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psnet.ahrq.gov/issue/what-has-airbus-a380-captain-got-do-omfs-lessons-aviation-improve-patient-safety
October 04, 2023 - Commentary
What has an Airbus A380 captain got to do with OMFS? Lessons from aviation to improve patient safety.
Citation Text:
Davidson M, Brennan PA. Leading article: What has an Airbus A380 Captain got to do with OMFS? Lessons from aviation to improve patient safety. Br J Oral Maxillo…
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psnet.ahrq.gov/web-mm/fatal-patient-controlled-analgesia-pca-opioid-induced-respiratory-depression
May 26, 2021 - should be performed every 2 to 2.5 hours. 38
Patient-specific monitoring plans should reflect the type … While recommendations related to monitoring for patients receiving PCA may vary, increasing the type
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psnet.ahrq.gov/issue/intimidation-concept-analysis
May 20, 2020 - Review
Intimidation: a concept analysis.
Citation Text:
Lamontagne C. Intimidation: a concept analysis. Nurs Forum. 2010;45(1):54-65. doi:10.1111/j.1744-6198.2009.00162.x.
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psnet.ahrq.gov/issue/smart-pumps-implications-nurse-leaders
February 02, 2022 - Commentary
Smart pumps: implications for nurse leaders.
Citation Text:
Kirkbride G, Vermace B. Smart pumps: implications for nurse leaders. Nurs Adm Q. 2011;35(2):110-118. doi:10.1097/NAQ.0b013e31820fbdc0.
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psnet.ahrq.gov/issue/2012-ismp-international-medication-safety-self-assessment-oncology
January 26, 2023 - Press Release/Announcement
2012 ISMP International Medication Safety Self Assessment for Oncology.
Citation Text:
2012 ISMP International Medication Safety Self Assessment for Oncology. Institute for Safe Medication Practices and Institute for Safe Medication Practices Canada.
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psnet.ahrq.gov/node/42868/psn-pdf
October 31, 2014 - Communication-and-resolution programs: the challenges
and lessons learned from six early adopters.
October 31, 2014
Mello MM, Boothman RC, McDonald TB, et al. Communication-and-resolution programs: the challenges
and lessons learned from six early adopters. Health Aff (Millwood). 2014;33(1):20-29.
doi:10.1377/hlth…
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psnet.ahrq.gov/classics
August 01, 2023 - Classics and Emerging Classics
To help our readers navigate the tremendous breadth of the PSNet Collection, AHRQ PSNet editors and advisors have given the designation of “Classic” to review articles, empirical studies, government and stakeholder reports, commentaries, and books of lasting importance to the patient sa…
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psnet.ahrq.gov/web-mm/chest-pain-rural-hospital
June 02, 2021 - Emergency Department Visits by County Type.( 2 )
County Group
Total EDs
Total Visits
Visit … Incidence and predictors of silent myocardial infarction in type 2 diabetes and the effect of fenofibrate
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psnet.ahrq.gov/web-mm/contaminated-or-not-guidelines-interpretation-positive-blood-cultures
November 16, 2022 - The Case
A 62-year-old man with type 2 diabetes mellitus, chronic kidney disease, and a history of … September 30, 2011
Errors in a stat laboratory: changes in type and frequency since 1996
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psnet.ahrq.gov/web-mm/stable-airway-fatal-airway-occlusion-after-inadequate-post-tracheostomy-care
June 28, 2023 - Regardless of the type of tracheostomy tube, patients require regular assessment and monitoring to ensure … percutaneously placed and 3-7 days for surgically placed tubes, due to healing times. 1 , 15 If the type
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psnet.ahrq.gov/perspective/patient-safety-events-and-role-patient-safety-organizations-during-covid-19-pandemic
January 12, 2022 - So, staff that were used to a certain type of central line care kit, for example, now had to use something … Or they were used to a certain type of protective foam to prevent pressure injuries and now they must … The other thing that we saw related to pressure injuries was a type of skin lesion the National Pressure
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psnet.ahrq.gov/issue/contemporary-view-medication-related-harm-new-paradigm
July 20, 2012 - Tools/Toolkit
Contemporary View of Medication-Related Harm. A New Paradigm.
Citation Text:
Contemporary View of Medication-Related Harm. A New Paradigm. National Coordinating Council for Medication Error Reporting and Prevention; NCCMERP.
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psnet.ahrq.gov/issue/medication-errors-year-review-january-through-december-2021
September 26, 2018 - Newspaper/Magazine Article
Medication errors: the year in review: January through December 2021.
Citation Text:
Medication errors: the year in review: January through December 2021. Pharmacy Practice News Special Edition. December 13, 2022: 43-54.
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psnet.ahrq.gov/issue/characteristics-and-trends-medical-diagnostic-errors-united-states
December 14, 2022 - Study
Characteristics and trends of medical diagnostic errors in the United States.
Citation Text:
Ao HS, Matthews T. Characteristics and trends of medical diagnostic errors in the United States. Patient Safety. 2024;6(1):123603. doi:10.33940/001c.123603.
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psnet.ahrq.gov/issue/recommendations-using-revised-safer-dx-instrument-help-measure-and-improve-diagnostic-safety
March 11, 2020 - Commentary
Recommendations for using the Revised Safer Dx instrument to help measure and improve diagnostic safety.
Citation Text:
Singh H, Khanna A, Spitzmueller C, et al. Recommendations for using the Revised Safer Dx Instrument to help measure and improve diagnostic safety. Diagnosis …
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psnet.ahrq.gov/issue/preventing-home-medication-administration-errors
March 03, 2019 - Organizational Policy/Guidelines
Preventing home medication administration errors.
Citation Text:
Yin HS, Neuspiel DR, Paul IM, et al. Preventing home medication administration errors. Pediatrics. 2021;148(6):e2021054666. doi:10.1542/peds.2021-054666.
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psnet.ahrq.gov/issue/addressing-prehospital-patient-safety-using-science-injury-prevention-and-control
April 12, 2019 - Commentary
Addressing prehospital patient safety using the science of injury prevention and control.
Citation Text:
Meisel ZF, Hargarten S, Vernick J. Addressing prehospital patient safety using the science of injury prevention and control. Prehosp Emerg Care. 2008;12(4):411-6. doi:10.1…
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psnet.ahrq.gov/issue/addressing-delays-medication-administration-patients-transferred-hospital-nursing-home-pilot
November 16, 2022 - Study
Addressing delays in medication administration for patients transferred from the hospital to the nursing home: a pilot quality improvement project.
Citation Text:
Ward KT, Bates-Jensen B, Eslami MS, et al. Addressing delays in medication administration for patients transferred …
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psnet.ahrq.gov/issue/five-strategies-clinicians-advance-diagnostic-excellence
June 22, 2022 - Commentary
Five strategies for clinicians to advance diagnostic excellence.
Citation Text:
Singh H, Connor DM, Dhaliwal G. Five strategies for clinicians to advance diagnostic excellence. BMJ. 2022;376:e068044. doi:10.1136/bmj-2021-068044.
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psnet.ahrq.gov/issue/how-surgical-trainees-handle-catastrophic-errors-qualitative-study
March 19, 2019 - Study
How surgical trainees handle catastrophic errors: a qualitative study.
Citation Text:
Balogun JA, Bramall AN, Bernstein M. How Surgical Trainees Handle Catastrophic Errors: A Qualitative Study. J Surg Educ. 2015;72(6):1179-84. doi:10.1016/j.jsurg.2015.05.003.
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