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  1. Bias in radiology: the how and why of misses and misinterpretations. | PSNet

    psnet.ahrq.gov/issue/bias-radiology-how-and-why-misses-and-misinterpretations
    March 01, 2023 - Commentary Bias in radiology: the how and why of misses and misinterpretations. Citation Text: Busby LP, Courtier JL, Glastonbury CM. Bias in Radiology: The How and Why of Misses and Misinterpretations. Radiographics. 2018;38(1):236-247. doi:10.1148/rg.2018170107. Copy Citation For…

  2. Spike in fatal medication errors at the beginning of each month. | PSNet

    psnet.ahrq.gov/issue/spike-fatal-medication-errors-beginning-each-month
    January 26, 2022 - Study Spike in fatal medication errors at the beginning of each month. Citation Text: Phillips DP, Jarvinen JR, Phillips RR. A spike in fatal medication errors at the beginning of each month. Pharmacotherapy. 2005;25(1):1-9. Copy Citation Format: Google Scholar PubMed BibT…

  3. Using technology to promote perinatal patient safety. | PSNet

    psnet.ahrq.gov/issue/using-technology-promote-perinatal-patient-safety
    January 27, 2021 - Commentary Using technology to promote perinatal patient safety. Citation Text: McCartney PR. Using technology to promote perinatal patient safety. J Obstet Gynecol Neonatal Nurs. 2006;35(3):424-31. Copy Citation Format: Google Scholar PubMed BibTeX EndNote X3 XML EndNote…

  4. Finding the patient in patient safety. | PSNet

    psnet.ahrq.gov/issue/finding-patient-patient-safety
    November 17, 2014 - Commentary Finding the patient in patient safety. Citation Text: Hor S-Y, Godbold N, Collier A, et al. Finding the patient in patient safety. Health (London). 2013;17(6):567-83. doi:10.1177/1363459312472082. Copy Citation Format: DOI Google Scholar PubMed BibTeX EndNote X…

  5. Disclosure of medical errors: the right thing to do. | PSNet

    psnet.ahrq.gov/issue/disclosure-medical-errors-right-thing-do
    September 13, 2010 - Commentary Disclosure of medical errors: the right thing to do. Citation Text: Schuer KM, AAPA QCC of the. Disclosure of medical errors: the right thing to do. JAAPA. 2010;23(8):27-9. Copy Citation Format: Google Scholar PubMed BibTeX EndNote X3 XML EndNote 7 XML Endnote …

  6. Patient death after inadvertent infusion of PRN medication hanging on bedside intravenous (IV) pole. | PSNet

    psnet.ahrq.gov/issue/patient-death-after-inadvertent-infusion-prn-medication-hanging-bedside-intravenous-iv-pole
    April 17, 2024 - Newspaper/Magazine Article Patient death after inadvertent infusion of PRN medication hanging on bedside intravenous (IV) pole. Citation Text: Patient death after inadvertent infusion of PRN medication hanging on bedside intravenous (IV) pole. ISMP Medication Safety Alert! Acute Care. 20…

  7. Medical and surgical comanagement after elective hip and knee arthroplasty: a randomized, controlled trial. | PSNet

    psnet.ahrq.gov/issue/medical-and-surgical-comanagement-after-elective-hip-and-knee-arthroplasty-randomized
    January 22, 2014 - Study Medical and surgical comanagement after elective hip and knee arthroplasty: a randomized, controlled trial. Citation Text: Huddleston JM, Long KH, Naessens JM, et al. Medical and surgical comanagement after elective hip and knee arthroplasty: a randomized, controlled trial. Ann I…

  8. Metric units and the preferred dosing of orally administered liquid medications. | PSNet

    psnet.ahrq.gov/issue/metric-units-and-preferred-dosing-orally-administered-liquid-medications
    April 11, 2011 - Organizational Policy/Guidelines Metric units and the preferred dosing of orally administered liquid medications. Citation Text: Metric Units and the Preferred Dosing of Orally Administered Liquid Medications. doi:10.1542/peds.2015-0072. Copy Citation Format: DOI Google Sch…

  9. Level IV evidence—adverse anecdote and clinical practice. | PSNet

    psnet.ahrq.gov/issue/level-iv-evidence-adverse-anecdote-and-clinical-practice
    October 06, 2021 - Commentary Level IV evidence—adverse anecdote and clinical practice. Citation Text: Stuebe AM. Level IV evidence--adverse anecdote and clinical practice. N Engl J Med. 2011;365(1):8-9. doi:10.1056/NEJMp1102632. Copy Citation Format: DOI Google Scholar PubMed BibTeX EndNot…

  10. Learning from adverse events and near misses. | PSNet

    psnet.ahrq.gov/issue/learning-adverse-events-and-near-misses
    January 15, 2020 - Commentary Learning from adverse events and near misses. Citation Text: Greenberg CC. Learning from adverse events and near misses. J Gastrointest Surg. 2009;13(1):3-5. doi:10.1007/s11605-008-0693-6. Copy Citation Format: DOI Google Scholar PubMed BibTeX EndNote X3 XML En…

  11. The path to safe and reliable healthcare. | PSNet

    psnet.ahrq.gov/issue/path-safe-and-reliable-healthcare
    August 20, 2018 - Commentary The path to safe and reliable healthcare. Citation Text: Leonard MW, Frankel A. The path to safe and reliable healthcare. Patient Educ Couns. 2010;80(3). doi:10.1016/j.pec.2010.07.001. Copy Citation Format: DOI Google Scholar BibTeX EndNote X3 XML EndNote 7 XML…

  12. How a series of errors led to recurrent hypoglycemia. | PSNet

    psnet.ahrq.gov/issue/how-series-errors-led-recurrent-hypoglycemia
    April 23, 2014 - Commentary How a series of errors led to recurrent hypoglycemia. Citation Text: Singh R. How a series of errors led to recurrent hypoglycemia. J Fam Pract. 2006;55(6):489-97. Copy Citation Format: Google Scholar PubMed BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged Pu…

  13. Perioperative pharmacology: a framework for perioperative medication safety. | PSNet

    psnet.ahrq.gov/issue/perioperative-pharmacology-framework-perioperative-medication-safety
    December 19, 2012 - Commentary Perioperative pharmacology: a framework for perioperative medication safety. Citation Text: Hicks RW, Wanzer LJ, Goeckner BL. Perioperative Pharmacology: A Framework for Perioperative Medication Safety. AORN J. 2010;93(1):136-145. doi:10.1016/j.aorn.2010.08.020. Copy Citat…

  14. Tubing misconnections: normalization of deviance. | PSNet

    psnet.ahrq.gov/issue/tubing-misconnections-normalization-deviance
    December 16, 2015 - Review Tubing misconnections: normalization of deviance. Citation Text: Simmons D, Symes L, Guenter P, et al. Tubing misconnections: normalization of deviance. Nutr Clin Pract. 2011;26(3):286-293. doi:10.1177/0884533611406134. Copy Citation Format: DOI Google Scholar PubM…

  15. Trends in adverse events over time: why are we not improving? | PSNet

    psnet.ahrq.gov/issue/trends-adverse-events-over-time-why-are-we-not-improving
    October 02, 2019 - Commentary Trends in adverse events over time: why are we not improving? Citation Text: Shojania KG, Thomas EJ. Trends in adverse events over time: why are we not improving? BMJ Qual Saf. 2013;22(4):273-7. doi:10.1136/bmjqs-2013-001935. Copy Citation Format: DOI Google Sc…

  16. FDA Guidance Document: Hospital Bed System Dimensional and Assessment Guidance to Reduce Entrapment. | PSNet

    psnet.ahrq.gov/issue/fda-guidance-document-hospital-bed-system-dimensional-and-assessment-guidance-reduce
    July 01, 2009 - Organizational Policy/Guidelines FDA Guidance Document: Hospital Bed System Dimensional and Assessment Guidance to Reduce Entrapment. Citation Text: FDA Guidance Document: Hospital Bed System Dimensional and Assessment Guidance to Reduce Entrapment. Rockville MD: Center for Devices a…

  17. Reporting near-miss events in nursing homes. | PSNet

    psnet.ahrq.gov/issue/reporting-near-miss-events-nursing-homes
    January 24, 2018 - Commentary Reporting near-miss events in nursing homes. Citation Text: Wagner LM, Capezuti E, Ouslander JG. Reporting near-miss events in nursing homes. Nurs Outlook. 2006;54(2). doi:10.1016/j.outlook.2006.01.003. Copy Citation Format: DOI Google Scholar BibTeX EndNote X3…

  18. When should a leader apologize—and when not? | PSNet

    psnet.ahrq.gov/issue/when-should-leader-apologize-and-when-not
    October 07, 2020 - Commentary When should a leader apologize—and when not? Citation Text: Kellerman B. When should a leader apologize and when not? Harv Bus Rev. 2006;84(4):72-81; 148. Copy Citation Format: Google Scholar PubMed BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged PubMedId RI…

  19. Patient safety answers require outreach, in-reach, and partnerships. | PSNet

    psnet.ahrq.gov/issue/patient-safety-answers-require-outreach-reach-and-partnerships
    August 23, 2023 - Commentary Patient safety answers require outreach, in-reach, and partnerships. Citation Text: Burt HA. Patient Safety Answers Require Outreach, In-reach, and Partnerships. J Hosp Librariansh. 2011;11(4). doi:10.1080/15323269.2011.611436. Copy Citation Format: DOI Google …

  20. Medication bar coding: to scan or not to scan? | PSNet

    psnet.ahrq.gov/issue/medication-bar-coding-scan-or-not-scan
    October 19, 2022 - Commentary Medication bar coding: to scan or not to scan? Citation Text: Galvin L, McBeth S, Hasdorff C, et al. Medication bar coding: to scan or not to scan? Comput Inform Nurs. 2007;25(2):86-92. Copy Citation Format: Google Scholar PubMed BibTeX EndNote X3 XML EndNote 7…
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