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psnet.ahrq.gov/node/44062/psn-pdf
September 09, 2015 - How to make medication error reporting systems
work—factors associated with their successful
development and implementation.
September 9, 2015
Holmström A-R, Laaksonen R, Airaksinen M. How to make medication error reporting systems work--
Factors associated with their successful development and implementation. Hea…
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psnet.ahrq.gov/node/47653/psn-pdf
January 16, 2019 - Exploring pharmacist experiences of delivering
individualised prescribing error feedback in an acute
hospital setting.
January 16, 2019
Lloyd M, Watmough SD, O'Brien S, et al. Exploring pharmacist experiences of delivering individualised
prescribing error feedback in an acute hospital setting. Res Social Adm Pharm…
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psnet.ahrq.gov/node/837040/psn-pdf
May 04, 2022 - Use duodenoscopes with innovative designs to enhance
safety: FDA Safety Communication.
May 4, 2022
Silver Spring, MD: US Food and Drug Administration; April 5, 2022.
https://psnet.ahrq.gov/issue/use-duodenoscopes-innovative-designs-enhance-safety-fda-safety-
communication
The challenge of medical device steriliza…
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psnet.ahrq.gov/node/42928/psn-pdf
September 19, 2016 - Supporting second victims of patient safety events:
shouldn't these communications be covered by legal
privilege?
September 19, 2016
de Wit ME, Marks CM, Natterman JP, et al. Supporting second victims of patient safety events: shouldn't
these communications be covered by legal privilege? J Law Med Ethics. 2013;41(…
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psnet.ahrq.gov/node/74042/psn-pdf
November 03, 2021 - An Investigation into the Death of Baby J at University
Hospitals Bristol and Weston NHS Foundation Trust.
November 3, 2021
Manchester, UK: Parliamentary and Health Service Ombudsman; October 2021.
https://psnet.ahrq.gov/issue/investigation-death-baby-j-university-hospitals-bristol-and-weston-nhs-
foundation-trust…
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psnet.ahrq.gov/node/43048/psn-pdf
April 02, 2014 - Building a Culture of Candour: a Review of the Threshold
for the Duty of Candour and of the Incentives for Care
Organisations to Be Candid.
April 2, 2014
Dalton D, Williams N. London, UK: The Royal College of Surgeons of England; March 2014.
https://psnet.ahrq.gov/issue/building-culture-candour-review-thresh…
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psnet.ahrq.gov/node/35284/psn-pdf
July 14, 2010 - Learning from others: legal aspects of sharing patient
safety data using provider consortia.
July 14, 2010
Liang BA; Weinger MB; Suydam S. J Patient Saf 2005;1:83–89
https://psnet.ahrq.gov/issue/learning-others-legal-aspects-sharing-patient-safety-data-using-provider-
consortia
The authors present a detailed anal…
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psnet.ahrq.gov/node/44547/psn-pdf
November 25, 2015 - Monitoring patient safety in primary care: an exploratory
study using in-depth semistructured interviews.
November 25, 2015
Samra R, Bottle A, Aylin PP. Monitoring patient safety in primary care: an exploratory study using in-depth
semistructured interviews. BMJ Open. 2015;5(9):e008128. doi:10.1136/bmjopen-2015-008…
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psnet.ahrq.gov/node/45030/psn-pdf
November 01, 2016 - The impact of drug shortages on patients with
cardiovascular disease: causes, consequences, and a call
to action.
November 1, 2016
Reed BN, Fox ER, Konig M, et al. The impact of drug shortages on patients with cardiovascular disease:
causes, consequences, and a call to action. Am Heart J. 2016;175:130-41. doi:10.1…
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psnet.ahrq.gov/node/74722/psn-pdf
February 02, 2022 - Preventing and mitigating radiology system failures: a
guide to disaster planning.
February 2, 2022
Gibney BT, Roberts JM, D'Ortenzio RM, et al. Preventing and mitigating radiology system failures: a guide
to disaster planning. RadioGraphics. 2021;41(7):2111-2126. doi:10.1148/rg.2021210083.
https://psnet.ahrq.gov/…
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psnet.ahrq.gov/node/41659/psn-pdf
September 05, 2012 - Canadian Association of University Surgeons' Annual
Symposium. Surgical simulation: the solution to safe
training or a promise unfulfilled?
September 5, 2012
Brindley PG, Jones DB, Grantcharov T, et al. Canadian Association of University Surgeons' Annual
Symposium. Surgical simulation: the solution to safe trainin…
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psnet.ahrq.gov/node/46369/psn-pdf
September 06, 2017 - Critical Issues in Food Allergy: A National Academies
Consensus Report.
September 6, 2017
Sicherer SH, Allen K, Lack G, et al. Critical Issues in Food Allergy: A National Academies Consensus
Report. Pediatrics. 2017;140(2). doi:10.1542/peds.2017-0194.
https://psnet.ahrq.gov/issue/critical-issues-food-allergy-natio…
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psnet.ahrq.gov/node/44454/psn-pdf
September 29, 2017 - Ethical issues in patient safety research: a systematic
review of the literature.
September 29, 2017
Whicher DM, Kass NE, Audera-Lopez C, et al. Ethical issues in patient safety research: a systematic
review of the literature. J Patient Saf. 2015;11(3):174-184. doi:10.1097/PTS.0000000000000064.
https://psnet.ahrq.…
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psnet.ahrq.gov/node/42671/psn-pdf
October 23, 2013 - Safety during night shifts: a cross-sectional survey of
junior doctors' preparation and practice.
October 23, 2013
Jackson EJ, Moreton A. Safety during night shifts: a cross-sectional survey of junior doctors' preparation
and practice. BMJ Open. 2013;3(9):e003567. doi:10.1136/bmjopen-2013-003567.
https://psnet.ahr…
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psnet.ahrq.gov/node/39614/psn-pdf
June 18, 2021 - Preventing violence in the health care setting.
June 18, 2021
Preventing violence in the health care setting. Sentinel Event Alert. 2010;(45):1-3.
https://psnet.ahrq.gov/issue/preventing-violence-health-care-setting
Revised June 2021. The Joint Commission issues sentinel event alerts to highlight areas of high risk…
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psnet.ahrq.gov/node/33936/psn-pdf
May 27, 2011 - Computer physician order entry: benefits, costs, and
issues.
May 27, 2011
Kuperman GJ, Gibson RF. Computer physician order entry: benefits, costs, and issues. Ann Intern Med.
2003;139(1):31-9.
https://psnet.ahrq.gov/issue/computer-physician-order-entry-benefits-costs-and-issues
Using existing research, this revie…
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psnet.ahrq.gov/node/35374/psn-pdf
January 02, 2017 - Intimidation: practitioners speak up about this unresolved
problem.
January 2, 2017
Smetzer JL, Cohen MR. Intimidation: Practitioners Speak Up About This Unresolved Problem. Jt Comm J
Qual Patient Saf. 2016;31(10):594-599. doi:10.1016/s1553-7250(05)31077-4.
https://psnet.ahrq.gov/issue/intimidation-practitioners-s…
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psnet.ahrq.gov/node/45826/psn-pdf
January 18, 2017 - Ensuring staff safety when treating potentially violent
patients.
January 18, 2017
Roca RP, Charen B, Boronow J. Ensuring Staff Safety When Treating Potentially Violent Patients. JAMA.
2016;316(24):2669-2670. doi:10.1001/jama.2016.18260.
https://psnet.ahrq.gov/issue/ensuring-staff-safety-when-treating-potentially-…
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psnet.ahrq.gov/node/72582/psn-pdf
December 16, 2020 - Deficiencies in the Veterans Crisis Line Response to a
Veteran Caller Who Died.
December 16, 2020
Washington, DC: Department of Veterans Affairs, Office of Inspector General; November 17, 2020. Report
No 19-08542-11.
https://psnet.ahrq.gov/issue/deficiencies-veterans-crisis-line-response-veteran-caller-who-died
I…
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www.ahrq.gov/patient-safety/settings/long-term-care/resource/index.html
November 01, 2021 - Long-term Care Resources
Toolkits, recommendations, and other resources for long-term care facilities to improve quality, reduce errors, and increase patient safety.
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Comparative Effectiveness Reviews
Comparative effectiveness reviews about long-term care
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