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psnet.ahrq.gov/issue/your-companys-secret-change-agents
June 09, 2021 - Commentary
Your company's secret change agents.
Citation Text:
Pascale RT, Sternin J. Your company's secret change agents. Harv Bus Rev. 2005;83(5):72-81, 153.
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psnet.ahrq.gov/issue/health-care-governance-quality-and-safety-new-agenda
August 09, 2023 - Review
Health care governance for quality and safety: the new agenda.
Citation Text:
Clough J, Nash DB. Health care governance for quality and safety: the new agenda. Am J Med Qual. 2007;22(3):203-13.
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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.
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psnet.ahrq.gov/issue/sleep-science-and-policy-change
September 21, 2022 - Commentary
Sleep, science, and policy change.
Citation Text:
Wylie D. Sleep, science, and policy change. N Engl J Med. 2005;352(2):196-7.
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psnet.ahrq.gov/issue/sample-sample-carryover-source-analytical-laboratory-error-and-its-relevance-integrated
January 12, 2022 - Study
Sample to sample carryover: a source of analytical laboratory error and its relevance to integrated clinical chemistry/immunoassay systems.
Citation Text:
Armbruster DA, Alexander DB. Sample to sample carryover: a source of analytical laboratory error and its relevance to integra…
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psnet.ahrq.gov/issue/medical-devices-and-patient-safety
February 22, 2012 - Commentary
Medical devices and patient safety.
Citation Text:
Mattox E. Medical devices and patient safety. Crit Care Nurse. 2012;32(4):60-8. doi:10.4037/ccn2012925.
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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.
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psnet.ahrq.gov/issue/common-formats-allow-uniform-collection-and-reporting-patient-safety-data-patient-safety
May 20, 2009 - Commentary
Common formats allow uniform collection and reporting of patient safety data by patient safety organizations.
Citation Text:
Clancy CM. Common Formats Allow Uniform Collection and Reporting of Patient Safety Data by Patient Safety Organizations. Am J Med Qual. 2009;25(1):73-…
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psnet.ahrq.gov/issue/measuring-patient-safety-emergency-department
June 29, 2011 - Commentary
Measuring patient safety in the emergency department.
Citation Text:
Pham JC, Alblaihed L, Cheung DS, et al. Measuring patient safety in the emergency department. Am J Med Qual. 2014;29(2):99-104. doi:10.1177/1062860613489846.
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psnet.ahrq.gov/issue/when-my-father-died
July 01, 2011 - Commentary
When my father died.
Citation Text:
Van Spall HGC. When my father died. Ann Intern Med. 2007;146(12):893-894.
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psnet.ahrq.gov/issue/revitalizing-established-rapid-response-team
September 23, 2020 - Commentary
Revitalizing an established rapid response team.
Citation Text:
Genardi ME, Cronin SN, Thomas LD. Revitalizing an established rapid response team. Dimens Crit Care Nurs. 2008;27(3):104-9. doi:10.1097/01.DCC.0000286837.95720.8c.
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psnet.ahrq.gov/issue/clinical-cognition-and-biomedical-informatics-issues-patient-safety
September 04, 2024 - Commentary
Clinical cognition and biomedical informatics: issues of patient safety.
Citation Text:
Patel VL, Currie L. Clinical cognition and biomedical informatics: Issues of patient safety. Int J Med Inform. 2005;74(11-12). doi:10.1016/j.ijmedinf.2005.07.009.
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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.
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/quality-resources/tools/cauti-ltc/modules/resources/tools/engage/rfe-role-leader.pdf
March 01, 2017 - Resident and Family Engagement: What is my role as a leader?
• Resident and family engagement is one
component of person-centered care, a
philosophy that recognizes residents as
individuals and as partners.
• Effective resident and family partnerships are
demonstrated by including the residents and
family a…
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psnet.ahrq.gov/issue/medication-safety-issue-brief-look-alike-sound-alike-drugs
June 17, 2014 - Newspaper/Magazine Article
Medication safety issue brief. Look-alike, sound-alike drugs.
Citation Text:
Association AH, Pharmacists AS of H-S, Networks H & H. Medication safety issue brief, look-alike, sound-alike drugs. Hospitals and Health Networks. October 2005;79(10):57-58.
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digital.ahrq.gov/program-overview/research-stories/safer-inter-hospital-transfers-improving-access-health
January 01, 2023 - Safer Inter-Hospital Transfers by Improving Access to Health Information
Theme:
Supporting Health Systems in Advancing Care Delivery
Subtheme:
Using Digital Healthcare Tools to Improve Patient Safety
An enhanced health information exchange platform that improves workflow, interoperability,…
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integrationacademy.ahrq.gov/news-and-events/calendar/event/23088
January 29, 2025 - An official website of the Department of Health & Human Services
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psnet.ahrq.gov/issue/safe-practices-better-healthcare-2009-update
September 29, 2017 - Multi-use Website
Safe Practices for Better Healthcare–2009 Update.
Citation Text:
Safe Practices for Better Healthcare–2009 Update. National Quality Forum. Washington, DC: National Quality Forum; 2009.
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psnet.ahrq.gov/issue/error-reduction-health-care-systems-approach-improving-patient-safety-2nd-edition
May 06, 2016 - Book/Report
Classic
Error Reduction in Health Care: A Systems Approach to Improving Patient Safety, Second edition.
Citation Text:
Error Reduction in Health Care: A Systems Approach to Improving Patient Safety, Second edition. Spath PL, ed. San Francisco, CA: Jo…
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digital.ahrq.gov/organization/university-washington
January 01, 2023 - University of Washington
Preventing Medication-Related Problems in Care Transitions to Skilled Nursing Facilities
Description
This research aims to determine the effectiveness of a program designed to reduce medication-related issues among patients during the hospital-to-skill…