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Psn-Pdf (pdf file)
psnet.ahrq.gov/node/44877/psn-pdfApril 27, 2016 - Actions Needed to Help Ensure Appropriate Medication Continuation and Prescribing Practices. April 27, 2016 Washington, DC: United States Government Accountability Office; January 5, 2016. Publication GAO-16- 158. https://psnet.ahrq.gov/issue/actions-needed-help-ensure-appropriate-medication-continuation-and- pre… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/44391/psn-pdfJanuary 22, 2016 - Safety culture in cardiac surgical teams: data from five programs and national surgical comparison. January 22, 2016 Marsteller JA, Wen M, Hsu Y-J, et al. Safety Culture in Cardiac Surgical Teams: Data From Five Programs and National Surgical Comparison. Ann Thorac Surg. 2015;100(6):2182-9. doi:10.1016/j.athoracsu… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/40984/psn-pdfSeptember 01, 2016 - Provider and pharmacist responses to warfarin drug–drug interaction alerts: a study of healthcare downstream of CPOE alerts. September 1, 2016 Miller AM, Boro MS, Korman NE, et al. Provider and pharmacist responses to warfarin drug-drug interaction alerts: a study of healthcare downstream of CPOE alerts. J Am Med … -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/34803/psn-pdfJanuary 05, 2017 - Systematic root cause analysis of adverse drug events in a tertiary referral hospital. January 5, 2017 Rex JH, Turnbull JE, Allen SJ, et al. Systematic Root Cause Analysis of Adverse Drug Events in a Tertiary Referral Hospital. Jt Comm J Qual Improv. 2016;26(10). doi:10.1016/s1070-3241(00)26048-3. https://psnet.ah… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/41561/psn-pdfAugust 01, 2012 - Few Adverse Events in Hospitals Were Reported to State Adverse Event Reporting Systems. August 1, 2012 Wright S. Washington, DC: US Department of Health and Human Services, Office of the Inspector General; July 2012. Report No. OEI-06-09-00092. https://psnet.ahrq.gov/issue/few-adverse-events-hospitals-were-reporte… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/45845/psn-pdfDecember 19, 2017 - You can't blame the wreck on the train. December 19, 2017 Potts JR. You can't blame the wreck on the train. Am J Surg. 2017;214(5):974-978. doi:10.1016/j.amjsurg.2016.11.046. https://psnet.ahrq.gov/issue/you-cant-blame-wreck-train Insufficient supervision can limit resident education, which may increase risks to p… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/44406/psn-pdfDecember 04, 2016 - Drug manufacturers' delayed disclosure of serious and unexpected adverse events to the US Food and Drug Administration. December 4, 2016 Ma P, Marinovic I, Karaca-Mandic P. Drug Manufacturers' Delayed Disclosure of Serious and Unexpected Adverse Events to the US Food and Drug Administration. JAMA Intern Med. 2015;… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/46475/psn-pdfApril 16, 2018 - Incident reporting behaviours following the Francis report: a cross-sectional survey. April 16, 2018 Archer G, Colhoun A. Incident reporting behaviours following the Francis report: A cross-sectional survey. J Eval Clin Pract. 2017;24(2). doi:10.1111/jep.12849. https://psnet.ahrq.gov/issue/incident-reporting-behav… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/866254/psn-pdfJuly 10, 2024 - Top Penn State Health surgeon warned leaders about transplant problems months before shutdown. Then he was let go. July 10, 2024 Massey W, Keith C. Spotlight PA: June 20, 2024. https://psnet.ahrq.gov/issue/top-penn-state-health-surgeon-warned-leaders-about-transplant-problems- months-shutdown-then Whistleblowers… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/39074/psn-pdfNovember 04, 2009 - Development and usability of a behavioural marking system for performance assessment of obstetrical teams. November 4, 2009 Tregunno D, Pittini R, Haley M, et al. Development and usability of a behavioural marking system for performance assessment of obstetrical teams. Qual Saf Health Care. 2009;18(5):393-6. doi:1… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/43665/psn-pdfNovember 20, 2015 - Patient safety education to change medical students' attitudes and sense of responsibility. November 20, 2015 Roh H, Park SJ, Kim T. Patient safety education to change medical students' attitudes and sense of responsibility. Med Teach. 2015;37(10):908-14. doi:10.3109/0142159X.2014.970988. https://psnet.ahrq.gov/is… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/35838/psn-pdfMarch 28, 2011 - Unscheduled returns to the emergency department: an outcome of medical errors? March 28, 2011 Nuñez S, Hexdall A, Aguirre-Jaime A. Unscheduled returns to the emergency department: an outcome of medical errors? Qual Saf Health Care. 2006;15(2):102-8. https://psnet.ahrq.gov/issue/unscheduled-returns-emergency-depart… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/866346/psn-pdfJuly 24, 2024 - A human right-based approach to dealing with adverse events in residential care facilities. July 24, 2024 McGrane N, Behan L, Keyes LM. A human right-based approach to dealing with adverse events in residential care facilities. Health Hum Rights. 2024;26(1):115-128. https://psnet.ahrq.gov/issue/human-right-based-a… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/73345/psn-pdfJune 02, 2021 - An estimate of missed pediatric sepsis in the emergency department. June 2, 2021 Cifra CL, Westlund E, Ten Eyck P, et al. An estimate of missed pediatric sepsis in the emergency department. Diagnosis (Berl). 2020;8(2):193-198. doi:10.1515/dx-2020-0023. https://psnet.ahrq.gov/issue/estimate-missed-pediatric-sepsis-… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/72638/psn-pdfJanuary 13, 2021 - Observational study of drug formulation manipulation in pediatric versus adult inpatients. January 13, 2021 Spishock S, Meyers R, Robinson CA, et al. Observational Study of Drug Formulation Manipulation in Pediatric Versus Adult Inpatients. J Patient Saf. 2021;17(1):e10-e14. doi:10.1097/pts.0000000000000646. https… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/50419/psn-pdfSeptember 04, 2019 - Hospitalisation for medication misadventures among older adults with and without dementia: a 5-year retrospective study. September 4, 2019 Mullan J, Burns P, Mohanan L, et al. Hospitalisation for medication misadventures among older adults with and without dementia: A 5-year retrospective study. Australas J Ageing… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/837961/psn-pdfAugust 31, 2022 - Risk reduction strategy to decrease incidence of retained surgical items. August 31, 2022 Kaplan HJ, Spiera ZC, Feldman DL, et al. Risk reduction strategy to decrease incidence of retained surgical items. J Am Coll Surg. 2022;235(3):494-499. doi:10.1097/xcs.0000000000000264. https://psnet.ahrq.gov/issue/risk-reduc… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/43200/psn-pdfMay 21, 2014 - How Does Hospital Quality Management Drive Quality? Results From the "Deepening Our Understanding of Quality Improvement (DUQuE)" Project. May 21, 2014 Schneider EC, ed. Int J Qual Healthc. 2014;26(suppl 1):1-115. https://psnet.ahrq.gov/issue/how-does-hospital-quality-management-drive-quality-results-deepening-our… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/48073/psn-pdfJune 19, 2019 - Special Section on Human Factors and Ergonomics in the Operating Room: Contributions That Advance Surgical Practice. June 19, 2019 Hallbeck MS, Paquet V, eds. Appl Ergon. 2019;78:248-308. https://psnet.ahrq.gov/issue/special-section-human-factors-and-ergonomics-operating-room-contributions- advance-surgical Surg… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/855001/psn-pdfNovember 01, 2023 - Rethinking Patient Safety: A Discussion Guide for Patients, Healthcare Providers and Leaders. November 1, 2023 Gilbert R, Asselbergs M, Davis D, et al. Healthcare Excellence Canada; 2023. https://psnet.ahrq.gov/issue/rethinking-patient-safety-discussion-guide-patients-healthcare-providers-and- leaders Patient saf…
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