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psnet.ahrq.gov/issue/review-literature-examining-linkages-between-organizational-factors-medical-errors-and
June 24, 2010 - Review
A review of the literature examining linkages between organizational factors, medical errors, and patient safety.
Citation Text:
Hoff T, Jameson L, Hannan E, et al. A review of the literature examining linkages between organizational factors, medical errors, and patient safety. …
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psnet.ahrq.gov/issue/near-misses-are-opportunity-improve-patient-safety-adapting-strategies-high-reliability
July 01, 2011 - Review
Near-misses are an opportunity to improve patient safety: adapting strategies of high reliability organizations to healthcare.
Citation Text:
Van Spall H, Kassam A, Tollefson TT. Near-misses are an opportunity to improve patient safety: adapting strategies of high reliability orga…
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psnet.ahrq.gov/issue/building-safety-net
December 21, 2009 - Newspaper/Magazine Article
Building a safety net.
Citation Text:
Rogoski RR. Building a safety net. By leveraging huge amounts of data and applying it to a wide array of projects and purposes, hospitals stay focused on patient safety and make headway. Health management technology. 2006…
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psnet.ahrq.gov/issue/developing-and-pilot-testing-practical-measures-preanalytic-surgical-specimen-identification
June 16, 2011 - Study
Developing and pilot testing practical measures of preanalytic surgical specimen identification defects.
Citation Text:
Bixenstine PJ, Zarbo RJ, Holzmueller CG, et al. Developing and pilot testing practical measures of preanalytic surgical specimen identification defects. Am J M…
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psnet.ahrq.gov/issue/risk-factors-retained-surgical-items-meta-analysis-and-proposed-risk-stratification-system
January 18, 2013 - Study
Risk factors for retained surgical items: a meta-analysis and proposed risk stratification system.
Citation Text:
Moffatt-Bruce SD, Cook CH, Steinberg SM, et al. Risk factors for retained surgical items: a meta-analysis and proposed risk stratification system. J Surg Res. 2014;190(…
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psnet.ahrq.gov/issue/oncologic-errors-diagnostic-radiology-10-year-analysis-based-medical-malpractice-claims
September 27, 2017 - Study
Oncologic errors in diagnostic radiology: a 10-year analysis based on medical malpractice claims.
Citation Text:
Rosenkrantz AB, Siegal D, Skillings JA, et al. Oncologic errors in diagnostic radiology: a 10-year analysis based on medical malpractice claims. J Am Coll Radiol. 2021;1…
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psnet.ahrq.gov/issue/what-evidence-pharmacy-team-working-acute-or-emergency-medicine-department-improves-outcomes
August 10, 2022 - Review
What is the evidence that a pharmacy team working in an acute or emergency medicine department improves outcomes for patients: a systematic review.
Citation Text:
Punj E, Collins A, Agravedi N, et al. What is the evidence that a pharmacy team working in an acute or emergency medic…
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psnet.ahrq.gov/issue/qualitative-exploration-patients-attitudes-towards-participate-inform-notice-know-pink
July 06, 2012 - Study
A qualitative exploration of patients' attitudes towards the 'Participate Inform Notice Know' (PINK) patient safety video.
Citation Text:
Pinto A, Vincent CA, Darzi A, et al. A qualitative exploration of patients' attitudes towards the 'Participate Inform Notice Know' (PINK) patien…
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psnet.ahrq.gov/issue/health-literacy-informed-communication-reduce-discharge-medication-errors-hospitalized
July 12, 2023 - Study
Health literacy-informed communication to reduce discharge medication errors in hospitalized children: a randomized clinical trial.
Citation Text:
Carroll AR, Johnson JA, Stassun JC, et al. Health literacy-informed communication to reduce discharge medication errors in hospitalized…
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psnet.ahrq.gov/issue/association-between-night-or-weekend-admission-and-hospitalization-relevant-patient-outcomes
November 26, 2014 - Study
The association between night or weekend admission and hospitalization-relevant patient outcomes.
Citation Text:
Khanna R, Wachsberg K, Marouni A, et al. The association between night or weekend admission and hospitalization-relevant patient outcomes. J Hosp Med. 2011;6(1):10-4.…
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psnet.ahrq.gov/issue/greatest-impact-safe-harbor-rule-may-be-improve-patient-safety-not-reduce-liability-claims
July 05, 2017 - Study
Greatest impact of safe harbor rule may be to improve patient safety, not reduce liability claims paid by physicians.
Citation Text:
Kachalia A, Little A, Isavoran M, et al. Greatest impact of safe harbor rule may be to improve patient safety, not reduce liability claims paid by p…
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psnet.ahrq.gov/issue/medication-errors-and-trainees-advice-learners-and-organizations
April 10, 2019 - Commentary
Medication errors and trainees: advice for learners and organizations.
Citation Text:
Wheeler JS, Duncan R, Hohmeier K. Medication Errors and Trainees: Advice for Learners and Organizations. Ann Pharmacother. 2017;51(12):1138-1141. doi:10.1177/1060028017725092.
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psnet.ahrq.gov/issue/teamstepps-evidence-based-approach-reduce-clinical-errors-threatening-safety-outpatient
November 18, 2009 - Review
TeamSTEPPS: an evidence-based approach to reduce clinical errors threatening safety in outpatient settings: an integrative review.
Citation Text:
Parker AL, Forsythe LL, Kohlmorgen IK. TeamSTEPPS : An evidence-based approach to reduce clinical errors threatening safety in outpatie…
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psnet.ahrq.gov/issue/structured-patient-handoff-internal-medicine-ward-cluster-randomized-control-trial
September 23, 2020 - Study
Structured patient handoff on an internal medicine ward: a cluster randomized control trial.
Citation Text:
Tam P, Nijjar AP, Fok M, et al. Structured patient handoff on an internal medicine ward: A cluster randomized control trial. PLoS One. 2018;13(4):e0195216. doi:10.1371/journa…
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psnet.ahrq.gov/issue/standard-drug-concentrations-and-smart-pump-technology-reduce-continuous-medication-infusion
October 06, 2011 - Study
Standard drug concentrations and smart-pump technology reduce continuous-medication-infusion errors in pediatric patients.
Citation Text:
Larsen G, Parker HB, Cash J, et al. Standard drug concentrations and smart-pump technology reduce continuous-medication-infusion errors in ped…
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psnet.ahrq.gov/issue/practice-advisory-prevention-and-management-operating-room-fires
December 14, 2010 - Commentary
Practice advisory for the prevention and management of operating room fires.
Citation Text:
Fires AS of ATF on OR, Caplan RA, Barker SJ, et al. Practice advisory for the prevention and management of operating room fires. Anesthesiology. 2008;108(5):786-801; quiz 971-2. doi:10…
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psnet.ahrq.gov/issue/high-reliability-pediatric-heart-centers-always-working-toward-getting-better
September 18, 2024 - Commentary
High reliability pediatric heart centers: always working toward getting better.
Citation Text:
Torzone A, Birely A. High reliability pediatric heart centers: always working toward getting better. Curr Opin Cardiol. 2024;39(4):356-363. doi:10.1097/hco.0000000000001143.
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psnet.ahrq.gov/issue/ventilator-related-adverse-events-taxonomy-and-findings-3-incident-reporting-systems
March 01, 2017 - Study
Ventilator-related adverse events: a taxonomy and findings from 3 incident reporting systems.
Citation Text:
Pham JC, Williams TL, Sparnon EM, et al. Ventilator-Related Adverse Events: A Taxonomy and Findings From 3 Incident Reporting Systems. Respir Care. 2016;61(5):621-31. doi:10…
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effectivehealthcare.ahrq.gov/sites/default/files/pdf/TND-0543_05-24-2013.pdf
January 01, 2013 - Summary: alternative strategies, including educational strategies and antibiotic management, for
reducing … Individuals with acute cough illness Intervention(s): Educational and
antimicrobial strategies for reducing … present with ACI, what is the comparative effectiveness of various
from Nominator: interventions for reducing
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cds.ahrq.gov/sites/default/files/cds/artifact/136331/Benzodiazepine%20Patient%20Handout.pdf
January 01, 2018 - Microsoft PowerPoint - Updated Handouts - Read-Only
REDUCING MEDICATIONS SAFELY
TO MEET LIFE’S CHANGES … taking:_____________________
Your dose: _____________________________________________
WHY CONSIDER REDUCING … Adapted from “Reducing Medications Safely to Meet Life’s Changes, Focus on Benzodiazepine Receptor Agonists