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  1. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/837335/psn-pdf
    June 08, 2022 - Root cause analysis using the prevention and recovery information system for monitoring and analysis method in healthcare facilities: a systematic literature review. June 8, 2022 Driesen BEJM, Baartmans M, Merten H, et al. Root cause analysis using the prevention and recovery information system for monitoring and …
  2. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/838127/psn-pdf
    September 21, 2022 - Opioid dependence and overdose after surgery: rate, risk factors, and reasons. September 21, 2022 Wylie JA, Kong L, Barth RJ. Opioid dependence and overdose after surgery: rate, risk factors, and reasons. Ann Surg. 2022;276(3):e192-e198. doi:10.1097/sla.0000000000005546. https://psnet.ahrq.gov/issue/opioid-depende…
  3. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/852455/psn-pdf
    August 16, 2023 - A quality improvement initiative to improve pediatric discharge medication safety and efficiency. August 16, 2023 Ring LM, Cinotti J, Hom LA, et al. A quality improvement initiative to improve pediatric discharge medication safety and efficiency. Pediatr Qual Saf. 2023;8(4):e671. doi:10.1097/pq9.0000000000000671. …
  4. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/845652/psn-pdf
    March 14, 2023 - Controlled substance drug diversion by healthcare workers as a threat to patient safety. March 14, 2023 ISMP Medication Safety Alert! Acute care edition. February 23, 2023;28(4):1-4; March 9, 2023:28(5):1-4. https://psnet.ahrq.gov/issue/controlled-substance-drug-diversion-healthcare-workers-threat-patient-safety D…
  5. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/38579/psn-pdf
    February 18, 2011 - Transitions of Care Consensus Policy Statement American College of Physicians-Society of General Internal Medicine-Society of Hospital Medicine-American Geriatrics Society-American College of Emergency Physicians-Society of Academic Emergency Medicine. February 18, 2011 Snow V, Beck D, Budnitz T, et al. Transitio…
  6. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/44202/psn-pdf
    June 10, 2015 - Medication reconciliation to facilitate transitions of care after hospitalization. June 10, 2015 Liu VC, Garwood CL. Medication reconciliation to facilitate transitions of care after hospitalization. Am J Health Syst Pharm. 2015;72(9):690-693. doi:10.2146/ajhp140133. https://psnet.ahrq.gov/issue/medication-reconci…
  7. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/838240/psn-pdf
    October 05, 2022 - Potentially inappropriate prescribing for adults living with diabetes mellitus: a scoping review. October 5, 2022 Ayalew MB, Spark MJ, Quirk F, et al. Potentially inappropriate prescribing for adults living with diabetes mellitus: a scoping review. Int J Clin Pharm. 2022;44(4):860-872. doi:10.1007/s11096-022-01414-…
  8. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/74074/psn-pdf
    November 17, 2021 - How safe is prehospital care? A systematic review. November 17, 2021 O’Connor P, O’malley R, Lambe KA, et al. How safe is prehospital care? A systematic review. Int J Qual Health Care. 2021;33(4):mzab138. doi:10.1093/intqhc/mzab138. https://psnet.ahrq.gov/issue/how-safe-prehospital-care-systematic-review Patient s…
  9. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/851065/psn-pdf
    June 28, 2023 - Patient safety of perioperative medication through the lens of digital health and artificial intelligence. June 28, 2023 Ye J. Patient safety of perioperative medication through the lens of digital health and artificial intelligence. JMIR Periop Med. 2023;6:e34453. doi:10.2196/34453. https://psnet.ahrq.gov/issue/p…
  10. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/60730/psn-pdf
    January 01, 2021 - A machine learning approach to reclassifying miscellaneous patient safety event reports. July 29, 2020 Fong A, Behzad S, Pruitt Z, et al. A machine learning approach to reclassifying miscellaneous patient safety event reports. J Patient Saf. 2021;17(8):e829-e833. doi:10.1097/pts.0000000000000731. https://psnet.ahr…
  11. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/47631/psn-pdf
    March 27, 2019 - Assessing the effectiveness of engaging patients and their families in the three-step fall prevention process across modalities of an evidence-based fall prevention toolkit: an implementation science study. March 27, 2019 Duckworth M, Adelman JS, Belategui K, et al. Assessing the Effectiveness of Engaging Patients…
  12. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/46099/psn-pdf
    May 31, 2017 - A quality improvement approach to standardization and sustainability of the hand-off process. May 31, 2017 Fryman C, Hamo C, Raghavan S, et al. A Quality Improvement Approach to Standardization and Sustainability of the Hand-off Process. BMJ Qual Improv Rep. 2017;6(1). doi:10.1136/bmjquality.u222156.w8291. https:…
  13. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/863760/psn-pdf
    March 06, 2024 - Imagining improved interactions: patients' designs to address implicit bias. March 6, 2024 Yang C, Coney L, Mohanraj D, et al. AMIA Annu Symp Proc. 2023;2023:774-783. https://psnet.ahrq.gov/issue/imagining-improved-interactions-patients-designs-address-implicit-bias Implicit biases can compromise decision making a…
  14. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/853612/psn-pdf
    September 20, 2023 - Pharmacy e-prescription dispensing before and after CancelRx implementation. September 20, 2023 Pitts SI, Olson S, Yanek LR, et al. Pharmacy e-prescription dispensing before and after CancelRx implementation. JAMA Intern Med. 2023;183(10):1120-1126. doi:10.1001/jamainternmed.2023.4192. https://psnet.ahrq.gov/issue…
  15. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/43311/psn-pdf
    July 02, 2014 - Some IV medications are diluted unnecessarily in patient care areas, creating undue risk. July 2, 2014 ISMP Medication Safety Alert! Acute Care Edition. June 19, 2014;19:1-5. https://psnet.ahrq.gov/issue/some-iv-medications-are-diluted-unnecessarily-patient-care-areas-creating- undue-risk This newsletter article …
  16. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/42916/psn-pdf
    February 05, 2014 - Are autopsy findings still relevant to the management of critically ill patients in the modern era? February 5, 2014 Fröhlich S, Ryan O, Murphy N, et al. Are autopsy findings still relevant to the management of critically ill patients in the modern era? Crit Care Med. 2014;42(2):336-43. doi:10.1097/CCM.0b013e3182a2…
  17. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/45292/psn-pdf
    September 07, 2016 - Electronic approaches to making sense of the text in the adverse event reporting system. September 7, 2016 Benin AL, Fodeh SJ, Lee K, et al. Electronic approaches to making sense of the text in the adverse event reporting system. J Healthc Risk Manag. 2016;36(2):10-20. doi:10.1002/jhrm.21237. https://psnet.ahrq.go…
  18. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/45996/psn-pdf
    May 10, 2017 - Evaluation of medication-related clinical decision support alert overrides in the intensive care unit. May 10, 2017 Wong A, Amato MG, Seger DL, et al. Evaluation of medication-related clinical decision support alert overrides in the intensive care unit. J Crit Care. 2017;39:156-161. doi:10.1016/j.jcrc.2017.02.027. …
  19. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/837059/psn-pdf
    May 11, 2022 - Anti-black racism as a chronic condition. May 11, 2022 Sederstrom N, Lasege T. Anti-black racism as a chronic condition. Hastings Cent Rep. 2022;52(S1):s24- s29. doi:10.1002/hast.1364. https://psnet.ahrq.gov/issue/anti-black-racism-chronic-condition Racial bias and systemic racism in healthcare are increasingly se…
  20. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/47823/psn-pdf
    March 13, 2019 - Greater Focus on Credentialing Needed to Prevent Disqualified Providers From Delivering Patient Care. March 13, 2019 Washington, DC: United States Government Accountability Office; February 2019. Publication GAO-19-6. https://psnet.ahrq.gov/issue/greater-focus-credentialing-needed-prevent-disqualified-providers-del…