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  1. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/37653/psn-pdf
    May 14, 2008 - Getting boards on board: engaging governing boards in quality and safety.  May 14, 2008 Conway JB. Getting boards on board: engaging governing boards in quality and safety. Jt Comm J Qual Saf. 2008;34(4):214-220. https://psnet.ahrq.gov/issue/getting-boards-board-engaging-governing-boards-quality-and-safety This a…
  2. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/42344/psn-pdf
    September 24, 2016 - Strategies for preventing distractions and interruptions in the OR. September 24, 2016 Clark GJ. Strategies for preventing distractions and interruptions in the OR. AORN J. 2013;97(6):702-707. doi:10.1016/j.aorn.2013.01.018. https://psnet.ahrq.gov/issue/strategies-preventing-distractions-and-interruptions-or Dist…
  3. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/40696/psn-pdf
    December 01, 2011 - Rapid response systems: a prospective study of response times. December 1, 2011 Adelstein B-A, Piza MA, Nayyar V, et al. Rapid response systems: a prospective study of response times. J Crit Care. 2011;26(6):635.e11-8. doi:10.1016/j.jcrc.2011.03.013. https://psnet.ahrq.gov/issue/rapid-response-systems-prospective-…
  4. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/43318/psn-pdf
    July 02, 2014 - Sign up to Safety. July 2, 2014 National Health Service. https://psnet.ahrq.gov/issue/sign-safety Through a coordinated effort to set goals and devise plans to improve safety in hospitals, the Sign up to Safety campaign aims to prevent 6000 patient deaths in the next 3 years in National Health Service facilities.…
  5. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/37704/psn-pdf
    April 23, 2008 - Decreasing paediatric prescribing errors in a district general hospital. April 23, 2008 Davey AL, Britland A, Naylor RJ. Decreasing paediatric prescribing errors in a district general hospital. Qual Saf Health Care. 2008;17(2):146-9. doi:10.1136/qshc.2006.021212. https://psnet.ahrq.gov/issue/decreasing-paediatric-…
  6. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/36039/psn-pdf
    March 02, 2011 - The effects of on-duty napping on intern sleep time and fatigue. March 2, 2011 Arora V, Dunphy C, Chang VY, et al. The effects of on-duty napping on intern sleep time and fatigue. Ann Intern Med. 2006;144(11):792-8. https://psnet.ahrq.gov/issue/effects-duty-napping-intern-sleep-time-and-fatigue The investigators …
  7. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/46466/psn-pdf
    July 11, 2018 - Distinct newborn identification requirement. July 11, 2018 R3 Report. June 25, 2018;7:1-2. https://psnet.ahrq.gov/issue/distinct-newborn-identification-requirement Neonatal patients are at risk for misidentification due to communication challenges and lack of distinguishable features. This report highlights new Jo…
  8. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/40903/psn-pdf
    March 08, 2015 - Does your patient really understand? March 8, 2015 Huff C. Does your patient really understand? Hospitals & health networks. 2011;85(10):34-5, 37-8, 2. https://psnet.ahrq.gov/issue/does-your-patient-really-understand This article discusses health literacy and describes an initiative to reduce gaps in understanding …
  9. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/41955/psn-pdf
    January 09, 2013 - Making Medical Devices Safer at Home. January 9, 2013 Consumer Updates. Silver Spring, MD: US Food and Drug Administration; December 12, 2012. https://psnet.ahrq.gov/issue/making-medical-devices-safer-home Highlighting concerns associated with patients' use of medical devices at home, such as difficulty understand…
  10. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/42830/psn-pdf
    December 18, 2013 - How to Identify and Address Unsafe Conditions Associated With Health IT. December 18, 2013 Wallace C, Zimmer KP, Possanza L, Giannini R, Solomon R. Washington, DC: Office of the National Coordinator for Health Information Technology; November 15, 2013. https://psnet.ahrq.gov/issue/how-identify-and-address-unsafe-c…
  11. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/40668/psn-pdf
    March 04, 2015 - Body CT: technical advances for improving safety. March 4, 2015 Marin D, Nelson RC, Rubin GD, et al. Body CT: technical advances for improving safety. AJR Am J Roentgenol. 2011;197(1):33-41. doi:10.2214/AJR.11.6755. https://psnet.ahrq.gov/issue/body-ct-technical-advances-improving-safety This article explores risk…
  12. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/42364/psn-pdf
    September 18, 2013 - The pursuit of better diagnostic performance: a human factors perspective. September 18, 2013 Henriksen K, Brady J. The pursuit of better diagnostic performance: a human factors perspective. BMJ Qual Saf. 2013;22(Suppl 2):ii1-ii5. doi:10.1136/bmjqs-2013-001827. https://psnet.ahrq.gov/issue/pursuit-better-diagnosti…
  13. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/38341/psn-pdf
    April 02, 2009 - CPOE: it don't come easy. April 2, 2009 Anderson HJ. CPOE: it don't come easy. Health Data Manag. 2009;17(1):18-20, 22, 24 passim. https://psnet.ahrq.gov/issue/cpoe-it-dont-come-easy Although shifting from paper-based or verbal orders to computerized physician order entry (CPOE) systems could reduce medical errors…
  14. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/42332/psn-pdf
    June 12, 2013 - Quality improvement through implementation of discharge order reconciliation. June 12, 2013 Lu Y, Clifford P, Bjorneby A, et al. Quality improvement through implementation of discharge order reconciliation. Am J Health Syst Pharm. 2013;70(9):815-20. doi:10.2146/ajhp120050. https://psnet.ahrq.gov/issue/quality-impr…
  15. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/40568/psn-pdf
    June 29, 2011 - Tubing misconnections: normalization of deviance. June 29, 2011 Simmons D, Symes L, Guenter P, et al. Tubing misconnections: normalization of deviance. Nutr Clin Pract. 2011;26(3):286-293. doi:10.1177/0884533611406134. https://psnet.ahrq.gov/issue/tubing-misconnections-normalization-deviance Analyzing published ca…
  16. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/41411/psn-pdf
    October 19, 2012 - Minnesota Hospital Association Statewide Project: SAFE from FALLS. October 19, 2012 Apold J, Quigley PA. Minnesota Hospital Association Statewide Project: SAFE from FALLS. J Nurs Care Qual. 2012;27(4):299-306. doi:10.1097/NCQ.0b013e3182599d1b. https://psnet.ahrq.gov/issue/minnesota-hospital-association-statewide-p…
  17. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/35382/psn-pdf
    October 05, 2005 - Rx for a better prescription. Hospital bans doctors from using confusing medical abbreviations. October 5, 2005 Hall J. Fredericksburg Times. September 25, 2005 https://psnet.ahrq.gov/issue/rx-better-prescription-hospital-bans-doctors-using-confusing-medical- abbreviations This article presents one hospital’s pro…
  18. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/42493/psn-pdf
    August 14, 2013 - Partnering to prevent falls: using a multimodal multidisciplinary team. August 14, 2013 Volz TM, Swaim J. Partnering to prevent falls: using a multimodal multidisciplinary team. J Nurs Adm. 2013;43(6):336-41. doi:10.1097/NNA.0b013e3182942c5a. https://psnet.ahrq.gov/issue/partnering-prevent-falls-using-multimodal-m…
  19. digital.ahrq.gov/organization/mainegeneral-medical-center
    January 01, 2023 - Mainegeneral Medical Center Improving Health Information Technology Implementation in a Rural Health System - 2008 Principal Investigator Mingle, Daniel Project Name Improving Health Information Technology Implementation in a Rural Health System …
  20. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/43055/psn-pdf
    May 01, 2017 - AHRQ's Safety Program for Ambulatory Surgery. May 1, 2017 Health Research & Educational Trust. Rockville, MD: Agency for Healthcare Research and Quality; May 2017. AHRQ Publication No. 16(17)-0019-1-EF. https://psnet.ahrq.gov/issue/ahrqs-safety-program-ambulatory-surgery This report provides information about a na…