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  1. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/836972/psn-pdf
    April 20, 2022 - Diagnostic Centers of Excellence: Partnerships to Improve Diagnostic Safety and Quality (R18). April 20, 2022 Rockville, MD: Agency for Healthcare Research and Quality; April 7, 2022. RFA-HS-22-008. https://psnet.ahrq.gov/issue/diagnostic-centers-excellence-partnerships-improve-diagnostic-safety-and- quality-r18 …
  2. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/846455/psn-pdf
    March 22, 2023 - Diagnostic Centers of Excellence (X01 Clinical Trial Not Allowed). March 22, 2023 PAR-23-120. Bethesda, MD: National Institutes of Health; March 7, 2023 https://psnet.ahrq.gov/issue/diagnostic-centers-excellence-x01-clinical-trial-not-allowed Approaching diagnosis as a team activity is seen as a key approach to di…
  3. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/60656/psn-pdf
    July 08, 2020 - COVID-19: to be or not to be; that is the diagnostic question. July 8, 2020 Coleman JJ, Manavi K, Marson EJ, et al. COVID-19: to be or not to be; that is the diagnostic question. Postgrad Med J. 2020;96(1137):392-398. doi:10.1136/postgradmedj-2020-137979. https://psnet.ahrq.gov/issue/covid-19-be-or-not-be-diagnost…
  4. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/46630/psn-pdf
    November 15, 2017 - Patient Safety in the Office-Based Practice Setting. November 15, 2017 Philadelphia, PA: American College of Physicians; 2017. https://psnet.ahrq.gov/issue/patient-safety-office-based-practice-setting Patient safety in the ambulatory setting is gaining traction as a focus for research, intervention, and policy. Th…
  5. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/73256/psn-pdf
    May 12, 2021 - Addiction treatment providers in Pa. face little state scrutiny despite harm to clients. May 12, 2021 Pattani A, Mahon E. Kaiser Health News.  April 30, 2021. https://psnet.ahrq.gov/issue/addiction-treatment-providers-pa-face-little-state-scrutiny-despite-harm-clients Systemic oversight weaknesses and lack of…
  6. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/47412/psn-pdf
    October 31, 2018 - The systems approach at the sharp end. October 31, 2018 Cross SRH. The systems approach at the sharp end. Future Healthc J. 2019;5(3):176-180. doi:10.7861/futurehosp.5-3-176. https://psnet.ahrq.gov/issue/systems-approach-sharp-end Systems solutions are often focused on creating improvements at the organizational o…
  7. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/843095/psn-pdf
    January 25, 2023 - Eliminating racial and ethnic disparities causing mortality and morbidity in pregnant and postpartum patients. January 25, 2023 Sentinel Event Alert. January 17, 2023:(66):1-5. https://psnet.ahrq.gov/issue/eliminating-racial-and-ethnic-disparities-causing-mortality-and-morbidity- pregnant-and Racial and ethnic in…
  8. www.ahrq.gov/prevention/guidelines/tobacco/clinicians/presentations/2008update-full/slide168.html
    October 01, 2014 - 168. Components of Intensive Treatment (Continued) Treating Tobacco Use and Dependence: 2008 Update Text version of slide presentation. Medication Every smoker should be offered medications endorsed in this Guideline, except where contraindicated or for specific populations for which there is insu…
  9. www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/cauti-tools/impl-guide/implementation-guide-appendix-e.pdf
    September 01, 2015 - Appendix E. Poster on Urinary Catheter Risks and Indications AHRQ Safety Program for Reducing CAUTI in Hospitals Appendix E. Poster on Urinary Catheter Risks and Indications ■ Acute urinary retention or obstruction ■ Perioperative use in selected surgeries ■ Assistance of healing of severe perineal an…
  10. www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-family-engagement/pfeprimarycare/pfeprimarycare-infographic.pdf
    April 01, 2018 - Guide Promotional Postcard Did you know...Patient safety issues in primary care are real. Annually, 1 in 20 outpatients experiences a diagnostic error 55% of patients said diagnostic errors were a chief concern in outpatient visits 1 in 9 ED admissions are related to an adverse drug event An estimated …
  11. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/39119/psn-pdf
    November 25, 2009 - Effect of a weight-based prescribing method within an electronic health record on prescribing errors. November 25, 2009 Ginzburg R, Barr WB, Harris M, et al. Effect of a weight-based prescribing method within an electronic health record on prescribing errors. Am J Health Syst Pharm. 2009;66(22):2037-41. doi:10.214…
  12. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/36711/psn-pdf
    July 25, 2011 - Designing decision support for insulin ordering in a computerized provider order entry system. July 25, 2011 Wright L, Feldott CC, Hargrove FR. Designing Decision Support for Insulin Ordering in a Computerized Provider Order Entry System. Hosp Pharm. 2010;42(2). doi:10.1310/hpj4202-158. https://psnet.ahrq.gov/issu…
  13. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/43229/psn-pdf
    June 04, 2014 - Liquid medication dosing errors in children: role of provider counseling strategies. June 4, 2014 Yin S, Dreyer BP, Moreira HA, et al. Liquid medication dosing errors in children: role of provider counseling strategies. Acad Pediatr. 2014;14(3):262-70. doi:10.1016/j.acap.2014.01.003. https://psnet.ahrq.gov/issue/l…
  14. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/47925/psn-pdf
    August 21, 2019 - Second victims and mindfulness: a systematic review. August 21, 2019 S Miller C, Scott SD, Beck M. Second victims and mindfulness: a systematic review. J Patient Saf Risk Manag. 2019;24(3):108-117. doi:10.1177/2516043519838176. https://psnet.ahrq.gov/issue/second-victims-and-mindfulness-systematic-review The secon…
  15. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/43379/psn-pdf
    August 14, 2014 - Unit of measurement used and parent medication dosing errors. August 14, 2014 Yin S, Dreyer BP, Ugboaja DC, et al. Unit of measurement used and parent medication dosing errors. Pediatrics. 2014;134(2):e354-61. doi:10.1542/peds.2014-0395. https://psnet.ahrq.gov/issue/unit-measurement-used-and-parent-medication-dosi…
  16. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/44990/psn-pdf
    July 11, 2017 - Automatic errors: a case series on the errors inherent in electronic prescribing. July 11, 2017 Lourenco LM, Bursua A, Groo VL. Automatic Errors: A Case Series on the Errors Inherent in Electronic Prescribing. J Gen Intern Med. 2016;31(7):808-811. doi:10.1007/s11606-016-3606-5. https://psnet.ahrq.gov/issue/automat…
  17. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/44358/psn-pdf
    September 24, 2016 - Interruptions and medication administration in critical care. September 24, 2016 Bower R, Jackson C, Manning JC. Interruptions and medication administration in critical care. Nurs Crit Care. 2015;20(4):183-95. doi:10.1111/nicc.12185. https://psnet.ahrq.gov/issue/interruptions-and-medication-administration-critical…
  18. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/35836/psn-pdf
    March 28, 2011 - Use of a standardized protocol to decrease medication errors and adverse events related to sliding scale insulin. March 28, 2011 Donihi AC, DiNardo MM, Devita MA, et al. Use of a standardized protocol to decrease medication errors and adverse events related to sliding scale insulin. Qual Saf Health Care. 2006;15(2)…
  19. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/50387/psn-pdf
    September 25, 2019 - Special Issue on Prescription Drug Misuse. September 25, 2019 Rickles NM, Fleming ML, Björnsdottir I, eds. Res Social Adm Pharm. 2019;15:907-1056. https://psnet.ahrq.gov/issue/special-issue-prescription-drug-misuse This special issue reviews research initiatives exploring persistent challenges associated with the …
  20. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/44298/psn-pdf
    July 08, 2015 - Preparing challenging medications for barcode scanning. July 8, 2015 Waxlax TJ. Preparing challenging medications for barcode scanning. Am J Health Syst Pharm. 2015;72(13):1089-90. doi:10.2146/ajhp140454. https://psnet.ahrq.gov/issue/preparing-challenging-medications-barcode-scanning Barcode scanning can reduce me…