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psnet.ahrq.gov/node/47486/psn-pdf
January 27, 2019 - Direct oral anticoagulants: a review of common
medication errors.
January 27, 2019
Barr D, Epps QJ. Direct oral anticoagulants: a review of common medication errors. J Thromb
Thrombolysis. 2019;47(1):146-154. doi:10.1007/s11239-018-1752-9.
https://psnet.ahrq.gov/issue/direct-oral-anticoagulants-review-common-medic…
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psnet.ahrq.gov/node/72571/psn-pdf
December 16, 2020 - Nurses' influence on consumers' experience of safety in
acute mental health units: a qualitative study.
December 16, 2020
Cutler NA, Sim J, Halcomb E, et al. Nurses' influence on consumers' experience of safety in acute mental
health units: a qualitative study. J Clin Nurs. 2020;29(21-22):4379-4386. doi:10.1111/joc…
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psnet.ahrq.gov/node/74158/psn-pdf
December 08, 2021 - An analysis of the structure and content of dashboards
used to monitor patient safety in the inpatient setting.
December 8, 2021
Kuznetsova M, Frits ML, Dulgarian S, et al. An analysis of the structure and content of dashboards used to
monitor patient safety in the inpatient setting. JAMIA Open. 2021;4(4):ooab096.
…
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psnet.ahrq.gov/node/73293/psn-pdf
May 19, 2021 - Exploring the barriers and facilitators of psychological
safety in primary care teams: a qualitative study.
May 19, 2021
Remtulla R, Hagana A, Houbby N, et al. Exploring the barriers and facilitators of psychological safety in
primary care teams: a qualitative study. BMC Health Serv Res. 2021;21(1):269. doi:10.1186…
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psnet.ahrq.gov/node/74002/psn-pdf
October 27, 2021 - EMS non-conveyance: a safe practice to decrease ED
crowding or a threat to patient safety?
October 27, 2021
Paulin J, Kurola J, Koivisto M, et al. EMS non-conveyance: A safe practice to decrease ED crowding or a
threat to patient safety? BMC Emerg Med. 2021;21(1):115. doi:10.1186/s12873-021-00508-1.
https://psnet.…
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psnet.ahrq.gov/node/854989/psn-pdf
November 01, 2023 - Understanding the facilitators and barriers to barcode
medication administration by nursing staff using
behavioural science frameworks. A mixed methods study.
November 1, 2023
Grailey K, Hussain R, Wylleman E, et al. Understanding the facilitators and barriers to barcode medication
administration by nursing staff …
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psnet.ahrq.gov/node/865815/psn-pdf
May 08, 2024 - Frontline providers' and patients' perspectives on
improving diagnostic safety in the emergency
department: a qualitative study.
May 8, 2024
Mangus CW, James TG, Parker SJ, et al. Frontline providers' and patients' perspectives on improving
diagnostic safety in the emergency department: a qualitative study. Jt Com…
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psnet.ahrq.gov/node/35647/psn-pdf
June 25, 2010 - Nurse staffing in hospitals: is there a business case for
quality?
June 25, 2010
Needleman J, Buerhaus P, Stewart M, et al. Nurse staffing in hospitals: is there a business case for
quality? Health Aff (Millwood). 2006;25(1):204-11.
https://psnet.ahrq.gov/issue/nurse-staffing-hospitals-there-business-case-quality
…
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psnet.ahrq.gov/node/34651/psn-pdf
March 04, 2011 - Incidence and types of preventable adverse events in
elderly patients: population based review of medical
records.
March 4, 2011
Thomas EJ, Brennan TA. Incidence and types of preventable adverse events in elderly patients: population
based review of medical records. BMJ. 2000;320(7237):741-4.
https://psnet.ahrq.g…
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psnet.ahrq.gov/node/60530/psn-pdf
January 01, 2022 - A systematic review of patient-report safety climate
measures in health care.
May 27, 2020
Madden C, Lydon S, O’Dowd E, et al. A systematic review of patient-report safety climate measures in
health care. J Patient Saf. 2022;18(1):e51-e60. doi:10.1097/pts.0000000000000705.
https://psnet.ahrq.gov/issue/systematic-r…
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psnet.ahrq.gov/node/34070/psn-pdf
February 18, 2011 - Effect of reducing interns' work hours on serious medical
errors in intensive care units.
February 18, 2011
Landrigan CP, Rothschild JM, Cronin JW, et al. Effect of reducing interns' work hours on serious medical
errors in intensive care units. N Engl J Med. 2004;351(18):1838-48.
https://psnet.ahrq.gov/issue/effec…
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psnet.ahrq.gov/node/837150/psn-pdf
May 18, 2022 - Video-based communication assessment of physician
error disclosure skills by crowdsourced laypeople and
patient advocates who experienced medical harm:
reliability assessment with generalizability theory.
May 18, 2022
White AA, King AM, D’Addario AE, et al. Video-based communication assessment of physician error
…
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psnet.ahrq.gov/node/44773/psn-pdf
January 13, 2016 - A tool for the concise analysis of patient safety incidents.
January 13, 2016
Pham JC, Hoffman C, Popescu I, et al. A Tool for the Concise Analysis of Patient Safety Incidents. Jt
Comm J Qual Patient Saf. 2016;42(1):26-33.
https://psnet.ahrq.gov/issue/tool-concise-analysis-patient-safety-incidents
Once identified,…
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psnet.ahrq.gov/node/34642/psn-pdf
June 24, 2015 - Human factor in cardiac surgery: errors and near misses
in a high technology medical domain.
June 24, 2015
Carthey J, de Leval MR, Reason JT. The human factor in cardiac surgery: errors and near misses in a high
technology medical domain. Ann Thorac Surg. 2001;72(1):300-5.
https://psnet.ahrq.gov/issue/human-factor…
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psnet.ahrq.gov/node/44075/psn-pdf
July 16, 2015 - Physicians failed to write flawless prescriptions when
computerized physician order entry system crashed.
July 16, 2015
Hsu C-C, Chou C-L, Chen T-J, et al. Physicians Failed to Write Flawless Prescriptions When Computerized
Physician Order Entry System Crashed. Clin Ther. 2015;37(5):1076-1080.e1.
doi:10.1016/j.cli…
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psnet.ahrq.gov/node/44689/psn-pdf
February 24, 2018 - What is the role of individual accountability in patient
safety? A multi-site ethnographic study.
February 24, 2018
Aveling E-L, Parker M, Dixon-Woods M. What is the role of individual accountability in patient safety? A
multi-site ethnographic study. Sociol Health Illn. 2016;38(2):216-32. doi:10.1111/1467-9566.123…
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psnet.ahrq.gov/node/45629/psn-pdf
September 01, 2018 - Physician EHR adoption and potentially preventable
hospital admissions among Medicare beneficiaries: panel
data evidence, 2010–2013.
September 1, 2018
Lammers EJ, McLaughlin CG, Barna M. Physician EHR Adoption and Potentially Preventable Hospital
Admissions among Medicare Beneficiaries: Panel Data Evidence, 2010-2…
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psnet.ahrq.gov/node/47846/psn-pdf
March 06, 2019 - Assessment of the FDA Risk Evaluation and Mitigation
Strategy for transmucosal immediate-release fentanyl
products.
March 6, 2019
Rollman JE, Heyward J, Olson L, et al. Assessment of the FDA Risk Evaluation and Mitigation Strategy for
Transmucosal Immediate-Release Fentanyl Products. JAMA. 2019;321(7):676-685.
do…
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psnet.ahrq.gov/node/60317/psn-pdf
May 13, 2020 - The nurse's experience of decision-making processes in
missed nursing care: a qualitative study.
May 13, 2020
Abdelhadi N, Drach?Zahavy A, Srulovici E. The nurse’s experience of decision?making processes in
missed nursing care: a qualitative study. J Adv Nurs. 2020;76(8):2161-2170. doi:10.1111/jan.14387.
https://p…
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psnet.ahrq.gov/node/46168/psn-pdf
June 14, 2017 - The HOSPITAL score predicts potentially preventable 30-
day readmissions in conditions targeted by the Hospital
Readmissions Reduction Program.
June 14, 2017
Burke RE, Schnipper JL, Williams M, et al. The HOSPITAL Score Predicts Potentially Preventable 30-Day
Readmissions in Conditions Targeted by the Hospital Rea…