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psnet.ahrq.gov/issue/evaluation-contextual-influences-medication-administration-practice-paediatric-nurses
January 20, 2021 - Study
Evaluation of contextual influences on the medication administration practice of paediatric nurses.
Citation Text:
Davis L, Ware R, McCann D, et al. Evaluation of contextual influences on the medication administration practice of paediatric nurses. J Adv Nurs. 2009;65(6):1293-9. …
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psnet.ahrq.gov/issue/getting-underuse-interpreters-resident-physicians
February 21, 2018 - Study
Getting by: underuse of interpreters by resident physicians.
Citation Text:
Diamond LC, Schenker Y, Curry LA, et al. Getting by: underuse of interpreters by resident physicians. J Gen Intern Med. 2009;24(2):256-62. doi:10.1007/s11606-008-0875-7.
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psnet.ahrq.gov/issue/leaving-patients-their-own-devices-smart-technology-safety-and-therapeutic-relationships
December 04, 2024 - Commentary
Emerging Classic
Leaving patients to their own devices? Smart technology, safety and therapeutic relationships.
Citation Text:
Ho A, Quick O. Leaving patients to their own devices? Smart technology, safety and therapeutic relationships. BMC Med Ethics…
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psnet.ahrq.gov/issue/consensus-bundle-prevention-surgical-site-infections-after-major-gynecologic-surgery
January 15, 2014 - Commentary
Consensus bundle on prevention of surgical site infections after major gynecologic surgery.
Citation Text:
Pellegrini JE, Toledo P, Soper DE, et al. Consensus Bundle on Prevention of Surgical Site Infections After Major Gynecologic Surgery. Obstet Gynecol. 2017;129(1):50-61. d…
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psnet.ahrq.gov/issue/board-pharmacy-practices-related-medication-errors-and-their-potential-impact-patient-safety
December 20, 2017 - Study
Board of pharmacy practices related to medication errors and their potential impact on patient safety.
Citation Text:
Degnan DD, Hertig JB, Peters MJ, et al. Board of Pharmacy Practices Related to Medication Errors and Their Potential Impact on Patient Safety. J Pharm Pract. 2018;3…
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psnet.ahrq.gov/issue/high-reliability-pediatric-heart-centers-always-working-toward-getting-better
September 18, 2024 - Commentary
High reliability pediatric heart centers: always working toward getting better.
Citation Text:
Torzone A, Birely A. High reliability pediatric heart centers: always working toward getting better. Curr Opin Cardiol. 2024;39(4):356-363. doi:10.1097/hco.0000000000001143.
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psnet.ahrq.gov/node/33565/psn-pdf
September 01, 2024 - Healthcare-associated Infections
June 15, 2024
Healthcare - Associated Infections. PSNet [internet]. 2019.
https://psnet.ahrq.gov/primer/health-care-associated-infections
PSNet primers are regularly reviewed and updated by the UC Davis PSNet Editorial Team to ensure that
they reflect current research and practice …
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psnet.ahrq.gov/node/866847/psn-pdf
September 25, 2024 - In Conversation with Carole Stockmeier about Zero Harm:
Striving to Reduce Preventable Harms – Point,
Counterpoint, and Areas of Agreement
September 25, 2024
Stockmeier CA, Mossburg S, Lee M. In Conversation with Carole Stockmeier about Zero Harm: Striving to
Reduce Preventable Harms – Point, Counterpoint, and Are…
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psnet.ahrq.gov/node/49439/psn-pdf
March 01, 2004 - Lethal Cap
March 1, 2004
Schillinger D. Lethal Cap. PSNet [internet]. 2004.
https://psnet.ahrq.gov/web-mm/lethal-cap
The Case
A 9-month-old child was seen by her pediatrician for a fever and decreased appetite. She was found to
have otitis media and was prescribed amoxicillin. The doctor gave the first dose to th…
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psnet.ahrq.gov/node/49868/psn-pdf
July 02, 2019 - Delayed Clozapine Prescription in an Elderly Man With
Dementia
July 2, 2019
Tsourounis C, Ghomeshi KK. Delayed Clozapine Prescription in an Elderly Man With Dementia. PSNet
[internet]. 2019.
https://psnet.ahrq.gov/web-mm/delayed-clozapine-prescription-elderly-man-dementia
The Case
An 86-year-old man with neurode…
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psnet.ahrq.gov/node/43176/psn-pdf
July 03, 2014 - Patient safety in the era of the 80-hour workweek.
July 3, 2014
Shelton J, Kummerow K, Phillips S, et al. Patient safety in the era of the 80-hour workweek. J Surg Educ.
2014;71(4):551-9. doi:10.1016/j.jsurg.2013.12.011.
https://psnet.ahrq.gov/issue/patient-safety-era-80-hour-workweek
Regulations intended to reduc…
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psnet.ahrq.gov/node/72709/psn-pdf
February 03, 2021 - COVID-19 hospital outbreaks: protecting healthcare
workers to protect frail patients. An Italian observational
cohort study.
February 3, 2021
Vimercati L, De Maria L, Quarato M, et al. COVID-19 hospital outbreaks: Protecting healthcare workers to
protect frail patients. An Italian observational cohort study. Int J…
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psnet.ahrq.gov/node/865708/psn-pdf
May 01, 2024 - Missed nursing care in surgical care- a hazard to patient
safety: a quantitative study within the inCHARGE
programme.
May 1, 2024
Edfeldt K, Nyholm L, Jangland E, et al. Missed nursing care in surgical care– a hazard to patient safety: a
quantitative study within the inCHARGE programme. BMC Nurs. 2024;23(1):233. d…
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psnet.ahrq.gov/node/866686/psn-pdf
September 11, 2024 - Impact of automated alerts on discharge opioid
overprescribing after general surgery.
September 11, 2024
Rizk E, Kaur N, Duong PY, et al. Impact of automated alerts on discharge opioid overprescribing after
general surgery. Am J Health Syst Pharm. 2024;81(24):1288-1296. doi:10.1093/ajhp/zxae185.
https://psnet.ahrq…
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psnet.ahrq.gov/node/46531/psn-pdf
January 24, 2019 - Tracking progress in improving diagnosis: a framework
for defining undesirable diagnostic events.
January 24, 2019
Olson A, Graber ML, Singh H. Tracking Progress in Improving Diagnosis: A Framework for Defining
Undesirable Diagnostic Events. J Gen Intern Med. 2018;33(7):1187-1191. doi:10.1007/s11606-018-4304-2.
ht…
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psnet.ahrq.gov/node/45959/psn-pdf
June 29, 2017 - Impact of the Opioid Safety Initiative on opioid-related
prescribing in veterans.
June 29, 2017
Lin LA, Bohnert ASB, Kerns RD, et al. Impact of the Opioid Safety Initiative on opioid-related prescribing in
veterans. Pain. 2017;158(5):833-839. doi:10.1097/j.pain.0000000000000837.
https://psnet.ahrq.gov/issue/impact…
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psnet.ahrq.gov/node/46111/psn-pdf
May 17, 2017 - Implementation and adaptation of the Re-Engineered
Discharge (RED) in five California hospitals: a qualitative
research study.
May 17, 2017
Mitchell SE, Weigel GM, Laurens V, et al. Implementation and adaptation of the Re-Engineered Discharge
(RED) in five California hospitals: a qualitative research study. BMC He…
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psnet.ahrq.gov/node/40982/psn-pdf
March 23, 2012 - Emergency hospitalizations for adverse drug events in
older Americans.
March 23, 2012
Budnitz DS, Lovegrove MC, Shehab N, et al. Emergency hospitalizations for adverse drug events in older
Americans. New Engl J Med. 2011;365(21):2002-2012. doi:10.1056/NEJMsa1103053.
https://psnet.ahrq.gov/issue/emergency-hospitali…
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psnet.ahrq.gov/node/38886/psn-pdf
August 26, 2009 - Medication overdoses leading to emergency department
visits among children.
August 26, 2009
Schillie SF, Shehab N, Thomas KE, et al. Medication overdoses leading to emergency department visits
among children. Am J Prev Med. 2009;37(3):181-7. doi:10.1016/j.amepre.2009.05.018.
https://psnet.ahrq.gov/issue/medication…
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psnet.ahrq.gov/node/72567/psn-pdf
December 16, 2020 - Transforming the medication regimen review process
using telemedicine to prevent adverse events.
December 16, 2020
Kane?Gill SL, Wong A, Culley CM, et al. Transforming the medication regimen review process using
telemedicine to prevent adverse events. J Am Geriatr Soc. 2020;69(2):530-538. doi:10.1111/jgs.16946.
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