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psnet.ahrq.gov/node/44936/psn-pdf
May 09, 2017 - Potential benefit of electronic pharmacy claims data to
prevent medication history errors and resultant inpatient
order errors.
May 9, 2017
Pevnick JM, Palmer KA, Shane R, et al. Potential benefit of electronic pharmacy claims data to prevent
medication history errors and resultant inpatient order errors. J Am Med…
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psnet.ahrq.gov/node/44675/psn-pdf
July 05, 2016 - Why July matters.
July 5, 2016
Petrilli CM, Del Valle J, Chopra V. Why July Matters. Acad Med. 2016;91(7):910-912.
doi:10.1097/ACM.0000000000001196.
https://psnet.ahrq.gov/issue/why-july-matters
Studies have reached conflicting conclusions about whether the "July Effect"—the belief that inpatient
mortality increa…
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psnet.ahrq.gov/node/34706/psn-pdf
December 23, 2012 - Analysing potential harm in Australian general practice:
an incident-monitoring study.
December 23, 2012
Bhasale AL, Miller GC, Reid SE, et al. Analysing potential harm in Australian general practice: an incident-
monitoring study. Med J Aust. 1998;169(2):73-6.
https://psnet.ahrq.gov/issue/analysing-potential-harm…
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psnet.ahrq.gov/node/43385/psn-pdf
August 06, 2014 - Medicines management support to older people:
understanding the context of systems failure.
August 6, 2014
Rogers S, Martin G, Rai G. Medicines management support to older people: understanding the context of
systems failure. BMJ Open. 2014;4(7):e005302. doi:10.1136/bmjopen-2014-005302.
https://psnet.ahrq.gov/issu…
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psnet.ahrq.gov/node/45271/psn-pdf
August 10, 2016 - Patient identification and tube labelling—a call for
harmonisation.
August 10, 2016
van Dongen-Lases EC, Cornes MP, Grankvist K, et al. Patient identification and tube labelling – a call for
harmonisation. Clinical Chemistry and Laboratory Medicine (CCLM). 2016;54(7). doi:10.1515/cclm-2015-
1089.
https://psnet.ah…
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psnet.ahrq.gov/node/44076/psn-pdf
May 19, 2018 - The trigger tool as a method to measure harmful
medication errors in children.
May 19, 2018
Maaskant JM, Smeulers M, Bosman D, et al. The Trigger Tool as a Method to Measure Harmful Medication
Errors in Children. J Patient Saf. 2018;14(2):95-100. doi:10.1097/PTS.0000000000000177.
https://psnet.ahrq.gov/issue/trigg…
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psnet.ahrq.gov/node/44572/psn-pdf
January 22, 2016 - Can social media be used as a hospital quality
improvement tool?
January 22, 2016
Lagu T, Goff SL, Craft B, et al. Can social media be used as a hospital quality improvement tool? J Hosp
Med. 2016;11(1):52-5. doi:10.1002/jhm.2486.
https://psnet.ahrq.gov/issue/can-social-media-be-used-hospital-quality-improvement-t…
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psnet.ahrq.gov/node/34692/psn-pdf
February 10, 2011 - The economic consequences of medical injuries:
implications for a no-fault insurance plan.
February 10, 2011
Johnson WG, Brennan TA, Newhouse JP, et al. The economic consequences of medical injuries.
Implications for a no-fault insurance plan. JAMA. 1992;267(18):2487-92.
https://psnet.ahrq.gov/issue/economic-conse…
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psnet.ahrq.gov/node/36964/psn-pdf
March 24, 2011 - Patients use an internet technology to report when things
go wrong.
March 24, 2011
Wasson JH, MacKenzie TA, Hall M. Patients use an internet technology to report when things go wrong.
Qual Saf Health Care. 2007;16(3):213-5.
https://psnet.ahrq.gov/issue/patients-use-internet-technology-report-when-things-go-wrong
…
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psnet.ahrq.gov/node/33737/psn-pdf
September 01, 2012 - Preparing for Health Reform: The Federal Government
and the Nursing Workforce
September 1, 2012
Buerhaus P. Preparing for Health Reform: The Federal Government and the Nursing Workforce. PSNet
[internet]. 2012.
https://psnet.ahrq.gov/perspective/preparing-health-reform-federal-government-and-nursing-workforce
Per…
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psnet.ahrq.gov/node/35456/psn-pdf
February 19, 2010 - The working hours of hospital staff nurses and patient
safety.
February 19, 2010
Rogers AE, Hwang W-T, Scott LD, et al. The working hours of hospital staff nurses and patient safety.
Health Aff (Millwood). 2004;23(4):202-212.
https://psnet.ahrq.gov/issue/working-hours-hospital-staff-nurses-and-patient-safety
This…
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psnet.ahrq.gov/node/45996/psn-pdf
May 10, 2017 - Evaluation of medication-related clinical decision support
alert overrides in the intensive care unit.
May 10, 2017
Wong A, Amato MG, Seger DL, et al. Evaluation of medication-related clinical decision support alert
overrides in the intensive care unit. J Crit Care. 2017;39:156-161. doi:10.1016/j.jcrc.2017.02.027.
…
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psnet.ahrq.gov/node/47359/psn-pdf
October 10, 2018 - Is there evidence of a July effect among patients
undergoing hysterectomy surgery?
October 10, 2018
Varma S, Mehta A, Hutfless S, et al. Is there evidence of a July effect among patients undergoing
hysterectomy surgery? Am J Obstet Gynecol. 2018;219(2):176.e1-176.e9. doi:10.1016/j.ajog.2018.05.033.
https://psnet.a…
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psnet.ahrq.gov/node/37294/psn-pdf
May 21, 2013 - Improving Hand-Off Communication.
May 21, 2013
Oakbrook Terrace lL: Joint Commission Resources; 2007. ISBN 9781599400907.
https://psnet.ahrq.gov/issue/improving-hand-communication
The process of transferring primary responsibility for patient care is commonly referred to as a handoff.
Handoffs are inherently dange…
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psnet.ahrq.gov/node/47331/psn-pdf
October 17, 2018 - Description and factors associated with missed nursing
care in an acute care community hospital.
October 17, 2018
Duffy JR, Culp S, Padrutt T. Description and factors associated with missed nursing care in an acute care
community hospital. J Nurs Adm. 2018;48(7-8):361-367. doi:10.1097/NNA.0000000000000630.
https:/…
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psnet.ahrq.gov/perspective/patient-safety-ambulatory-care-setting
April 27, 2022 - yield false negatives for a variety of reasons, such as testing too soon after exposure or inadequate sampling
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psnet.ahrq.gov/node/35300/psn-pdf
March 04, 2011 - How strong is the evidence for the use of perioperative
beta blockers in non-cardiac surgery? Systematic review
and meta-analysis of randomised controlled trials.
March 4, 2011
Devereaux PJ, Beattie WS, Choi PT-L, et al. How strong is the evidence for the use of perioperative ?
blockers in non-cardiac surgery? Sys…
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psnet.ahrq.gov/node/38995/psn-pdf
March 04, 2011 - Does computerized provider order entry reduce
prescribing errors for hospital inpatients? A systematic
review.
March 4, 2011
Reckmann MH, Westbrook JI, Koh Y, et al. Does computerized provider order entry reduce prescribing
errors for hospital inpatients? A systematic review. J Am Med Inform Assoc. 2009;16(5):613-…
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psnet.ahrq.gov/node/47379/psn-pdf
November 14, 2018 - Analysis of medication therapy discontinuation orders in
new electronic prescriptions and opportunities for
implementing CancelRx.
November 14, 2018
Yang Y, Ward-Charlerie S, Kashyap N, et al. Analysis of medication therapy discontinuation orders in new
electronic prescriptions and opportunities for implementing C…
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psnet.ahrq.gov/node/845348/psn-pdf
February 02, 2012 - Liquid-based Papanicolaou tests in endometrial
carcinoma diagnosis: performance, error root cause
analysis, and quality improvement.
February 2, 2012
Sams SB, Currens HS, Raab SS. Liquid-based Papanicolaou tests in endometrial carcinoma diagnosis:
performance, error root cause analysis, and quality improvement. Am…