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Psn-Pdf (pdf file)
psnet.ahrq.gov/node/73451/psn-pdfJune 30, 2021 - National Patient Safety Syllabus. June 30, 2021 Spurgeon P, Cross S. London, UK; Academy of Medical Royal Colleges: May 2021. https://psnet.ahrq.gov/issue/national-patient-safety-syllabus Amending curricula to incorporate the increasing scholarship related to patient safety improvement is a challenge. This st… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/40204/psn-pdfApril 14, 2011 - Residents' intentions and actions after patient safety education. April 14, 2011 Jansma JD, Wagner C, Bijnen AB. Residents' intentions and actions after patient safety education. BMC Health Serv Res. 2010;10:350. doi:10.1186/1472-6963-10-350. https://psnet.ahrq.gov/issue/residents-intentions-and-actions-after-pati… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/47047/psn-pdfJune 06, 2018 - MedStar Health Institute for Quality and Safety. June 6, 2018 MedStar Health. 10980 Grantchester Way, Columbia, MD 21044. https://psnet.ahrq.gov/issue/medstar-health-institute-quality-and-safety Health care has recognized the importance of designing systems solutions that reduce risks. Established within MedStar H… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/41790/psn-pdfDecember 12, 2012 - Assessment of teamwork during structured interdisciplinary rounds on medical units. December 12, 2012 O'Leary KJ, Boudreau YN, Creden AJ, et al. Assessment of teamwork during structured interdisciplinary rounds on medical units. J Hosp Med. 2012;7(9):679-83. doi:10.1002/jhm.1970. https://psnet.ahrq.gov/issue/asses… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/838184/psn-pdfSeptember 28, 2022 - The hidden risk of wheelchair use. September 28, 2022 Quesenberry M. The hidden risk of wheelchair use. Patient Safety. 2022;4(3):6-9. doi:10.33940/alert/2022.9.1. https://psnet.ahrq.gov/issue/hidden-risk-wheelchair-use Medical devices intended to improve patient safety can unintentionally lead to patient harm. Th… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/41710/psn-pdfNovember 08, 2012 - Improving teamwork on general medical units: when teams do not work face-to-face. November 8, 2012 McComb SA, Henneman EA, Hinchey KT, et al. Improving teamwork on general medical units: when teams do not work face-to-face. Jt Comm J Qual Patient Saf. 2012;38(10):471-478. https://psnet.ahrq.gov/issue/improving-tea… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/42111/psn-pdfMarch 13, 2013 - "Just like EKGs!" Should EEGs undergo a confirmatory interpretation by a clinical neurophysiologist? March 13, 2013 Benbadis SR. "Just like EKGs!" Should EEGs undergo a confirmatory interpretation by a clinical neurophysiologist? Neurology. 2013;80(1 Suppl 1):S47-51. doi:10.1212/WNL.0b013e3182797539. https://psnet… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/41334/psn-pdfApril 25, 2012 - Understanding the role of non-technical skills in patient safety. April 25, 2012 White N. Understanding the role of non-technical skills in patient safety. Nurs Stand. 2012;26(26):43-8. https://psnet.ahrq.gov/issue/understanding-role-non-technical-skills-patient-safety Examining a case study in which a patient die… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/48117/psn-pdfJuly 10, 2019 - Miro's dots and lines. July 10, 2019 Taran S, Detsky AS. Miro’s Dots and Lines. JAMA Intern Med. 2019;179(8):1019–1020. doi:10.1001/jamainternmed.2019.1922. https://psnet.ahrq.gov/issue/miros-dots-and-lines This commentary draws parallels between experiences in viewing and exploring meaning in modern art to the c… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/39093/psn-pdfNovember 11, 2009 - For whom the Bell Commission tolls: unintended effects of limiting residents' hours. November 11, 2009 Millard WB. For whom the bell commission tolls: unintended effects of limiting residents' hours. Ann Emerg Med. 2009;54(4):A25-9. https://psnet.ahrq.gov/issue/whom-bell-commission-tolls-unintended-effects-limitin… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/61052/psn-pdfApril 01, 2019 - Inadvertent Administration of an Oral Liquid Medicine into a Vein. April 1, 2019 Farnborough, UK; Healthcare Safety Investigation Branch: April 2019. https://psnet.ahrq.gov/issue/inadvertent-administration-oral-liquid-medicine-vein Wrong route medication administration is a never event. This report examined the co… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/38982/psn-pdfFebruary 03, 2011 - Association of resident fatigue and distress with perceived medical errors. February 3, 2011 West CP, Tan AD, Habermann TM, et al. Association of resident fatigue and distress with perceived medical errors. JAMA. 2009;302(12):1294-300. doi:10.1001/jama.2009.1389. https://psnet.ahrq.gov/issue/association-resident-f… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/43941/psn-pdfFebruary 25, 2015 - How to make surgery safer. February 25, 2015 https://psnet.ahrq.gov/issue/how-make-surgery-safer This newspaper article reports on various ways hospitals are working to make surgical care safer and reduce readmissions due to surgical complications, including checklists, teamwork training courses for surgeons, preo… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/34754/psn-pdfFebruary 06, 2018 - Patient Safety in Anesthetic Practice. February 6, 2018 Morell RC; Eichhorn JH, eds. New York: Churchill Livingstone, 1997. ISBN: 9780443076824. https://psnet.ahrq.gov/issue/patient-safety-anesthetic-practice Anesthesiology made its mark early on in the quest for patient safety. Eichhorn was a part of the converge… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/41444/psn-pdfJune 13, 2012 - Evaluation of Registered Nurse Competency Processes in Veterans Health Administration Facilities. June 13, 2012 Washington, DC: VA Office of Inspector General; April 20, 2012. Report No. 12-00956-159. https://psnet.ahrq.gov/issue/evaluation-registered-nurse-competency-processes-veterans-health- administration-faci… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/37337/psn-pdfJanuary 02, 2017 - Attitudes toward medical device use errors and the prevention of adverse events. January 2, 2017 Johnson TR, Tang X, Graham MJ, et al. Attitudes toward medical device use errors and the prevention of adverse events. Jt Comm J Qual Patient Saf. 2007;33(11):689-94. https://psnet.ahrq.gov/issue/attitudes-toward-medic… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/37816/psn-pdfApril 27, 2010 - In situ simulation: a method of experiential learning to promote safety and team behavior. April 27, 2010 Miller KK, Riley W, Davis SE, et al. In situ simulation: a method of experiential learning to promote safety and team behavior. J Perinat Neonatal Nurs. 2008;22(2):105-113. doi:10.1097/01.JPN.0000319096.97790.… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/73401/psn-pdfJune 16, 2021 - Second victim: a traumatic experience. June 16, 2021 Wands B. AANA J. 2021;89(2):168-174. https://psnet.ahrq.gov/issue/second-victim-traumatic-experience Healthcare professionals who experience emotional consequences after adverse events are often referred to as “second victims.” Targeted towards certified registe… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/854638/psn-pdfOctober 18, 2023 - Early identification and evaluation of severe pressure injuries. October 18, 2023 Quick Safety. October 2023;70:1-2. https://psnet.ahrq.gov/issue/early-identification-and-evaluation-severe-pressure-injuries Pressure injuries are a significant and preventable patient safety threat. This article summarizes recommen… -
Psn-Pdf (pdf file)
psnet.ahrq.gov/node/44383/psn-pdfJanuary 05, 2017 - Field Guide to Collaborative Care: Implementing the Future of Health Care. January 5, 2017 Uhlig P, Raboin WE. Overland Park, KS: Oak Prairie Health Press; 2015. ISBN: 9780991411290. https://psnet.ahrq.gov/issue/field-guide-collaborative-care-implementing-future-health-care This online resource provides instructio…
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