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psnet.ahrq.gov/node/44234/psn-pdf
September 09, 2015 - Improving the reliability of verbal communication between
primary care physicians and pediatric hospitalists at
hospital discharge.
September 9, 2015
Mussman GM, Vossmeyer MT, Brady PW, et al. Improving the reliability of verbal communication between
primary care physicians and pediatric hospitalists at hospital d…
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psnet.ahrq.gov/node/72605/psn-pdf
December 23, 2020 - Society for Maternal-Fetal Medicine Special Statement: a
maternal transport briefing form and checklist.
December 23, 2020
Gibson KS, McLean D. Society for Maternal-Fetal Medicine Special Statement: A maternal transport
briefing form and checklist. Am J Obstet Gynecol. 2020;223(5):B12-B15. doi:10.1016/j.ajog.2020.0…
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psnet.ahrq.gov/node/43139/psn-pdf
April 23, 2014 - Patient safety in obstetrics and obstetric anesthesia.
April 23, 2014
Kung A, Pratt SD. Patient safety in obstetrics and obstetric anesthesia. Int Anesthesiol Clin. 2014;52(2):86-
110. doi:10.1097/AIA.0000000000000017.
https://psnet.ahrq.gov/issue/patient-safety-obstetrics-and-obstetric-anesthesia
Labor and delive…
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psnet.ahrq.gov/node/43830/psn-pdf
February 04, 2015 - A combined teamwork training and work standardisation
intervention in operating theatres: controlled interrupted
time series study.
February 4, 2015
Morgan L, Pickering S, Hadi M, et al. A combined teamwork training and work standardisation intervention
in operating theatres: controlled interrupted time series stu…
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psnet.ahrq.gov/node/48160/psn-pdf
January 01, 2020 - Engaging the patient and family in the surgical safety
process utilizing SafeStart.
August 28, 2019
Elger BM, Esparaz JR, Nierstedt RT, et al. Engaging the patient and family in the surgical safety process
utilizing. J Pediatr Surg. 2020;55(4). doi:10.1016/j.jpedsurg.2019.06.012.
https://psnet.ahrq.gov/issue/engag…
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psnet.ahrq.gov/node/44836/psn-pdf
January 27, 2016 - Advancing the next generation of handover research and
practice with cognitive load theory.
January 27, 2016
Young JQ, Wachter R, Cate OT, et al. Advancing the next generation of handover research and practice
with cognitive load theory. BMJ Qual Saf. 2016;25(2):66-70. doi:10.1136/bmjqs-2015-004181.
https://psnet.…
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psnet.ahrq.gov/node/838921/psn-pdf
October 26, 2022 - Improving discharge safety in a pediatric emergency
department.
October 26, 2022
Paydar-Darian N, Stack AM, Volpe D, et al. Improving discharge safety in a pediatric emergency
department. Pediatrics. 2022;150(5):e2021054307. doi:10.1542/peds.2021-054307.
https://psnet.ahrq.gov/issue/improving-discharge-safety-pedi…
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psnet.ahrq.gov/node/42286/psn-pdf
May 22, 2013 - Impact of a team and leaders-directed strategy to improve
nurses' adherence to hand hygiene guidelines: a cluster
randomised trial.
May 22, 2013
Huis A, Schoonhoven L, Grol R, et al. Impact of a team and leaders-directed strategy to improve nurses'
adherence to hand hygiene guidelines: a cluster randomised trial. …
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psnet.ahrq.gov/node/45286/psn-pdf
May 07, 2018 - Paralyzed by mistakes: reassess the safety of
neuromuscular blockers in your facility.
May 7, 2018
ISMP Medication Safety Alert! Acute Care Edition. June 16, 2016;21:1-6.
https://psnet.ahrq.gov/issue/paralyzed-mistakes-reassess-safety-neuromuscular-blockers-your-facility
Neuromuscular blockers can result in seriou…
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psnet.ahrq.gov/node/45886/psn-pdf
July 05, 2017 - Organizational perspectives of nurse executives in 15
hospitals on the impact and effectiveness of rapid
response teams.
July 5, 2017
Smith PL, McSweeney J. Organizational Perspectives of Nurse Executives in 15 Hospitals on the Impact
and Effectiveness of Rapid Response Teams. Jt Comm J Qual Patient Saf. 2017;43(6…
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psnet.ahrq.gov/node/46526/psn-pdf
December 22, 2018 - Risk factors for adverse events in emergency department
procedural sedation for children.
December 22, 2018
Bhatt M, Johnson DW, Chan J, et al. Risk Factors for Adverse Events in Emergency Department
Procedural Sedation for Children. JAMA Pediatr. 2017;171(10):957-964.
doi:10.1001/jamapediatrics.2017.2135.
https:…
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psnet.ahrq.gov/node/866243/psn-pdf
July 10, 2024 - Building a resilient patient safety culture: a large
healthcare organization's approach to systematically
reviewing serious harm events.
July 10, 2024
Harvey B, Dhalla IA, O'Neill C, et al. Building a resilient patient safety culture: a large healthcare
organization's approach to systematically reviewing serious h…
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psnet.ahrq.gov/node/43245/psn-pdf
June 18, 2014 - Paediatric nurses' adherence to the double-checking
process during medication administration in a children's
hospital: an observational study.
June 18, 2014
Alsulami Z, Choonara I, Conroy S. Paediatric nurses' adherence to the double-checking process during
medication administration in a children's hospital: an ob…
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psnet.ahrq.gov/node/44196/psn-pdf
March 27, 2017 - Patient Safety in Ambulance Services: A Scoping Review.
March 27, 2017
Patient Safety In Ambulance Services: A Scoping Review.
https://psnet.ahrq.gov/issue/patient-safety-ambulance-services-scoping-review
The safety of emergency medical care delivered in conjunction with ambulance services has not been
studied in …
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psnet.ahrq.gov/node/42264/psn-pdf
May 25, 2022 - Safety Considerations for Container Labels and Carton
Labeling Design to Minimize Medication Errors: Guidance
for Industry.
May 25, 2022
Rockville, MD: US Department of Health and Human Services, Food and Drug Administration, Center for
Drug Evaluation and Research; May 18, 2022.
https://psnet.ahrq.gov/issue/safe…
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psnet.ahrq.gov/node/44883/psn-pdf
February 17, 2016 - Comparison of barcode scanning by pharmacy
technicians and pharmacists' visual checks for final
product verification.
February 17, 2016
Wang BN-T, Brummond P, Stevenson JG. Comparison of barcode scanning by pharmacy technicians and
pharmacists' visual checks for final product verification. Am J Health Syst Pharm. …
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psnet.ahrq.gov/node/47432/psn-pdf
September 26, 2018 - Malnutrition in the hospital: the pharmacist’s role in
prevention and treatment.
September 26, 2018
Decerbo M. Pharmacy Practice News. September 13, 2018.
https://psnet.ahrq.gov/issue/malnutrition-hospital-pharmacists-role-prevention-and-treatment
Parenteral nutrition errors can result in patient malnutrition and …
-
psnet.ahrq.gov/node/43625/psn-pdf
October 29, 2014 - Assessing distractors and teamwork during surgery:
developing an event-based method for direct observation.
October 29, 2014
Seelandt JC, Tschan F, Keller S, et al. Assessing distractors and teamwork during surgery: developing an
event-based method for direct observation. BMJ Qual Saf. 2014;23(11):918-29. doi:10.11…
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www.ahrq.gov/patient-safety/settings/hospital/candor/modules/guide4/aph.html
August 01, 2022 - Event Investigation and Analysis Guide: Appendix H
Hierarchy of Solutions
Do solutions meet the following criteria:
Address the root cause/contributing factor.
Are specific and concrete.
Can be understood and implemented by a reader unfamiliar with the situation.
Will be tested or simulated prior to…
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www.uspreventiveservicestaskforce.org/uspstf/draft-update-summary/cardiovascular-disease-enhanced-risk-assessment-non-traditional-risk-factors
September 19, 2024 - Share to Facebook
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Enhanced Risk Assessment for Cardiovascular Disease: Coronary Artery Calcium Scoring
An Update for This Topic is In Progress
LAST UPDATED: Sep 19, 2024
The Task Force keeps rec…