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  1. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/41783/psn-pdf
    October 24, 2012 - How-to Guide: Prevent Obstetrical Adverse Events. October 24, 2012 Cambridge, MA: Institute for Healthcare Improvement; 2012. https://psnet.ahrq.gov/issue/how-guide-prevent-obstetrical-adverse-events This guide highlights strategies to enhance the use of care bundles to prevent errors in obstetric care. https://ps…
  2. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/41681/psn-pdf
    January 01, 2013 - Patient safety in plastic surgery. September 12, 2012 Trussler AP, Tabbal GN. Patient safety in plastic surgery. Plast Reconstr Surg. 2013;130(3):470e-478e. doi:10.1097/prs.0b013e31825dc349. https://psnet.ahrq.gov/issue/patient-safety-plastic-surgery This commentary outlines tactics to prevent complications in pla…
  3. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/39410/psn-pdf
    March 31, 2010 - Doctors fear work caps for residents may be bad medicine. March 31, 2010 Shapira I. https://psnet.ahrq.gov/issue/doctors-fear-work-caps-residents-may-be-bad-medicine This news piece examines the work week of resident physicians and discusses how further limiting trainees' work hours might reduce their experientia…
  4. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/41362/psn-pdf
    June 15, 2012 - Non-Luer connectors: are we nearly there yet? June 15, 2012 Cook TM. Non-Luer connectors: are we nearly there yet? Anaesthesia. 2012;67(7):784-792. doi:10.1111/j.1365-2044.2012.07154.x. https://psnet.ahrq.gov/issue/non-luer-connectors-are-we-nearly-there-yet This commentary reviews progress in reducing wrong-route…
  5. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/36156/psn-pdf
    September 29, 2010 - Addressing medication errors - the role of undergraduate nurse education. September 29, 2010 Page K, McKinney AA. Addressing medication errors--The role of undergraduate nurse education. Nurse Educ Today. 2007;27(3):219-24. https://psnet.ahrq.gov/issue/addressing-medication-errors-role-undergraduate-nurse-educatio…
  6. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/42726/psn-pdf
    November 13, 2013 - Mistakes even good doctors make. November 13, 2013 Consumer Reports on Health. November 2013;25:6-7.  https://psnet.ahrq.gov/issue/mistakes-even-good-doctors-make This article reveals commonly misdiagnosed conditions, why diagnostic errors occur, and tips for patients to reduce risks. https://psnet.ahrq.gov/…
  7. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/41734/psn-pdf
    October 03, 2012 - Prescribing errors in hospital practice. October 3, 2012 Tully MP. Prescribing errors in hospital practice. Br J Clin Pharmacol. 2012;74(4):668-75. doi:10.1111/j.1365-2125.2012.04313.x. https://psnet.ahrq.gov/issue/prescribing-errors-hospital-practice Highlighting inconsistencies in defining and measuring prescrib…
  8. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/36115/psn-pdf
    September 28, 2010 - Safe prescribing: an educational intervention for medical students. September 28, 2010 Garbutt J, DeFer TM, Highstein G, et al. Safe prescribing: an educational intervention for medical students. Teach Learn Med. 2006;18(3):244-50. https://psnet.ahrq.gov/issue/safe-prescribing-educational-intervention-medical-stud…
  9. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/41492/psn-pdf
    June 27, 2018 - Alarm fatigue hazards: the sirens are calling. June 27, 2018 Welch J. https://psnet.ahrq.gov/issue/alarm-fatigue-hazards-sirens-are-calling This article reports on alarm fatigue in clinical care, including the risks associated with it, and describes tactics to help reduce nuisance alarms. https://psnet.ahrq.gov/i…
  10. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/37449/psn-pdf
    January 09, 2008 - Safety First: One Year On. January 9, 2008 London, England: National Patient Safety Agency; 2008. https://psnet.ahrq.gov/issue/safety-first-one-year This report shares the results of the British National Patient Safety Agency effort to reduce medical error and found that safety wasn’t always given the priority nec…
  11. digital.ahrq.gov/principal-investigator/marks-lawrence-b
    January 01, 2023 - Marks, Lawrence B Development and Assessment of Artificial Intelligence (AI)-Enhanced Pretreatment Peer-review Process to Improve Patient Safety in Radiation Oncology Description This research develops and evaluates an artificial intelligence-enhanced pretreatment peer-review …
  12. digital.ahrq.gov/principal-investigator/rotenstein-lisa
    January 01, 2023 - Rotenstein, Lisa Assessing the Effects of EHR Optimization Interventions in Primary Care Description This research evaluates the adoption and impact of three electronic health record-optimization interventions—scribes, advanced team-based inbox management, and artificial intel…
  13. digital.ahrq.gov/ahrq-funded-projects/using-evidence-based-nursing-practices-and-electronic-health-record-decision-4
    January 01, 2023 - Staff nurse training presentation for the deployment of the CP-CDS tool Citation Staff nurse training presentation for the deployment of the CP-CDS tool PDF action-cp-cds-training.pdf Project Name Using Evidence-Based Nursing Practices and Electronic Health Record Decision …
  14. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/38535/psn-pdf
    April 01, 2009 - Preventing catheter-related bloodstream infections: thinking outside the checklist. April 1, 2009 Perencevich EN; Pittet D. https://psnet.ahrq.gov/issue/preventing-catheter-related-bloodstream-infections-thinking-outside-checklist Checklists for specific interventions have proved successful at markedly reducing ca…
  15. digital.ahrq.gov/location/usa-mi-marquette
    January 01, 2023 - USA, MI, Marquette Critical Access Hospital Partnership Health Information Technology Implementation Description Established a Web-based electronic medical record system for 10 small rural hospitals to connect them to the area's regional medical center. The project's ultimate …
  16. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/42620/psn-pdf
    April 04, 2018 - Diagnostic Error in Medicine. April 4, 2018 Singh H, ed. BMJ Qual Saf. 2013;22(suppl 2):ii1-ii72. https://psnet.ahrq.gov/issue/diagnostic-error-medicine-0 Articles in this special issue cover efforts to reduce diagnostic errors, including patient engagement and cognitive debiasing. https://psnet.ahrq.gov/issue/di…
  17. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/41819/psn-pdf
    November 07, 2012 - Order from Chaos: Accelerating Care Integration. November 7, 2012 Boston, MA: Lucian Leape Institute at the National Patient Safety Foundation; October 2012. https://psnet.ahrq.gov/issue/order-chaos-accelerating-care-integration This report discusses the need for improved coordination and integration in patient car…
  18. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/38462/psn-pdf
    June 24, 2010 - Care transitions and home health care. June 24, 2010 Boling PA. Care transitions and home health care. Clin Geriatr Med. 2009;25(1):135-48, viii. doi:10.1016/j.cger.2008.11.005. https://psnet.ahrq.gov/issue/care-transitions-and-home-health-care This article reviews the literature on transitions of care, discusses …
  19. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/36741/psn-pdf
    August 15, 2007 - Prescription for Improving Patient Safety: Addressing Medication Errors. August 15, 2007 The Medication Errors Panel. Sacramento, CA: California State Senate; March 2007.   https://psnet.ahrq.gov/issue/prescription-improving-patient-safety-addressing-medication-errors This report shares findings from an exper…
  20. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/37764/psn-pdf
    January 21, 2011 - Overconfidence as a cause of diagnostic error in medicine. January 21, 2011 Berner ES, Graber ML. Overconfidence as a cause of diagnostic error in medicine. Am J Med. 2008;121(5 Suppl):S2-S23. doi:10.1016/j.amjmed.2008.01.001. https://psnet.ahrq.gov/issue/overconfidence-cause-diagnostic-error-medicine This compre…