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  1. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/43438/psn-pdf
    February 23, 2018 - Safety-I and Safety-II: The Past and Future of Safety Management. February 23, 2018 Hollnagel E. Aldershot, Hampshire, England: Ashgate; 2014. ISBN: 9781472423085. https://psnet.ahrq.gov/issue/safety-i-and-safety-ii-past-and-future-safety-management Historically, the approach to patient safety has been more reacti…
  2. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49431/psn-pdf
    January 01, 2004 - Although they can never be eliminated, they can be reduced by learning optimal decision-making strategies
  3. psnet.ahrq.gov/web-mm/cognitive-overload-icu
    June 01, 2005 - cannulation procedures (including cannula-over-wire ["Seldinger"] techniques and ultrasound guidance) have reduced
  4. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/857258/psn-pdf
    November 30, 2023 - Elimination is significantly increased in patients taking anticonvulsant medications and significantly reduced
  5. psnet.ahrq.gov/innovation/handshake-antimicrobial-stewardship-model-recognize-and-prevent-diagnostic-errors
    September 08, 2021 - EMERGING INNOVATIONS Handshake antimicrobial stewardship as a model to recognize and prevent diagnostic errors Citation Text: Searns JB, Williams MC, MacBrayne CE, et al. Handshake antimicrobial stewardship as a model to recognize and prevent diagnostic errors. Diagnosis (Berl). 2020;8(3):347-352.…
  6. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/33604/psn-pdf
    December 15, 2024 - Pharmacist's Role in Medication Safety December 15, 2024 The Pharmacist's Role in Medication Safety. PSNet [internet]. 2019. https://psnet.ahrq.gov/primer/pharmacists-role-medication-safety PSNet primers are regularly reviewed and updated by the UC Davis PSNet Editorial Team to ensure that they reflect current res…
  7. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/33748/psn-pdf
    April 01, 2013 - The net result can indeed be one where fatigue-related errors are reduced and handoff errors are not
  8. psnet.ahrq.gov/web-mm/double-dose-transfer
    November 01, 2012 - Double Dose at Transfer Citation Text: Hackman JL. Double Dose at Transfer. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2012. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged Pu…
  9. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/33631/psn-pdf
    April 01, 2006 - Count and Be Counted: Preparing Future Pharmacists to Promote a Culture of Safety April 1, 2006 Alldredge BK, Koda-Kimble MA. Count and Be Counted: Preparing Future Pharmacists to Promote a Culture of Safety. PSNet [internet]. 2006. https://psnet.ahrq.gov/perspective/count-and-be-counted-preparing-future-pharmacis…
  10. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49867/psn-pdf
    July 02, 2019 - Diuretics and Electrolyte Abnormalities July 2, 2019 Dreischulte T. Diuretics and Electrolyte Abnormalities. PSNet [internet]. 2019. https://psnet.ahrq.gov/web-mm/diuretics-and-electrolyte-abnormalities Case Objectives Recognize that thiazide diuretics can lead to serious adverse events. State how commonly used t…
  11. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/50393/psn-pdf
    September 01, 2019 - Patient Safety and the Evolution of WebM&M and PSNet September 1, 2019 Ranji SR, Wachter R. Patient Safety and the Evolution of WebM&M and PSNet. PSNet [internet]. 2019. https://psnet.ahrq.gov/perspective/patient-safety-and-evolution-webmm-and-psnet Perspective Progress in any field requires scholarship and dissem…
  12. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49387/psn-pdf
    February 01, 2003 - Patient Mix-Up February 1, 2003 Shojania KG. Patient Mix-Up. PSNet [internet]. 2003. https://psnet.ahrq.gov/web-mm/patient-mix The Case Joe Smith [not his real name], a 42-year-old man with nausea and vomiting for 4 days, was on the general medical service at an academic medical center. Overnight, another man wit…
  13. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/33761/psn-pdf
    February 01, 2014 - Interruptions and Distractions in Health Care: Improved Safety With Mindfulness February 1, 2014 Beyea SC. Interruptions and Distractions in Health Care: Improved Safety With Mindfulness. PSNet [internet]. 2014. https://psnet.ahrq.gov/perspective/interruptions-and-distractions-health-care-improved-safety-mindfulne…
  14. psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.362_slideshow.ppt
    December 01, 2015 - PowerPoint Presentation Spotlight Harm From Alarm Fatigue This presentation is based on the December 2015 AHRQ WebM&M Spotlight Case See the full article at https://psnet.ahrq.gov/webmm CME credit is available Commentary by: Michele M. Pelter, RN, PhD, and Barbara J. Drew, RN, PhD, University of California, San …
  15. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/33579/psn-pdf
    September 15, 2024 - Systems Approach September 15, 2024 Systems Approach. PSNet [internet]. 2019. https://psnet.ahrq.gov/primer/systems-approach PSNet primers are regularly reviewed and updated by the UC Davis PSNet Editorial Team to ensure that they reflect current research and practice in the patient safety field. Last reviewed in …
  16. psnet.ahrq.gov/innovation/combined-proactive-risk-assessment-cpra-4-step-technique-innovation-summary
    February 26, 2025 - Combined Proactive Risk Assessment (CPRA) – 4-Step Technique Innovation Summary Save Save to your library Print Download PDF Share Facebook Twitter Linkedin Copy URL February 26, 2025 Innovation Contact …
  17. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/865586/psn-pdf
    April 17, 2024 - Unmasking bias in artificial intelligence: a systematic review of bias detection and mitigation strategies in electronic health record-based models. April 17, 2024 Chen F, Wang L, Hong J, et al. Unmasking bias in artificial intelligence: a systematic review of bias detection and mitigation strategies in electronic…
  18. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/60646/psn-pdf
    July 01, 2020 - An integrative total worker health framework for keeping workers safe and healthy during the COVID-19 pandemic. July 1, 2020 Dennerlein JT, Burke L, Sabbath EL, et al. An Integrative Total Worker Health Framework for Keeping Workers Safe and Healthy During the COVID-19 Pandemic. Hum Factors. 2020;62(5):689–696. do…
  19. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/845074/psn-pdf
    March 02, 2011 - Preventable hospital admissions related to medication (HARM): cost analysis of the HARM study. March 2, 2011 Leendertse AJ, van den Bemt PMLA, Poolman JB, et al. Preventable hospital admissions related to medication (HARM): cost analysis of the HARM study. Value Health. 2011;14(1):34-40. doi:10.1016/j.jval.2010.10…
  20. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/857455/psn-pdf
    January 01, 2024 - Addressing veteran health-related social needs: how Joint Commission standards accelerated integration and expansion of tools and services in the Veterans Health Administration. December 6, 2023 List JM, Russell LE, Hausmann LRM, et al. Addressing veteran health-related social needs: how Joint Commission standard…

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