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101. ISMP survey shows provider text messaging often runs afoul of patient safety. | PSNet
     psnet.ahrq.gov/issue/ismp-survey-shows-provider-text-messaging-often-runs-afoul-patient-safety
     May 07, 2018 - Newspaper/Magazine Article ISMP survey shows provider text messaging often runs afoul of patient safety. Citation Text: ISMP survey shows provider text messaging often runs afoul of patient safety. ISMP Medication Safety Alert! Acute Care Edition. November 16, 2017;22:1-5. Copy Citatio…

102. Strategies and Approaches for Investigating Patient Safety Events | PSNet
     psnet.ahrq.gov/primer/strategies-and-approaches-investigating-patient-safety-events
     March 15, 2025 - cultures that value patient safety, policies and procedures to ensure the confidentiality of employees who submit … review of reports, and close the loop by developing and communicating action plans to individuals who submit

103. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/35239/psn-pdf
     August 02, 2023 - American Hospital Association–McKesson Quest for Quality Prize. August 2, 2023 American Hospital Association. https://psnet.ahrq.gov/issue/american-hospital-association-mckesson-quest-quality-prize-1 This award program recognizes organization-wide commitment to five key goals that support high-quality health care…

104. Choice, transparency, coordination, and quality among direct-to-consumer telemedicine websites and apps treating skin disease. | PSNet
     psnet.ahrq.gov/issue/choice-transparency-coordination-and-quality-among-direct-consumer-telemedicine-websites-and
     May 29, 2019 - Study Choice, transparency, coordination, and quality among direct-to-consumer telemedicine websites and apps treating skin disease. Citation Text: Resneck JS, Abrouk M, Steuer M, et al. Choice, Transparency, Coordination, and Quality Among Direct-to-Consumer Telemedicine Websites and Ap…

105. Implementation of an online reporting system to identify unprofessional behaviors and mistreatment directed at trainees at an academic medical center. | PSNet
     psnet.ahrq.gov/issue/implementation-online-reporting-system-identify-unprofessional-behaviors-and-mistreatment
     July 13, 2022 - Study Implementation of an online reporting system to identify unprofessional behaviors and mistreatment directed at trainees at an academic medical center. Citation Text: Leitman IM, Muller D, Miller S, et al. Implementation of an online reporting system to identify unprofessional behav…

106. MEDMARX 5th Anniversary Data Report: A Chartbook of 2003 Findings and Trends 1999-2003. | PSNet
     psnet.ahrq.gov/issue/medmarx-5th-anniversary-data-report-chartbook-2003-findings-and-trends-1999-2003
     August 24, 2015 - Book/Report MEDMARX 5th Anniversary Data Report: A Chartbook of 2003 Findings and Trends 1999-2003. Citation Text: MEDMARX 5th Anniversary Data Report: A Chartbook of 2003 Findings and Trends 1999-2003. Hicks RW, Santell JP, Cousins DD, et al. Rockville, MD: USP Center for …

107. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/35919/psn-pdf
     January 01, 2019 - Pennsylvania Patient Safety Advisory. August 9, 2017 Patient Safety Authority https://psnet.ahrq.gov/issue/pennsylvania-patient-safety-advisory This quarterly newsletter shares insights and analysis on incident reports submitted through the Pennsylvania Patient Safety Reporting System. In 2019 this open-access pub…

108. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/39835/psn-pdf
     December 27, 2018 - Advancement toward High Reliability in Healthcare Awards. December 27, 2018 Department of Defense Patient Safety Program; DoD PSP; DoD https://psnet.ahrq.gov/issue/advancement-toward-high-reliability-healthcare-awards This award recognizes outstanding high reliability improvement work in the Military Health System…

109. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/38375/psn-pdf
     December 01, 2019 - ISMP QuarterWatch Reports. April 17, 2019 Horsham, PA: Institute for Safe Medication Practices. https://psnet.ahrq.gov/issue/ismp-quarterwatch-reports This website provides quarterly reports that identify and analyze new risks related to medications and adverse drug events submitted to the Food and Drug Administra…

110. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/35632/psn-pdf
     February 03, 2025 - Anesthesia Patient Safety Foundation (APSF) Grant Program. February 3, 2025 Anesthesia Patient Safety Foundation. https://psnet.ahrq.gov/issue/anesthesia-patient-safety-foundation-apsf-grant-program This grant program supports research that seeks to improve anesthesia safety and the development of researchers in …

111. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/74142/psn-pdf
     January 02, 2024 - Robert L. Wears Patient Safety Leadership Award. November 1, 2023 Regional Center at Jacksonville University, University of Florida College of Medicine – Jacksonville, FL. https://psnet.ahrq.gov/issue/robert-l-wears-patient-safety-leadership-award Inspired by the research and leadership of Dr. Robert Wears, this aw…

112. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/50850/psn-pdf
     January 29, 2020 - Better Safer Care Victoria. January 29, 2020 Safer Care Victoria and Victorian Agency for Health Information. https://psnet.ahrq.gov/issue/better-safer-care-victoria Large scale tracking of adverse care incidents offers evidence that governments and organizations can use to target care process improvement efforts.…

113. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/43202/psn-pdf
     September 11, 2023 - ISMP Survey on High-Alert Medications in Acute Care Settings. September 11, 2023 Plymouth Meeting, PA: Institute for Safe Medication Practices; 2023. https://psnet.ahrq.gov/issue/ismp-survey-high-alert-medications-acute-care-settings Experience from the sharp end helps to inform safety improvement initiatives. The…

114. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/46863/psn-pdf
     December 05, 2024 - Safer Together Annual Report. December 5, 2024 Child Health Patient Safety Organization. Washington, DC: Children's Hospital Association. https://psnet.ahrq.gov/issue/perfecting-detection-understanding-source-harm This annual publication provides common cause analyses of incidents submitted to a pediatric patient …

115. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/36110/psn-pdf
     April 04, 2024 - Sentinel Event Data Summary. April 4, 2024 Joint Commission. https://psnet.ahrq.gov/issue/sentinel-event-statistics-1995-2019 This website provides sentinel event data reported to The Joint Commission, which includes information on sentinel events reported from January through December 2023. Falls, wrong surgery a…

116. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/60162/psn-pdf
     March 25, 2020 - Patient Safety Improvement Act of 2020. March 25, 2020 SB 3380. 116th Congress (2020). https://psnet.ahrq.gov/issue/patient-safety-improvement-act-2020 This bill submits amendments to existing US federal law to strengthen state-organized efforts to improve health care-associated infection control efforts, pediatri…

117. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/43790/psn-pdf
     October 23, 2023 - Complaints to the Parliamentary and Health Service Ombudsman. October 23, 2023 Manchester, UK: Parliamentary and Health Service Ombudsman. https://psnet.ahrq.gov/issue/complaints-about-acute-trusts-2016-2017 The National Health Service broadly reports the results of system-level analyses and investigations into t…

118. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/35665/psn-pdf
     March 18, 2010 - Clear liquids may place patients at risk. March 18, 2010 Pennsylvania Patient Safety Reporting System. https://psnet.ahrq.gov/issue/clear-liquids-may-place-patients-risk Using reports submitted to the Pennsylvania Patient Safety Reporting System, this advisory cautions against using unlabeled clear liquids and pro…

119. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/46708/psn-pdf
     February 08, 2023 - FDA/ISMP Safe Medication Management Fellowship Program. February 8, 2023 Food and Drug Administration, Institute for Safe Medication Practices. https://psnet.ahrq.gov/issue/fdaismp-safe-medication-management-fellowship-program This fellowship program provides clinicians with learning opportunities at the Institute…

120. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/50719/psn-pdf
     December 04, 2019 - A lot happens when you report a hazard or error to ISMP—there’s no “black hole” here! December 4, 2019 ISMP Medication Safety Alert! Acute Care Edition. November 7, 2019 https://psnet.ahrq.gov/issue/lot-happens-when-you-report-hazard-or-error-ismp-theres-no-black-hole-here The reporting and analysis of incidents i…