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psnet.ahrq.gov/node/47069/psn-pdf
June 18, 2021 - Physical and verbal violence against health care workers.
June 18, 2021
Physical and verbal violence against health care workers. Sentinel Event Alert. 2018;59:1-9 (revised June
18, 2021).
https://psnet.ahrq.gov/issue/physical-and-verbal-violence-against-health-care-workers
The Joint Commission issues sentinel eve…
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psnet.ahrq.gov/node/44556/psn-pdf
December 23, 2016 - Preventing falls and fall-related injuries in health care
facilities.
December 23, 2016
Sentinel Event Alert. September 28, 2015;(55):1-5.
https://psnet.ahrq.gov/issue/preventing-falls-and-fall-related-injuries-health-care-facilities
Falls in the hospital are common, particularly among elderly patients, and falls …
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psnet.ahrq.gov/node/50443/psn-pdf
October 09, 2019 - Medicare's Hospital-Acquired Condition Reduction
Program and community diversity in the United States:
the need to account for racial and ethnic segregation.
October 9, 2019
Hamadi H, Tafili A, Apatu E, et al. Medicare' Hospital-Acquired Condition Reduction Program and
Community Diversity in the United States: The…
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psnet.ahrq.gov/node/865969/psn-pdf
May 29, 2024 - Impact of pharmacist-led interventions on medication-
related problems among patients treated for cancer: a
systematic review and meta-analysis of randomized
control trials.
May 29, 2024
Fentie AM, Huluka SA, Gebremariam GT, et al. Impact of pharmacist-led interventions on medication-
related problems among patie…
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psnet.ahrq.gov/node/42419/psn-pdf
July 17, 2013 - Health IT Patient Safety Action and Surveillance Plan.
July 17, 2013
Washington, DC: Office of the National Coordinator for Health Information Technology; July 2, 2013.
https://psnet.ahrq.gov/issue/health-it-patient-safety-action-and-surveillance-plan
This report from the Department of Health and Human Services (HH…
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psnet.ahrq.gov/node/72568/psn-pdf
January 01, 2021 - Alternatives to opioid education and a prescription drug
monitoring program cumulatively decreased outpatient
opioid prescriptions.
December 16, 2020
Sigal A, Shah A, Onderdonk A, et al. Alternatives to opioid education and a prescription drug monitoring
program cumulatively decreased outpatient opioid prescriptio…
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psnet.ahrq.gov/node/45701/psn-pdf
December 21, 2016 - Clinical decision support for drug related events: moving
towards better prevention.
December 21, 2016
Kane-Gill SL, Achanta A, Kellum JA, et al. Clinical decision support for drug related events: Moving towards
better prevention. World J Crit Care Med. 2016;5(4):204-211.
https://psnet.ahrq.gov/issue/clinical-deci…
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psnet.ahrq.gov/node/74725/psn-pdf
February 02, 2022 - A retrospective audit of postoperative days alive and out
of hospital, including before and after implementation of
the WHO surgical safety checklist.
February 2, 2022
Moore MR, Mitchell SJ, Weller JM, et al. A retrospective audit of postoperative days alive and out of
hospital, including before and after implemen…
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psnet.ahrq.gov/node/865585/psn-pdf
April 17, 2024 - Estimating the impact on patient safety of enabling the
digital transfer of patients' prescription information in the
English NHS.
April 17, 2024
Camacho EM, Gavan S, Keers RN, et al. Estimating the impact on patient safety of enabling the digital
transfer of patients’ prescription information in the English NHS. …
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psnet.ahrq.gov/node/61021/psn-pdf
October 14, 2020 - Deficiencies in provider-reported interpreter use in a
clinical trial comparing telephonic and video
interpretation in a pediatric emergency department.
October 14, 2020
Gutman CK, Klein EJ, Follmer K, et al. Deficiencies in provider-reported interpreter use in a clinical trial
comparing telephonic and video inter…
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psnet.ahrq.gov/node/45700/psn-pdf
September 01, 2018 - Resolving malpractice claims after tort reform: experience
in a self-insured Texas public academic health system.
September 1, 2018
Sage WM, Harding MC, Thomas EJ. Resolving Malpractice Claims after Tort Reform: Experience in a Self-
Insured Texas Public Academic Health System. Health Serv Res. 2016;51 Suppl 3:2615…
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psnet.ahrq.gov/node/42832/psn-pdf
September 01, 2016 - Overrides of medication-related clinical decision support
alerts in outpatients.
September 1, 2016
Nanji KC, Slight SP, Seger DL, et al. Overrides of medication-related clinical decision support alerts in
outpatients. J Am Med Inform Assoc. 2014;21(3):487-91. doi:10.1136/amiajnl-2013-001813.
https://psnet.ahrq.gov…
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psnet.ahrq.gov/node/36997/psn-pdf
June 29, 2011 - Dispensing errors in community pharmacy: perceived
influence of sociotechnical factors.
June 29, 2011
Szeinbach S, Seoane-Vazquez E, Parekh A, et al. Dispensing errors in community pharmacy: perceived
influence of sociotechnical factors. Int J Qual Health Care. 2007;19(4):203-9.
https://psnet.ahrq.gov/issue/dispen…
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psnet.ahrq.gov/node/854828/psn-pdf
October 25, 2023 - Medication safety amid technological change: usability
evaluation to inform inpatient nurses' electronic health
record system transition.
October 25, 2023
Reale C, Ariosto DA, Weinger MB, et al. Medication safety amid technological change: usability evaluation
to inform inpatient nurses' electronic health record s…
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psnet.ahrq.gov/node/74203/psn-pdf
December 22, 2021 - Surgical safety checklist audits may be misleading!
Improving the implementation and adherence of the
surgical safety checklist: a quality improvement project.
December 22, 2021
Brown B, Bermingham S, Vermeulen M, et al. Surgical safety checklist audits may be misleading!
Improving the implementation and adherence…
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psnet.ahrq.gov/node/42796/psn-pdf
December 13, 2013 - Telemedicine consultations and medication errors in rural
emergency departments.
December 13, 2013
Dharmar M, Kuppermann N, Romano PS, et al. Telemedicine consultations and medication errors in rural
emergency departments. Pediatrics. 2013;132(6):1090-7. doi:10.1542/peds.2013-1374.
https://psnet.ahrq.gov/issue/tel…
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psnet.ahrq.gov/node/74854/psn-pdf
February 23, 2022 - Nursing guidelines for comprehensive harm prevention
strategies for adult patients in acute hospitals: an
integrative review and synthesis.
February 23, 2022
Redley B, Douglas T, Hoon L, et al. Nursing guidelines for comprehensive harm prevention strategies for
adult patients in acute hospitals: An integrative rev…
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psnet.ahrq.gov/node/40436/psn-pdf
August 25, 2011 - Hospital discharge documentation and risk of
rehospitalisation.
August 25, 2011
Hansen LO, Strater A, Smith L, et al. Hospital discharge documentation and risk of rehospitalisation. BMJ
Qual Saf. 2011;20(9):773-8. doi:10.1136/bmjqs.2010.048470.
https://psnet.ahrq.gov/issue/hospital-discharge-documentation-and-risk…
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psnet.ahrq.gov/node/60580/psn-pdf
January 01, 2022 - Sustaining the gains: a 7-year follow-through of a
hospital-wide patient safety improvement project on
hospital-wide adverse event outcomes and patient safety
culture.
June 10, 2020
Sim MA, Ti LK, Mujumdar S, et al. Sustaining the gains: a 7-year follow-through of a hospital-wide patient
safety improvement projec…
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psnet.ahrq.gov/node/35906/psn-pdf
May 27, 2011 - Error reduction in pediatric chemotherapy: computerized
order entry and failure modes and effects analysis.
May 27, 2011
Kim G, Chen AR, Arceci RJ, et al. Error reduction in pediatric chemotherapy: computerized order entry and
failure modes and effects analysis. Arch Pediatr Adolesc Med. 2006;160(5):495-8.
https:/…