality of resuscitations. Pediatrics. 2010;125(3):539-546. doi:10.1542/ped…

8407. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/43976/psn-pdf
      November 16, 2015 - Multicenter development, implementation, and patient safety impacts of a simulation-based module to teach handovers to pediatric residents. November 16, 2015 Johnson DP, Zimmerman K, Staples B, et al. Multicenter development, implementation, and patient safety impacts of a simulation-based module to teach handover…

8408. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/764406/psn-pdf
      March 02, 2022 - Patient safety assurance in the age of defensive medicine: a review. March 2, 2022 Shenoy A, Shenoy GN, Shenoy GG. Patient safety assurance in the age of defensive medicine: a review. Patient Saf Surg. 2022;16(1):10. doi:10.1186/s13037-022-00319-8. https://psnet.ahrq.gov/issue/patient-safety-assurance-age-defensiv…

8409. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/43955/psn-pdf
      December 04, 2016 - For Colorado mom, story of daughter's hospital death is key to others' safety. December 4, 2016 Daley J. Colorado Public Radio. February 17, 2015. https://psnet.ahrq.gov/issue/colorado-mom-story-daughters-hospital-death-key-others-safety Patient and family stories of harm are increasingly promoted as a strategy to…

8410. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/46711/psn-pdf
      July 01, 2019 - The STOP Measure. Safe and Transparent Opioid Prescribing to Promote Patient Safety and Reduced Risk of Opioid Misuse. July 1, 2019 Washington, DC: America's Health Insurance Plans; 2019. https://psnet.ahrq.gov/issue/stop-measure-safe-and-transparent-opioid-prescribing-promote-patient-safety- and-reduced-risk Gu…

8411. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/34742/psn-pdf
      July 20, 2016 - Culture at Work in Aviation and Medicine: National, Organizational, and Professional Influences. July 20, 2016 Helmreich RL, Merritt AC. Brookfield, VT: Ashgate; 1998. ISBN: 9780291398536. https://psnet.ahrq.gov/issue/culture-work-aviation-and-medicine-national-organizational-and-professional- influences This boo…

8412. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/74196/psn-pdf
      December 15, 2021 - Adverse glycemic events and critical emergencies. December 15, 2021 ISMP Medication Safety Alert! Acute care edition. December 2, 2021;(24)1-4. https://psnet.ahrq.gov/issue/adverse-glycemic-events-and-critical-emergencies Insulin is a high-alert medication that requires extra attention to safely manage blood sugar …

8413. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/44954/psn-pdf
      January 07, 2019 - Snowball in a Blizzard: A Physician's Notes on Uncertainty in Medicine. January 7, 2019 Hatch S. New York, NY: Basic Books; 2016. ISBN: 9780465050642. https://psnet.ahrq.gov/issue/snowball-blizzard-physicians-notes-uncertainty-medicine Uncertainty is often present in various areas of medical practice. This book pr…

8414. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/42152/psn-pdf
      December 30, 2014 - A theory-driven, longitudinal evaluation of the impact of team training on safety culture in 24 hospitals. December 30, 2014 Jones KJ, Skinner AM, High R, et al. A theory-driven, longitudinal evaluation of the impact of team training on safety culture in 24 hospitals. BMJ Qual Saf. 2013;22(5):394-404. doi:10.1136/b…

8415. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/73706/psn-pdf
      September 15, 2021 - A meta-review of methods of measuring and monitoring safety in primary care. September 15, 2021 O’Connor P, Madden C, O’Dowd E, et al. A meta-review of methods of measuring and monitoring safety in primary care. Int J Qual Health Care. 2021;33(3):mzab117. doi:10.1093/intqhc/mzab117. https://psnet.ahrq.gov/issue/me…

8416. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/43459/psn-pdf
      August 27, 2014 - Serious Reportable Events. August 27, 2014 Nova Scotia Department of Health and Wellness. https://psnet.ahrq.gov/issue/serious-reportable-events Incident reporting systems are an important method for capturing, analyzing, and learning about a broad range of potential safety issues. This Web site provides access to…

8417. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/38747/psn-pdf
      September 16, 2009 - Examination of how a survey can spur culture changes using a quality improvement approach: a region-wide approach to determining a patient safety culture. September 16, 2009 Pringle J, Weber RJ, Rice K, et al. Examination of how a survey can spur culture changes using a quality improvement approach: a region-wide …

8418. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/844793/psn-pdf
      September 11, 2019 - PC standards for maternal safety. September 11, 2019 The Joint Commission. R3 Report. August 21, 2019;24:1-6. https://psnet.ahrq.gov/issue/pc-standards-maternal-safety Maternal safety in the United States is gaining momentum as a system-level patient safety concern. This report reviews the new Joint Commission Pro…

8419. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/43390/psn-pdf
      July 30, 2014 - Hazards tied to medical records rush. July 30, 2014 Rowland C. https://psnet.ahrq.gov/issue/hazards-tied-medical-records-rush Government incentives have led to rapid development and adoption of electronic health records (EHRs). This newspaper article examines some of the unintended consequences of implementing ele…

8420. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/840163/psn-pdf
      November 16, 2022 - Deep Dive: Racial and Ethnic Disparities in Health and Healthcare. November 16, 2022 Plymouth Meeting, PA: ECRI and the Institute for Safe Medication Practices; 2022. https://psnet.ahrq.gov/issue/deep-dive-racial-and-ethnic-disparities-health-and-healthcare Racist behavior directed at either patients or clinicians…