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psnet.ahrq.gov/node/851204/psn-pdf
July 05, 2023 - Drugmakers are abandoning cheap generics, and now US
cancer patients can’t get meds.
July 5, 2023
Allen A. KFF Health News. June 21, 2023.
https://psnet.ahrq.gov/issue/drugmakers-are-abandoning-cheap-generics-and-now-us-cancer-patients-
cant-get-meds
A variety of supply-chain, quality control, and economic factor…
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psnet.ahrq.gov/node/37709/psn-pdf
April 23, 2008 - Inappropriate medication use in the elderly: results from a
quality improvement project in 99 primary care practices.
April 23, 2008
Wessell AM, Nietert PJ, Jenkins RG, et al. Inappropriate medication use in the elderly: Results from a
quality improvement project in 99 primary care practices. Am J Geriatr Pharmacot…
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/cauti-tools/impl-guide/implementation-guide-appendix-h.docx
June 02, 2025 - Remove that Foley
AHRQ Safety Program for Reducing CAUTI in Hospitals
Appendix H. Urinary Catheter Pocket Card
Front
Front
Back
Remove that Urinary Catheter!
Foley catheters can cause:
· Infections
· Length of Stay
· Cost
· Patient Discomfort
· Antibiotic Use
Urinary catheters confine patients to bed, …
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psnet.ahrq.gov/node/48028/psn-pdf
August 28, 2019 - Error Reduction and Prevention in Surgical Pathology,
Second Edition.
August 28, 2019
Nakhleh RE, Volmar KE, eds. Cham, Switzerland: Springer Nature; 2019. ISBN: 9783030184636.
https://psnet.ahrq.gov/issue/error-reduction-and-prevention-surgical-pathology-2nd-edition
Surgical specimen and laboratory process proble…
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psnet.ahrq.gov/node/73100/psn-pdf
March 31, 2021 - Public comment period extended for strategies to
improve patient safety: Draft Report to Congress for
Public Comment and Review by the National Academy of
Medicine.
March 31, 2021
Fed Register. 2021;86(51):14752-14753.
https://psnet.ahrq.gov/issue/public-comment-period-extended-strategies-improve-patient-safety-d…
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psnet.ahrq.gov/node/44712/psn-pdf
December 09, 2015 - The effect of contact precautions on frequency of hospital
adverse events.
December 9, 2015
Croft LD, Liquori M, Ladd J, et al. The Effect of Contact Precautions on Frequency of Hospital Adverse
Events. Infect Control Hosp Epidemiol. 2015;36(11):1268-74. doi:10.1017/ice.2015.192.
https://psnet.ahrq.gov/issue/effec…
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www.ahrq.gov/sites/default/files/wysiwyg/hai/abate/introduction/toolkit-contents.pdf
March 01, 2022 - Toolkit Table of Contents
Decolonization of
Non-ICU Patients With Devices
Toolkit Table of Contents
Introduction and Toolkit Overview Section
Introduction and Welcome .................................................................................... 1
ABATE Trial Investigators and Toolkit Project T…
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psnet.ahrq.gov/node/837695/psn-pdf
July 20, 2022 - Narrowing the mindware gap in medicine.
July 20, 2022
Croskerry P. Narrowing the mindware gap in medicine. Diagnosis (Berl). 2022;9(2):176-183.
doi:10.1515/dx-2020-0128.
https://psnet.ahrq.gov/issue/narrowing-mindware-gap-medicine
In dual process thinking, Type 1 decisions are made rapidly, but can result in diagn…
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psnet.ahrq.gov/node/45866/psn-pdf
March 08, 2017 - Medication safety in the neonatal intensive care unit: big
measures for our smallest patients.
March 8, 2017
Rostas SE. Medication Safety in the Neonatal Intensive Care Unit: Big Measures for Our Smallest Patients.
J Perinat Neonatal Nurs. 2017;31(1):15-19. doi:10.1097/JPN.0000000000000230.
https://psnet.ahrq.gov/…
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psnet.ahrq.gov/node/74011/psn-pdf
October 27, 2021 - Dashboards for visual display of patient safety data: a
systematic review.
October 27, 2021
Murphy DR, Savoy A, Satterly T, et al. Dashboards for visual display of patient safety data: a systematic
review. BMJ Health Care Inform. 2021;28(1):e100437. doi:10.1136/bmjhci-2021-100437.
https://psnet.ahrq.gov/issue/dash…
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psnet.ahrq.gov/node/43307/psn-pdf
September 26, 2016 - Mitigating errors caused by interruptions during
medication verification and administration: interventions
in a simulated ambulatory chemotherapy setting.
September 26, 2016
Prakash V, Koczmara C, Savage P, et al. Mitigating errors caused by interruptions during medication
verification and administration: interven…
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psnet.ahrq.gov/node/42397/psn-pdf
September 05, 2013 - Impact of the World Health Organization's Surgical Safety
Checklist on safety culture in the operating theatre: a
controlled intervention study.
September 5, 2013
Haugen AS, Søfteland E, Eide GE, et al. Impact of the World Health Organization's Surgical Safety
Checklist on safety culture in the operating theatre: …
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psnet.ahrq.gov/node/46640/psn-pdf
August 08, 2018 - IDEA4PS: the development of a research-oriented
learning healthcare system.
August 8, 2018
Moffatt-Bruce SD, Huerta T, Gaughan A, et al. IDEA4PS: The Development of a Research-Oriented
Learning Healthcare System. Am J Med Qual. 2018;33(4):420-425. doi:10.1177/1062860617751044.
https://psnet.ahrq.gov/issue/idea4ps-…
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psnet.ahrq.gov/node/48005/psn-pdf
May 08, 2019 - Why your doctor's white coat can be a threat to your
health.
May 8, 2019
Haun N, Hooper-Lane C, Safdar N. Healthcare Personnel Attire and Devices as Fomites: A Systematic
Review. Infect Control Hosp Epidemiol. 2016;37(11):1367-1373.
https://psnet.ahrq.gov/issue/why-your-doctors-white-coat-can-be-threat-your-health…
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psnet.ahrq.gov/node/45469/psn-pdf
January 18, 2017 - Tamper-resistant drugs cannot solve the opioid crisis.
January 18, 2017
Leece P, Orkin AM, Kahan M. Tamper-resistant drugs cannot solve the opioid crisis. CMAJ.
2015;187(10):717-718. doi:10.1503/cmaj.150329.
https://psnet.ahrq.gov/issue/tamper-resistant-drugs-cannot-solve-opioid-crisis
Health care organizations ha…
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psnet.ahrq.gov/node/47681/psn-pdf
January 30, 2019 - Infection prevention in the operating room anesthesia
work area.
January 30, 2019
Munoz-Price S, Bowdle A, Johnston L, et al. Infection prevention in the operating room anesthesia work
area. Infect Control Hosp Epidemiol. 2018:1-17. doi:10.1017/ice.2018.303.
https://psnet.ahrq.gov/issue/infection-prevention-operat…
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psnet.ahrq.gov/node/46776/psn-pdf
February 28, 2018 - Older adults' awareness of deprescribing: a population-
based survey.
February 28, 2018
Turner JP, Tannenbaum C. Older adults' awareness of deprescribing: a population-based survey. J Am
Geriatr Soc. 2017;65(12):2691-2696. doi:10.1111/jgs.15079.
https://psnet.ahrq.gov/issue/older-adults-awareness-deprescribing-pop…
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psnet.ahrq.gov/node/866406/psn-pdf
July 31, 2024 - Impact of a daily huddle on safety in perioperative
services.
July 31, 2024
Tuyishime H, Claure RE, Balakrishnan K, et al. Impact of a daily huddle on safety in perioperative services.
Jt Comm J Qual Patient Saf. 2024;50(9):678-683. doi:10.1016/j.jcjq.2024.04.012.
https://psnet.ahrq.gov/issue/impact-daily-huddle-s…
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psnet.ahrq.gov/node/45082/psn-pdf
April 27, 2016 - Surgeons must tell patients of double-booked surgeries,
new guidelines say.
April 27, 2016
Abelson J, Staltzman J. Boston Globe. April 13, 2016.
https://psnet.ahrq.gov/issue/surgeons-must-tell-patients-double-booked-surgeries-new-guidelines-say
Although scheduling overlapping surgeries may improve operating room e…
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psnet.ahrq.gov/node/46968/psn-pdf
April 18, 2018 - Attitudes and practices related to clinical alarms: a follow-
up survey.
April 18, 2018
Ruppel H, Funk M, Clark T, et al. Attitudes and Practices Related to Clinical Alarms: A Follow-up Survey.
Am J Crit Care. 2018;27(2):114-123. doi:10.4037/ajcc2018185.
https://psnet.ahrq.gov/issue/attitudes-and-practices-related…