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  1. Patient engagement in health care safety: an overview of mixed-quality evidence. | PSNet

    psnet.ahrq.gov/issue/patient-engagement-health-care-safety-overview-mixed-quality-evidence
    October 21, 2020 - Analysis of incident reports from a patient safety organization. … February 9, 2022 Patient and caregiver factors in ambulatory incident reports: a mixed-methods … June 16, 2019 ISMP medication error report analysis. … June 16, 2019 ISMP medication error report analysis. … June 16, 2019 ISMP medication error report analysis.

  2. Examining the Status of VA’s Electronic Health Record Modernization Program. | PSNet

    psnet.ahrq.gov/issue/examining-status-vas-electronic-health-record-modernization-program
    November 10, 2021 - December 14, 2022 Comprehensive Healthcare Inspection Summary Report: Evaluation of Care … The Report of the Independent Medicines and Medical Devices Safety Review.

  3. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/847042/psn-pdf
    April 05, 2023 - The relationship between patient safety culture and the intentions of the nursing staff to report a … The relationship between patient safety culture and the intentions of the nursing staff to report a … https://psnet.ahrq.gov/issue/relationship-between-patient-safety-culture-and-intentions-nursing-staff-report … This mixed- methods study including 199 nurses, who worked in COVID-19 units, found that intent to report … glossary-0#glossary-heading-term-73808 https://psnet.ahrq.gov/issue/promote-culture-safety-good-catch-reports

  4. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/47292/psn-pdf
    May 01, 2022 - Nebraska Coalition for Patient Safety Annual Report. … https://psnet.ahrq.gov/issue/nebraska-coalition-patient-safety-2018-annual-report Patient Safety Organizations … This annual report describes a state-wide PSO's activities, summarizes breakdowns of data collected … between 2008 and 2021, offers insights drawn from an analysis of 1308 incident reports. … https://psnet.ahrq.gov/issue/nebraska-coalition-patient-safety-2018-annual-report https://psnet.ahrq.gov

  5. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/74172/psn-pdf
    December 08, 2021 - Differences in safety report event types submitted by graduate medical education trainees compared with … Differences in Safety Report Event Types Submitted by Graduate Medical Education Trainees Compared With … https://psnet.ahrq.gov/issue/differences-safety-report-event-types-submitted-graduate-medical-education … At one children’s hospital, graduate medical education (GME) trainees submitted reports of greater severity … https://psnet.ahrq.gov/issue/differences-safety-report-event-types-submitted-graduate-medical-education-trainees-compared

  6. Senators threaten consequences after VA confirms 4 deaths tied to computer system tested in Spokane. | PSNet

    psnet.ahrq.gov/issue/senators-threaten-consequences-after-va-confirms-4-deaths-tied-computer-system-tested-spokane
    September 21, 2022 - PubMed citation Related news article Related report Save Save to your library … December 14, 2022 Comprehensive Healthcare Inspection Summary Report: Evaluation of Care

  7. Use of tall man letters is gaining wide acceptance. | PSNet

    psnet.ahrq.gov/issue/use-tall-man-letters-gaining-wide-acceptance
    May 02, 2018 - This article reports the results of an ISMP survey on "tall man lettering," the use of uppercase letters … May 2, 2018 ISMP's second QuarterWatch report shows sharp increase in reports of serious … June 16, 2019 ISMP medication error report analysis. … June 16, 2019 ISMP medication error report analysis. … June 16, 2019 ISMP medication error report analysis.

  8. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/50795/psn-pdf
    January 15, 2020 - Diagnostic error in the emergency department: learning from national patient safety incident report … Diagnostic error in the emergency department: learning from national patient safety incident report … psnet.ahrq.gov/issue/diagnostic-error-emergency-department-learning-national-patient-safety- incident-report … This retrospective study reviewed incident reports to characterize diagnostic errors occurring in emergency … psnet.ahrq.gov/issue/diagnostic-error-emergency-department-learning-national-patient-safety-incident-report

  9. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/836966/psn-pdf
    April 20, 2022 - Performance variability in perioperative sentinel events: report on a nationwide data set. … Performance variability in perioperative sentinel events: report on a nationwide data set. … https://psnet.ahrq.gov/issue/performance-variability-perioperative-sentinel-events-report-nationwide-data … performance variability continued in almost all events, it was rarely explicitly mentioned in incident reports … https://psnet.ahrq.gov/issue/performance-variability-perioperative-sentinel-events-report-nationwide-data-set

  10. National Healthcare Safety Network. | PSNet

    psnet.ahrq.gov/issue/national-healthcare-safety-network-0
    April 06, 2022 - 14, 2024 - December 14, 2025 National and State Healthcare-Associated Infections Progress … Report.

  11. The Life and Death of Elizabeth Dixon: A Catalyst for Change. | PSNet

    psnet.ahrq.gov/issue/life-and-death-elizabeth-dixon-catalyst-change
    November 16, 2022 - The Report of the Independent Medicines and Medical Devices Safety Review. … July 1, 2020 Ockenden Report. … March 20, 2024 National Healthcare Quality and Disparities Reports. … August 10, 2022 Final Report of the Ockenden Review. … The Report of the Independent Medicines and Medical Devices Safety Review.

  12. Improving Medication Safety in High Risk Medicare Beneficiaries Toolkit. | PSNet

    psnet.ahrq.gov/issue/improving-medication-safety-high-risk-medicare-beneficiaries-toolkit
    October 23, 2019 - Effective Healthcare Research Report No. 38. … Effective Healthcare Research Report No. 38. … Effective Healthcare Research Report No. 38. … May 7, 2014 Guide to Patient and Family Engagement: Environmental Scan Report. … October 9, 2013 2012 User Comparative Database Report: Medical Office Survey on Patient

  13. Understanding care transitions as a patient safety issue. | PSNet

    psnet.ahrq.gov/issue/understanding-care-transitions-patient-safety-issue
    August 22, 2007 - September 30, 2009 Keeping the Commitment: A Progress Report on Four Early Leaders in … January 10, 2007 Scathing report on Kaiser kidney program.

  14. Where Medical Errors Occur and How to Avoid Them. | PSNet

    psnet.ahrq.gov/issue/where-medical-errors-occur-and-how-avoid-them
    September 22, 2010 - Industrial and Systems Engineering and Health Care: Critical Areas of Research: Final Report … Incorporating Health Information Technology Into Workflow Redesign: Request for Information Summary … Report. … 13, 2010 Hospital Survey on Patient Safety Culture: 2010 User Comparative Database Report

  15. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/38933/psn-pdf
    June 16, 2019 - ISMP medication error report analysis. June 16, 2019 Cohen MR. … https://psnet.ahrq.gov/issue/ismp-medication-error-report-analysis-38 This monthly selection of error … reports discusses incidents involving insulin preparation, automated medication cabinet stocking, and … https://psnet.ahrq.gov/issue/ismp-medication-error-report-analysis-38

  16. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/35275/psn-pdf
    June 16, 2019 - ISMP medication error report analysis. June 16, 2019 Cohen MR. … https://psnet.ahrq.gov/issue/ismp-medication-error-report-analysis This monthly selection of medication … error reports provides examples from the field of potential errors and helpful tips on how to avoid … https://psnet.ahrq.gov/issue/ismp-medication-error-report-analysis

  17. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/35560/psn-pdf
    June 16, 2019 - ISMP medication error report analysis. June 16, 2019 Cohen MR. … https://psnet.ahrq.gov/issue/ismp-medication-error-report-analysis-2 This monthly selection of medication … error reports provides examples of problems with neuromuscular blocking agents, confusion with drug … https://psnet.ahrq.gov/issue/ismp-medication-error-report-analysis-2

  18. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/37897/psn-pdf
    June 16, 2019 - ISMP medication error report analysis. June 16, 2019 Cohen MR. … https://psnet.ahrq.gov/issue/ismp-medication-error-report-analysis-26 This monthly selection of medication … error reports includes examples of look-alike/sound-alike medications and a discussion of immunosuppressant … https://psnet.ahrq.gov/issue/ismp-medication-error-report-analysis-26

  19. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/36071/psn-pdf
    June 16, 2019 - ISMP medication error report analysis. June 16, 2019 Cohen MR. … https://psnet.ahrq.gov/issue/ismp-medication-error-report-analysis-6 This monthly selection of medication … error reports provides examples of nimodipine administration mishaps, a lithium overdose, and suggested … https://psnet.ahrq.gov/issue/ismp-medication-error-report-analysis-6

  20. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/36840/psn-pdf
    June 16, 2019 - ISMP medication error report analysis. June 16, 2019 Cohen MR. … https://psnet.ahrq.gov/issue/ismp-medication-error-report-analysis-11 This monthly selection of medication … error reports provides examples of problems related to abbreviations, electronic prescribing, and communication … https://psnet.ahrq.gov/issue/ismp-medication-error-report-analysis-11
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