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psnet.ahrq.gov/node/39862/psn-pdf
September 24, 2016 - Errors and electronic prescribing: a controlled laboratory
study to examine task complexity and interruption effects.
September 24, 2016
Magrabi F, Li SYW, Day R, et al. Errors and electronic prescribing: a controlled laboratory study to examine
task complexity and interruption effects. J Am Med Inform Assoc. 2010;…
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psnet.ahrq.gov/node/37590/psn-pdf
April 13, 2018 - Just Culture: Restoring Trust and Accountability in Your
Organization, Third Edition.
April 13, 2018
Dekker S. Boca Raton, FL: CRC Press; 2017. ISBN: 9781472475756.
https://psnet.ahrq.gov/issue/just-culture-restoring-trust-and-accountability-your-organization-third-edition
Although early efforts in the patient saf…
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psnet.ahrq.gov/node/36551/psn-pdf
February 17, 2011 - An intervention to decrease catheter-related bloodstream
infections in the ICU.
February 17, 2011
Pronovost P, Needham DM, Berenholtz SM, et al. An intervention to decrease catheter-related
bloodstream infections in the ICU. N Engl J Med. 2006;355(26):2725-2732.
https://psnet.ahrq.gov/issue/intervention-decrease-c…
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psnet.ahrq.gov/node/865817/psn-pdf
May 08, 2024 - Using Healthcare Failure Mode and Effect Analysis in
prospective medication safety risk management in
secondary care inpatient wards.
May 8, 2024
Sova PM, Holmström A-R, Airaksinen M, et al. Using Healthcare Failure Mode and Effect Analysis in
prospective medication safety risk management in secondary care inpatie…
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psnet.ahrq.gov/node/48012/psn-pdf
June 12, 2019 - American Geriatrics Society 2019 Updated AGS Beers
Criteria for Potentially Inappropriate Medication Use in
Older Adults.
June 12, 2019
American Geriatrics Society 2019 Updated AGS Beers Criteria® for Potentially Inappropriate Medication
Use in Older Adults. J Am Geriatr Soc. 2019;67(4):674-694. doi:10.1111/jgs.15…
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psnet.ahrq.gov/node/45954/psn-pdf
December 22, 2017 - Effectiveness of a 'Do not interrupt' bundled intervention
to reduce interruptions during medication administration:
a cluster randomised controlled feasibility study.
December 22, 2017
Westbrook JI, Li L, Hooper TD, et al. Effectiveness of a 'Do not interrupt' bundled intervention to reduce
interruptions during m…
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psnet.ahrq.gov/node/867177/psn-pdf
January 01, 2025 - Experiences with diagnostic delay among underserved
racial and ethnic patients: a systematic review of the
qualitative literature.
November 20, 2024
Faugno E, Galbraith AA, Walsh KE, et al. Experiences with diagnostic delay among underserved racial and
ethnic patients: a systematic review of the qualitative litera…
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psnet.ahrq.gov/web-mm/translating-normal-abnormal
October 02, 2019 - this to the patient using a phone interpreter, she remained distressed and upset, complaining of a severe
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psnet.ahrq.gov/perspective/evidence-based-physical-examination-patient-safety-practice
November 01, 2012 - Severe lower limb cellulitis is best diagnosed by dermatologists and managed with shared care between … Effectiveness of early switch from intravenous to oral antibiotics in severe community acquired pneumonia
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psnet.ahrq.gov/issue/emergency-nursing-and-medical-error-survey-two-states
January 25, 2010 - December 1, 2011
Are temporary staff associated with more severe emergency department
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psnet.ahrq.gov/issue/ismp-quarterwatch-reports
June 07, 2017 - June 13, 2018
Severe hyperglycemia in patients incorrectly using insulin pens at home
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psnet.ahrq.gov/issue/2017-ismp-medication-safety-self-assessment-communityambulatory-pharmacy
June 07, 2017 - May 11, 2017
Severe hyperglycemia in patients incorrectly using insulin pens at home.
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psnet.ahrq.gov/issue/patient-safety-24
December 01, 2011 - July 8, 2013
Are temporary staff associated with more severe emergency department medication
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psnet.ahrq.gov/issue/nursing-care-quality-nqf
September 06, 2011 - July 8, 2009
Antecedents of severe and nonsevere medication errors.
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psnet.ahrq.gov/node/49811/psn-pdf
November 01, 2017 - worsening respiratory status, liver abnormalities, and colonic pseudo-obstruction were all
consistent with severe … These are rare but life-threatening conditions that result from either decompensated
thyrotoxicosis or severe … Effects Score
Absent 0
Mild (agitation) 10
Moderate (delirium, psychosis, extreme lethargy) 20
Severe … 25
Congestive Heart Failure Score
Absent 0
Mild (pedal edema) 5
Moderate (bibasilar rales) 10
Severe
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psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.25_slideshow.ppt
July 01, 2003 - advanced care discussions
Case: Code Status Confusion
A 60-year-old woman with a history of severe … preferences in scenarios with uncertain outcomes
i.e., successful cardiac resuscitation with resultant severe
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psnet.ahrq.gov/issue/10-medication-safety-tips-hospitalized-patients
February 06, 2019 - June 13, 2018
Severe hyperglycemia in patients incorrectly using insulin pens at home
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psnet.ahrq.gov/issue/ismp-long-term-care-advise-err
June 07, 2017 - June 13, 2018
Severe hyperglycemia in patients incorrectly using insulin pens at home
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psnet.ahrq.gov/issue/clinical-issues-series
July 05, 2006 - 2006
National Partnership for Maternal Safety: consensus bundle on support after a severe
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psnet.ahrq.gov/issue/fatal-gas-line-mix-how-avoid-making-gastly-mistake
April 29, 2018 - September 12, 2016
ALERT: reports of severe harm after intravenous administration of