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psnet.ahrq.gov/node/44923/psn-pdf
June 07, 2016 - Completeness of serious adverse drug event reports
received by the US Food and Drug Administration in 2014.
June 7, 2016
Moore TJ, Furberg CD, Mattison DR, et al. Completeness of serious adverse drug event reports received
by the US Food and Drug Administration in 2014. Pharmacoepidemiol Drug Saf. 2016;25(6):713-8.…
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psnet.ahrq.gov/node/44749/psn-pdf
December 27, 2018 - Southern Baptist Hospital of Florida v. Charles.
December 27, 2018
Fla Ct App, 1st Dist. October 28, 2015.
https://psnet.ahrq.gov/issue/southern-baptist-hospital-florida-v-charles
The Patient Safety and Quality Improvement Act (PSQIA) provides federal protection of adverse event
reports voluntarily submitted to pa…
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psnet.ahrq.gov/node/41573/psn-pdf
October 30, 2013 - The medical student as a patient: attitudes towards
involvement in the quality and safety of health care.
October 30, 2013
Davis R, Joshi D, Patel K, et al. The medical student as a patient: attitudes towards involvement in the
quality and safety of health care. J Eval Clin Pract. 2013;19(5):812-8. doi:10.1111/j.13…
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psnet.ahrq.gov/node/43030/psn-pdf
March 26, 2014 - Recommendations for practitioners and manufacturers to
address system-based causes of vaccine errors.
March 26, 2014
ISMP Medication Safety Alert! Acute care edition. March 13, 2014;19:1-2,4-5.
https://psnet.ahrq.gov/issue/recommendations-practitioners-and-manufacturers-address-system-based-
causes-vaccine-…
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psnet.ahrq.gov/node/44787/psn-pdf
January 20, 2016 - Medication errors involving overrides of healthcare
technology.
January 20, 2016
Grissinger M. PA-PSRS Patient Saf Advis. December 2015;12:141-148.
https://psnet.ahrq.gov/issue/medication-errors-involving-overrides-healthcare-technology
Users often bypass alerts meant to enhance safety of medication ordering and d…
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psnet.ahrq.gov/node/867638/psn-pdf
February 26, 2025 - Artificial intelligence related safety issues associated with
FDA medical device reports.
February 26, 2025
Handley JL, Krevat SA, Fong A, et al. Artificial intelligence related safety issues associated with FDA
medical device reports. NPJ Digit Med. 2024;7(1):351. doi:10.1038/s41746-024-01357-5.
https://psnet.ahr…
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psnet.ahrq.gov/node/866644/psn-pdf
September 04, 2024 - The impact of independent chemotherapy prescribing by
advanced practice providers on patient safety and
clinician satisfaction.
September 4, 2024
LeStrange N, Walton AM, Watson JL, et al. The impact of independent chemotherapy prescribing by
advanced practice providers on patient safety and clinician satisfaction.…
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psnet.ahrq.gov/node/45282/psn-pdf
July 13, 2016 - Health literacy and patient safety events.
July 13, 2016
Gardner LA. Health literacy and patient safety events. PA-PSRS Patient Saf Advis. 2016;13(2):58-65.
https://psnet.ahrq.gov/issue/health-literacy-and-patient-safety-events
Insufficient health literacy is a known patient safety hazard. This article reviews inci…
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psnet.ahrq.gov/node/42194/psn-pdf
April 24, 2013 - Drug errors and related interventions reported by United
States clinical pharmacists: The American College of
Clinical Pharmacy Practice-Based Research Network
medication error detection, amelioration and prevention
study.
April 24, 2013
Kuo GM, Touchette DR, Marinac JS. Drug errors and related interventions repo…
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psnet.ahrq.gov/node/44424/psn-pdf
August 19, 2015 - Taking patients' narratives about clinicians from anecdote
to science.
August 19, 2015
Schlesinger M, Grob R, Shaller D, et al. Taking Patients' Narratives about Clinicians from Anecdote to
Science. New Engl J Med. 2015;373(7):675-679. doi:10.1056/NEJMsb1502361.
https://psnet.ahrq.gov/issue/taking-patients-narrati…
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psnet.ahrq.gov/node/45790/psn-pdf
January 11, 2017 - Analysis of reported drug interactions: a recipe for harm
to patients.
January 11, 2017
Grissinger M. PA-PSRS Patient Saf Advis. December 2016;13:137-148.
https://psnet.ahrq.gov/issue/analysis-reported-drug-interactions-recipe-harm-patients
Drawing from reports of medication errors submitted over a 7-year period t…
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psnet.ahrq.gov/node/848361/psn-pdf
May 03, 2023 - More than algorithms: an analysis of safety events
involving ML-enabled medical devices reported to the
FDA.
May 3, 2023
Lyell D, Wang Y, Coiera E, et al. More than algorithms: an analysis of safety events involving ML-enabled
medical devices reported to the FDA. J Am Med Inform Assoc. 2023;30(7):1227-1236.
doi:1…
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psnet.ahrq.gov/node/842763/psn-pdf
January 18, 2023 - Implementation of peer messengers to deliver feedback:
an observational study to promote professionalism in
nursing.
January 18, 2023
Baldwin CA, Hanrahan K, Edmonds SW, et al. Implementation of peer messengers to deliver feedback: an
observational study to promote professionalism in nursing. Jt Comm J Qual Patien…
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psnet.ahrq.gov/node/60713/psn-pdf
July 22, 2020 - Assessment of health information technology-related
outpatient diagnostic delays in the US Veterans Affairs
health care system: a qualitative study of aggregated root
cause analysis data.
July 22, 2020
Powell L, Sittig DF, Chrouser K, et al. Assessment of health information technology-related outpatient
diagnosti…
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psnet.ahrq.gov/node/60361/psn-pdf
May 20, 2020 - Novel, High-Impact Studies Evaluating Health System and
Healthcare Professional Responsiveness to COVID-19
(R01).
May 20, 2020
Rockville, MD: Agency for Healthcare Research and Quality; May 14, 2020.
https://psnet.ahrq.gov/issue/novel-high-impact-studies-evaluating-health-system-and-healthcare-
professional-respo…
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psnet.ahrq.gov/node/837967/psn-pdf
September 01, 2022 - Free-text computerized provider order entry orders used
as workaround for communicating medication
information.
September 1, 2022
Kandaswamy S, Grimes J, Hoffman D, et al. Free-text computerized provider order entry orders used as
workaround for communicating medication information. J Patient Saf. 2022;18(5):430-4…
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psnet.ahrq.gov/node/73665/psn-pdf
September 01, 2021 - Challenges and potential solutions for patient safety in an
infectious-agent-isolation environment: a study of 484
COVID-19-related event reports across 94 hospitals
September 1, 2021
Taylor M, Reynolds C, Jones RM. Challenges and potential solutions for patient safety in an infectious-
agent-isolation environment…
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psnet.ahrq.gov/node/73288/psn-pdf
May 19, 2021 - 2020 Pennsylvania Patient Safety Reporting: an analysis
of serious events and incidents from the nation’s largest
event reporting database.
May 19, 2021
Kepner S, Jones RM. 2020 Pennsylvania Patient Safety Reporting: an analysis of serious events and
incidents from the nation’s largest event reporting database. Pa…
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psnet.ahrq.gov/node/862128/psn-pdf
February 07, 2024 - Embracing the future-is artificial intelligence already
better? A comparative study of artificial intelligence
performance in diagnostic accuracy and decision-making.
February 7, 2024
Fonseca Â, Ferreira A, Ribeiro L, et al. Embracing the future—is artificial intelligence already better? A
comparative study of art…
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psnet.ahrq.gov/issue/aacn-standards-establishing-and-sustaining-healthy-work-environments-journey-excellence
January 27, 2021 - Organizational Policy/Guidelines
AACN Standards for Establishing and Sustaining Healthy Work Environments: A Journey to Excellence.
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