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psnet.ahrq.gov/node/73239/psn-pdf
May 12, 2021 - Patient factors associated with new prescribing of
potentially inappropriate medications in multimorbid US
older adults using multiple medications.
May 12, 2021
Jungo KT, Streit S, Lauffenburger JC. Patient factors associated with new prescribing of potentially
inappropriate medications in multimorbid US older adu…
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psnet.ahrq.gov/node/46103/psn-pdf
September 23, 2017 - Polypharmacy in the elderly--when good drugs lead to
bad outcomes: a teachable moment.
September 23, 2017
Carroll C, Hassanin A. Polypharmacy in the Elderly-When Good Drugs Lead to Bad Outcomes: A
Teachable Moment. JAMA Intern Med. 2017;177(6):871. doi:10.1001/jamainternmed.2017.0911.
https://psnet.ahrq.gov/issue/…
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psnet.ahrq.gov/node/866819/psn-pdf
September 25, 2024 - Machine learning to enhance electronic detection of
diagnostic errors.
September 25, 2024
Zimolzak AJ, Wei L, Mir U, et al. Machine learning to enhance electronic detection of diagnostic errors.
JAMA Netw Open. 2024;7(9):e2431982. doi:10.1001/jamanetworkopen.2024.31982.
https://psnet.ahrq.gov/issue/machine-learnin…
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psnet.ahrq.gov/node/73114/psn-pdf
April 07, 2021 - Clinical and financial implications of second-opinion
surgical pathology review.
April 7, 2021
Johnson SM, Samulski TD, O’Connor SM, et al. Clinical and financial implications of second-opinion
surgical pathology review. Am J Clin Pathol. 2021;156(4):559-568. doi:10.1093/ajcp/aqaa263.
https://psnet.ahrq.gov/issue/…
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psnet.ahrq.gov/node/43678/psn-pdf
April 22, 2015 - 'Connecting the dots': leveraging visual analytics to make
sense of patient safety event reports.
April 22, 2015
Ratwani RM, Fong A. 'Connecting the dots': leveraging visual analytics to make sense of patient safety
event reports. J Am Med Inform Assoc. 2015;22(2):312-7. doi:10.1136/amiajnl-2014-002963.
https://ps…
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psnet.ahrq.gov/node/47676/psn-pdf
December 19, 2018 - Assessment of attitudes toward deprescribing in older
Medicare beneficiaries in the United States.
December 19, 2018
Reeve E, Wolff JL, Skehan M, et al. Assessment of Attitudes Toward Deprescribing in Older Medicare
Beneficiaries in the United States. JAMA Intern Med. 2018;178(12):1673-1680.
doi:10.1001/jamaintern…
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psnet.ahrq.gov/node/35398/psn-pdf
February 24, 2011 - Residency work-hours reform: a cost analysis including
preventable adverse events.
February 24, 2011
Nuckols TK, Escarce JJ. Residency work-hours reform. A cost analysis including preventable adverse
events. J Gen Intern Med. 2005;20(10):873-8.
https://psnet.ahrq.gov/issue/residency-work-hours-reform-cost-analysis…
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psnet.ahrq.gov/node/837966/psn-pdf
September 01, 2022 - Barcode medication administration software technology
use in the emergency department and medication error
rates.
September 1, 2022
Gauthier-Wetzel HE. Barcode medication administration software technology use in the emergency
department and medication error rates. Comput Inform Nurs. 2022;40(6):382-388.
doi:10.1…
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psnet.ahrq.gov/node/46506/psn-pdf
October 11, 2017 - Getting Ahead of Harm Before It Happens: A Guide About
Proactive Analysis for Improving Surgical Care Safety.
October 11, 2017
Wiley K, Davies JM. Edmonton, AB: Canadian Patient Safety Institute; 2017.
https://psnet.ahrq.gov/issue/getting-ahead-harm-it-happens-guide-about-proactive-analysis-improving-
surgical-car…
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psnet.ahrq.gov/node/46042/psn-pdf
July 12, 2017 - Implementation science for ambulatory care safety: a
novel method to develop context-sensitive interventions
to reduce quality gaps in monitoring high-risk patients.
July 12, 2017
McDonald KM, Su G, Lisker S, et al. Implementation science for ambulatory care safety: a novel method to
develop context-sensitive inte…
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psnet.ahrq.gov/node/837672/psn-pdf
July 13, 2022 - Optimizing post-acute care patient safety: a scoping
review of multifactorial fall prevention interventions for
older adults.
July 13, 2022
Leland NE, Lekovitch C, Martínez J, et al. Optimizing post-acute care patient safety: a scoping review of
multifactorial fall prevention interventions for older adults. J Appl…
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psnet.ahrq.gov/node/836743/psn-pdf
March 16, 2022 - Surgeon burnout, impact on patient safety and
professionalism: a systematic review and meta-analysis.
March 16, 2022
Al-Ghunaim TA, Johnson J, Biyani CS, et al. Surgeon burnout, impact on patient safety and
professionalism: A systematic review and meta-analysis. Am J Surg. 2022;224(1 Pt A):228-238.
doi:10.1016/j.a…
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psnet.ahrq.gov/node/35516/psn-pdf
February 03, 2011 - Supplemental perioperative oxygen and the risk of
surgical wound infection: a randomized controlled trial.
February 3, 2011
Belda J, Aguilera L, de la Asunción JG, et al. Supplemental perioperative oxygen and the risk of surgical
wound infection: a randomized controlled trial. JAMA. 2005;294(16):2035-42.
https://p…
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psnet.ahrq.gov/node/73514/psn-pdf
July 21, 2021 - Association between limiting the number of open records
in a tele-critical care setting and retract-reorder errors.
July 21, 2021
Udeh C, Canfield C, Briskin I, et al. Association between limiting the number of open records in a tele-
critical care setting and retract–reorder errors. J Am Med Inform Assoc. 2021;28(…
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psnet.ahrq.gov/node/841477/psn-pdf
December 14, 2022 - Health system redesign of cardiac monitoring oversight
to optimize alarm management, safety, and staff
engagement.
December 14, 2022
Engel JR, Lindsay M, O'Brien S, et al. Health system redesign of cardiac monitoring oversight to optimize
alarm management, safety, and staff engagement. J Nurs Adm. 2022;52(10):511-…
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psnet.ahrq.gov/node/47745/psn-pdf
March 06, 2019 - "I am administering medication—please do not interrupt
me": red tabards preventing interruptions as perceived by
surgical patients.
March 6, 2019
Palese A, Ferro M, Pascolo M, et al. "I Am Administering Medication-Please Do Not Interrupt Me": Red
Tabards Preventing Interruptions as Perceived by Surgical Patients. …
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psnet.ahrq.gov/node/866859/psn-pdf
October 02, 2024 - Severe hypertension in pregnancy: progress made and
future directions for patient safety, quality improvement,
and implementation of a patient safety bundle.
October 2, 2024
Prior A, Taylor I, Gibson KS, et al. Severe hypertension in pregnancy: progress made and future directions
for patient safety, quality improv…
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psnet.ahrq.gov/node/48079/psn-pdf
June 12, 2019 - Evaluating the implementation and impact of a pharmacy
technician-supported medicines administration service
designed to reduce omitted doses in hospitals: a
qualitative study.
June 12, 2019
Seston EM, Ashcroft DM, Lamerton E, et al. Evaluating the implementation and impact of a pharmacy
technician-supported medi…
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psnet.ahrq.gov/web-mm/complicated-course-severe-alcohol-withdrawal-dexmedetomidine-infusion
June 14, 2023 - neuronal excitability, and thereby mimicking the neurodepressant effect of alcohol. 12,13 This mechanism reduces
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psnet.ahrq.gov/perspective/ahrq-psnet-annual-perspective-impact-covid-19-pandemic-patient-safety
August 31, 2020 - This strategy not only reduces unnecessary patient visits and unnecessary patient monitoring and socially