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  1. Death due to pharmacy compounding error reinforces need for safety focus. | PSNet

    psnet.ahrq.gov/issue/death-due-pharmacy-compounding-error-reinforces-need-safety-focus
    May 31, 2017 - Newspaper/Magazine Article Death due to pharmacy compounding error reinforces need for safety focus. Citation Text: Death due to pharmacy compounding error reinforces need for safety focus. ISMP Medication Safety Alert! Acute Care Edition. June 15, 2017;22:1-4. Copy Citation …

  2. Promoting civility in the OR: an ethical imperative. | PSNet

    psnet.ahrq.gov/issue/promoting-civility-or-ethical-imperative
    September 12, 2016 - Commentary Promoting civility in the OR: an ethical imperative. Citation Text: Clark CM, Kenski D. Promoting Civility in the OR: An Ethical Imperative. AORN J. 2017;105(1):60-66. doi:10.1016/j.aorn.2016.10.019. Copy Citation Format: DOI Google Scholar PubMed BibTeX EndNote …

  3. Understanding the root cause analysis process to increase safety event reporting. | PSNet

    psnet.ahrq.gov/issue/understanding-root-cause-analysis-process-increase-safety-event-reporting
    August 08, 2018 - Commentary Understanding the root cause analysis process to increase safety event reporting. Citation Text: Dudley KA. Understanding the root cause analysis process to increase safety event reporting. AORN J. 2023;117(6):399-402. doi:10.1002/aorn.13935. Copy Citation Format: …

  4. Creating a culture of safety by using checklists. | PSNet

    psnet.ahrq.gov/issue/creating-culture-safety-using-checklists
    July 30, 2014 - Commentary Creating a culture of safety by using checklists. Citation Text: Huang LC, Kim R, Berry WR. Creating a culture of safety by using checklists. AORN J. 2013;97(3):365-8. doi:10.1016/j.aorn.2012.12.019. Copy Citation Format: DOI Google Scholar PubMed BibTeX EndNot…

  5. Assessment of transparency of cost estimates in economic evaluations of patient safety programmes. | PSNet

    psnet.ahrq.gov/issue/assessment-transparency-cost-estimates-economic-evaluations-patient-safety-programmes
    January 15, 2009 - Review Assessment of transparency of cost estimates in economic evaluations of patient safety programmes. Citation Text: Fukuda H, Imanaka Y. Assessment of transparency of cost estimates in economic evaluations of patient safety programmes. J Eval Clin Pract. 2009;15(3):451-9. doi:10.111…

  6. Pump up the volume: how to prioritize events and analyze error data. | PSNet

    psnet.ahrq.gov/issue/pump-volume-how-prioritize-events-and-analyze-error-data
    March 14, 2023 - Newspaper/Magazine Article Pump up the volume: how to prioritize events and analyze error data. Citation Text: Pump up the volume: how to prioritize events and analyze error data. ISMP Medication Safety Alert! Acute care edition. February 9, 2023;28(3):1-4. Copy Citation …

  7. Pump up the volume: tips for increasing error reporting and decreasing patient harm. | PSNet

    psnet.ahrq.gov/issue/pump-volume-tips-increasing-error-reporting-and-decreasing-patient-harm
    January 27, 2021 - Newspaper/Magazine Article Pump up the volume: tips for increasing error reporting and decreasing patient harm. Citation Text: Pump up the volume: tips for increasing error reporting and decreasing patient harm. ISMP Medication Safety Alert! Acute care edition. August 26, 2021;26(17);1-5…

  8. Cancer drug shortages are creating dire circumstances for some patients. | PSNet

    psnet.ahrq.gov/issue/cancer-drug-shortages-are-creating-dire-circumstances-some-patients
    September 21, 2022 - Newspaper/Magazine Article Cancer drug shortages are creating dire circumstances for some patients. Citation Text: Cancer drug shortages are creating dire circumstances for some patients. Lovelace B, Jr, Kopf M. NBC. April 11, 2023. Copy Citation Save Save to yo…

  9. Latent and active failures perfectly align to allow a preventable adverse event to reach a patient. | PSNet

    psnet.ahrq.gov/issue/latent-and-active-failures-perfectly-align-allow-preventable-adverse-event-reach-patient
    March 14, 2023 - Newspaper/Magazine Article Latent and active failures perfectly align to allow a preventable adverse event to reach a patient. Citation Text: Latent and active failures perfectly align to allow a preventable adverse event to reach a patient. ISMP Medication Safety Alert! Acute care editi…

  10. Medication errors: the year in review. | PSNet

    psnet.ahrq.gov/issue/medication-errors-year-review
    May 02, 2018 - Newspaper/Magazine Article Medication errors: the year in review. Citation Text: Medication errors: the year in review. Valentine D, Ingram V, Fobi B et al. Pharmacy Practice News. September 10, 2019. Copy Citation Save Save to your library Print Down…

  11. With oral chemotherapy, we simply must do better! | PSNet

    psnet.ahrq.gov/issue/oral-chemotherapy-we-simply-must-do-better
    February 13, 2019 - Newspaper/Magazine Article With oral chemotherapy, we simply must do better! Citation Text: With oral chemotherapy, we simply must do better! ISMP Medication Safety Alert! Acute Care Edition. July 17, 2014;19:1-4. Copy Citation Save Save to your library Prin…

  12. The absence of a drug–disease interaction alert leads to a child's death. | PSNet

    psnet.ahrq.gov/issue/absence-drug-disease-interaction-alert-leads-childs-death
    July 08, 2015 - Newspaper/Magazine Article The absence of a drug–disease interaction alert leads to a child's death. Citation Text: The absence of a drug–disease interaction alert leads to a child's death. ISMP Medication Safety Alert! Acute Care Edition. May 21, 2015;20:1-4. Copy Citation …

  13. Unintended exposure in radiotherapy: identification of prominent causes. | PSNet

    psnet.ahrq.gov/issue/unintended-exposure-radiotherapy-identification-prominent-causes
    May 01, 2003 - Study Unintended exposure in radiotherapy: identification of prominent causes. Citation Text: Boadu M, Rehani MM. Unintended exposure in radiotherapy: identification of prominent causes. Radiother Oncol. 2009;93(3):609-17. doi:10.1016/j.radonc.2009.08.044. Copy Citation Format: …

  14. Handoffs: transitions of care for children in the emergency department. | PSNet

    psnet.ahrq.gov/issue/handoffs-transitions-care-children-emergency-department
    July 03, 2016 - Organizational Policy/Guidelines Handoffs: transitions of care for children in the emergency department. Citation Text: Handoffs: transitions of care for children in the emergency department. American Academy of Pediatrics Committee on Pediatric Emergency Medicine, American College of Em…

  15. Assessing residents' communication skills: disclosure of an adverse event to a standardized patient. | PSNet

    psnet.ahrq.gov/issue/assessing-residents-communication-skills-disclosure-adverse-event-standardized-patient
    December 21, 2016 - Study Assessing residents' communication skills: disclosure of an adverse event to a standardized patient. Citation Text: Posner G, Nakajima A. Assessing residents' communication skills: disclosure of an adverse event to a standardized patient. J Obstet Gynaecol Can. 2011;33(3):262-26…

  16. Causes of near misses: perceptions of perioperative nurses. | PSNet

    psnet.ahrq.gov/issue/causes-near-misses-perceptions-perioperative-nurses
    October 07, 2020 - Study Causes of near misses: perceptions of perioperative nurses. Citation Text: Cohoon B. Causes of near misses: perceptions of perioperative nurses. AORN J. 2011;93(5):551-65. doi:10.1016/j.aorn.2010.02.017. Copy Citation Format: DOI Google Scholar PubMed BibTeX EndNote…

  17. Preventing falls and fall-related injuries in health care facilities. | PSNet

    psnet.ahrq.gov/issue/preventing-falls-and-fall-related-injuries-health-care-facilities
    December 23, 2016 - Sentinel Event Alerts Preventing falls and fall-related injuries in health care facilities. Citation Text: Preventing falls and fall-related injuries in health care facilities. Sentinel Event Alert. September 28, 2015;(55):1-5. Copy Citation Save Save to your li…

  18. Tackling implicit bias in health care. | PSNet

    psnet.ahrq.gov/issue/tackling-implicit-bias-health-care
    December 01, 2021 - Commentary Tackling implicit bias in health care. Citation Text: Sabin JA. Tackling implicit bias in health care. N Engl J Med. 2022;387(2):105-107. doi:10.1056/nejmp2201180. Copy Citation Format: DOI Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged PubMedI…

  19. Preventing home medication errors. | PSNet

    psnet.ahrq.gov/issue/preventing-home-medication-errors
    September 15, 2021 - Audiovisual Presentation Preventing home medication errors. Citation Text: Preventing home medication errors. Shaikh U, van der List L, Blumberg D. Kids Considered. March 27, 2023. Copy Citation Save Save to your library Print Download PDF Shar…

  20. Quest for the ideal: a redesign of the medication use system. | PSNet

    psnet.ahrq.gov/issue/quest-ideal-redesign-medication-use-system
    September 16, 2020 - Commentary Quest for the ideal: a redesign of the medication use system. Citation Text: Dang D, Feroli R, Gill C, et al. Quest for the ideal: a redesign of the medication use system. J Nurs Care Qual. 2007;22(1):11-19. Copy Citation Format: Google Scholar PubMed BibTeX En…
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