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psnet.ahrq.gov/issue/safety-mind-mental-health-services-and-patient-safety
August 07, 2018 - Book/Report
With Safety in Mind: Mental Health Services and Patient Safety.
Citation Text:
With Safety in Mind: Mental Health Services and Patient Safety. Scobie S, Minghella E, Dale C, et al. London, UK: National Patient Safety Agency; 2006.
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psnet.ahrq.gov/issue/complications-surgery-root-cause-analysis-and-preventive-measures
November 24, 2021 - Commentary
Complications in surgery: root cause analysis and preventive measures.
Citation Text:
Chung KC, Kotsis S. Complications in surgery: root cause analysis and preventive measures. Plast Reconstr Surg. 2012;129(6):1421-1427. doi:10.1097/PRS.0b013e31824ecda0.
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psnet.ahrq.gov/issue/problem-5-whys
July 19, 2023 - Commentary
The problem with the '5 whys.'
Citation Text:
Card AJ. The problem with '5 whys'. BMJ Qual Saf. 2017;26(8):671-677. doi:10.1136/bmjqs-2016-005849.
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psnet.ahrq.gov/issue/she-hoped-shine-light-maternal-mortality-among-native-americans-instead-she-became-statistic
July 22, 2020 - Newspaper/Magazine Article
She hoped to shine a light on maternal mortality among Native Americans. Instead, she became a statistic of it.
Citation Text:
She hoped to shine a light on maternal mortality among Native Americans. Instead, she became a statistic of it. Chuck E, Assefa H. N…
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psnet.ahrq.gov/issue/observational-study-evaluate-usability-and-intent-adopt-artificial-intelligence-powered
September 27, 2017 - Study
An observational study to evaluate the usability and intent to adopt an artificial intelligence–powered medication reconciliation tool.
Citation Text:
Long J, Yuan MJ, Poonawala R. An Observational Study to Evaluate the Usability and Intent to Adopt an Artificial Intelligence-Power…
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psnet.ahrq.gov/issue/caregiver-perspectives-safety-home-dementia-care
January 20, 2010 - Study
Caregiver perspectives on safety in home dementia care.
Citation Text:
Lach HW, Chang Y-P. Caregiver perspectives on safety in home dementia care. West J Nurs Res. 2007;29(8):993-1014.
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psnet.ahrq.gov/issue/closing-disclosure-gap-medical-errors-pediatrics
March 30, 2022 - Review
Closing the disclosure gap: medical errors in pediatrics.
Citation Text:
Lin M, Famiglietti H. Closing the Disclosure Gap: Medical Errors in Pediatrics. Pediatrics. 2019;143(4). doi:10.1542/peds.2019-0221.
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psnet.ahrq.gov/issue/delineation-risk-through-exploration-culture-safety-community-home-health
December 04, 2016 - Study
Delineation of risk through the exploration of a culture of safety in community home health.
Citation Text:
Stevenson L, McRae C, Mughal WA. Delineation of Risk Through the Exploration of a Culture of Safety in Community Home Health. Home Health Care Manag Pract. 2007;19(6). doi:…
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psnet.ahrq.gov/issue/eradicating-central-line-associated-bloodstream-infections-statewide-hawaii-experience
January 15, 2014 - Study
Eradicating central line–associated bloodstream infections statewide: the Hawaii experience.
Citation Text:
Lin D, Weeks K, Bauer L, et al. Eradicating Central Line–Associated Bloodstream Infections Statewide. American Journal of Medical Quality. 2011;27(2). doi:10.1177/106286061…
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psnet.ahrq.gov/issue/risk-factors-preventable-adverse-drug-events-pediatric-outpatients
December 15, 2011 - Study
Risk factors in preventable adverse drug events in pediatric outpatients.
Citation Text:
Zandieh SO, Goldmann DA, Keohane C, et al. Risk factors in preventable adverse drug events in pediatric outpatients. J Pediatr. 2008;152(2):225-31. doi:10.1016/j.jpeds.2007.09.054.
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psnet.ahrq.gov/issue/utilizing-systems-and-design-thinking-approach-improving-well-being-within-health
March 10, 2021 - Book/Report
Utilizing a Systems and Design Thinking Approach for Improving Well-Being Within Health Professional Education and Health Care.
Citation Text:
Utilizing a Systems and Design Thinking Approach for Improving Well-Being Within Health Professional Education and Health Care. Kreit…
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psnet.ahrq.gov/issue/using-opportunity-estimator-tool-improve-engagement-quality-and-safety-intervention
August 25, 2010 - Commentary
Using the opportunity estimator tool to improve engagement in a quality and safety intervention.
Citation Text:
Duval-Arnould J, Mathews SC, Weeks K, et al. Using the Opportunity Estimator tool to improve engagement in a quality and safety intervention. Jt Comm J Qual Patien…
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psnet.ahrq.gov/issue/problem-plan-do-study-act-cycles
June 26, 2019 - Commentary
The problem with Plan-Do-Study-Act cycles.
Citation Text:
Reed JE, Card AJ. The problem with Plan-Do-Study-Act cycles. BMJ Qual Saf. 2016;25(3):147-52. doi:10.1136/bmjqs-2015-005076.
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psnet.ahrq.gov/issue/variability-and-quality-medication-container-labels
March 04, 2009 - Study
The variability and quality of medication container labels.
Citation Text:
Shrank WH, Agnew-Blais J, Choudhry NK, et al. The variability and quality of medication container labels. Arch Intern Med. 2007;167(16):1760-1765.
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psnet.ahrq.gov/issue/risk-adverse-drug-events-and-hospital-related-morbidity-and-mortality-among-older-adults
October 10, 2012 - Study
The risk of adverse drug events and hospital-related morbidity and mortality among older adults with potentially inappropriate medication use.
Citation Text:
Page RL, Ruscin M. The risk of adverse drug events and hospital-related morbidity and mortality among older adults with po…
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psnet.ahrq.gov/issue/improving-safety-culture-results-rhode-island-icus-lessons-learned-development-action
September 17, 2010 - Study
Improving safety culture results in Rhode Island ICUs: lessons learned from the development of action-oriented plans.
Citation Text:
Vigorito MC, McNicoll L, Adams L, et al. Improving safety culture results in Rhode Island ICUs: lessons learned from the development of action-orie…
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psnet.ahrq.gov/issue/recommendations-and-low-technology-safety-solutions-following-neuromuscular-blocking-agent
October 02, 2024 - Commentary
Recommendations and low-technology safety solutions following neuromuscular blocking agent incidents.
Citation Text:
Graudins L, Downey G, Bui T, et al. Recommendations and Low-Technology Safety Solutions Following Neuromuscular Blocking Agent Incidents. Jt Comm J Qual Patient…
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psnet.ahrq.gov/issue/building-safer-systems-ecological-design-using-restoration-science-develop-medication-safety
February 14, 2024 - Study
Building safer systems by ecological design: using restoration science to develop a medication safety intervention.
Citation Text:
Marck PB, Kwan JA, Preville B, et al. Building safer systems by ecological design: using restoration science to develop a medication safety intervent…
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psnet.ahrq.gov/issue/unprofessional-behavior-leads-complications
October 31, 2023 - Audiovisual Presentation
Unprofessional Behavior Leads to Complications.
Citation Text:
Unprofessional Behavior Leads to Complications. JN Learning. 2020.
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psnet.ahrq.gov/issue/case-studies-patient-safety-research-classics-build-research-capacity-low-and-middle-income
September 29, 2017 - Study
Case studies of patient safety research classics to build research capacity in low- and middle-income countries.
Citation Text:
Andermann A, Wu AW, Lashoher A, et al. Case studies of patient safety research classics to build research capacity in low- and middle-income countries. …