-
psnet.ahrq.gov/node/39407/psn-pdf
March 31, 2010 - What ring tone should be used for patient safety? Early
results with a Blackberry-based telementoring safety
solution.
March 31, 2010
Parker A, Rubinfeld IS, Azuh O, et al. What ring tone should be used for patient safety? Early results with a
Blackberry-based telementoring safety solution. Am J Surg. 2010;199(3):…
-
psnet.ahrq.gov/node/34697/psn-pdf
December 08, 2010 - Sentinel events. In memory of Ben—a case study.
December 8, 2010
Haas D. Sentinel events. In memory of Ben--a case study. Jt Comm Perspect. 1997;17(2):12-5.
https://psnet.ahrq.gov/issue/sentinel-events-memory-ben-case-study
Written from the perspective of a risk manager, the author tells the story of a medication a…
-
psnet.ahrq.gov/node/41534/psn-pdf
July 25, 2012 - Protecting patients from an unsafe system: the etiology
and recovery of intraoperative deviations in care.
July 25, 2012
Hu Y-Y, Arriaga AF, Roth EM, et al. Protecting patients from an unsafe system: the etiology and recovery
of intraoperative deviations in care. Ann Surg. 2012;256(2):203-10. doi:10.1097/SLA.0b013e…
-
psnet.ahrq.gov/node/44190/psn-pdf
June 03, 2015 - Minimizing medical mistakes: mother's mission to reduce
hospital errors.
June 3, 2015
Takahara D. KDVR. May 19, 2015.
https://psnet.ahrq.gov/issue/minimizing-medical-mistakes-mothers-mission-reduce-hospital-errors
Parents of children who experience harm in the course of medical care serve as advocates to drive saf…
-
psnet.ahrq.gov/node/43177/psn-pdf
May 14, 2014 - Disclosing medical errors to patients: effects of nonverbal
involvement.
May 14, 2014
Hannawa AF. Disclosing medical errors to patients: effects of nonverbal involvement. Patient Educ Couns.
2014;94(3):310-313. doi:10.1016/j.pec.2013.11.007.
https://psnet.ahrq.gov/issue/disclosing-medical-errors-patients-effects-n…
-
psnet.ahrq.gov/node/44784/psn-pdf
May 03, 2017 - WISH Patient Safety Forum
May 3, 2017
World Innovation Summit for Health 2015. Doha, Qatar: Qatar Foundation; February 2015.
https://psnet.ahrq.gov/issue/wish-patient-safety-forum
The 2015 conference focused on persisting barriers to patient safety worldwide and recommended
strategies to achieve lasting improvemen…
-
psnet.ahrq.gov/node/837896/psn-pdf
January 01, 2023 - Helping healthcare teams to debrief effectively:
associations of debriefers' actions and participants'
reflections during team debriefings.
August 24, 2022
Kolbe M, Grande B, Lehmann-Willenbrock N, et al. Helping healthcare teams to debrief effectively:
associations of debriefers’ actions and participants’ reflect…
-
psnet.ahrq.gov/node/60916/psn-pdf
September 17, 2020 - Impact of professional interpreters on outcomes for
hospitalized children from migrant and refugee families
with limited English proficiency: a systematic review.
September 17, 2020
Boylen S, Cherian S, Gill FJ, et al. Impact of professional interpreters on outcomes for hospitalized children
from migrant and refug…
-
psnet.ahrq.gov/node/50866/psn-pdf
February 05, 2020 - Effectiveness of acute care remote triage systems: a
systematic review.
February 5, 2020
Boggan JC, Shoup JP, Whited JD, et al. Effectiveness of acute care remote triage systems: a systematic
review. J Gen Intern Med. 2020;35(7):2136-2145. doi:10.1007/s11606-019-05585-4.
https://psnet.ahrq.gov/issue/effectiveness-…
-
psnet.ahrq.gov/node/764405/psn-pdf
March 02, 2022 - Evaluation of communication and safety behaviors during
hospital-wide code response simulation.
March 2, 2022
Ren DM, Abrams A, Banigan M, et al. Evaluation of communication and safety behaviors during hospital-
wide code response simulation. Simul Healthc. 2022;17(1):e45-e50. doi:10.1097/sih.0000000000000575.
htt…
-
psnet.ahrq.gov/node/73567/psn-pdf
August 04, 2021 - Pharmacist-led educational interventions provided to
healthcare providers to reduce medication errors: a
systematic review and meta-analysis.
August 4, 2021
Jaam M, Naseralallah LM, Hussain TA, et al. Pharmacist-led educational interventions provided to
healthcare providers to reduce medication errors: a systemati…
-
psnet.ahrq.gov/node/50654/psn-pdf
November 13, 2019 - Exploring stakeholder perceptions around
implementation of the Operating Room Black Box for
patient safety research: a qualitative study using the
theoretical domains framework.
November 13, 2019
Etherington N, Usama A, Patey AM, et al. Exploring stakeholder perceptions around implementation of the
Operating Room…
-
psnet.ahrq.gov/node/60254/psn-pdf
January 01, 2022 - Do patients and relatives have different dispositions when
challenging healthcare professionals about patient
safety? Results before and after an educational program.
April 22, 2020
Rodrigo-Rincon I, Irigoyen-Aristorena I, Tirapu-Leon B, et al. Do patients and relatives have different
dispositions when challenging…
-
psnet.ahrq.gov/node/74862/psn-pdf
February 23, 2022 - Use of pediatric injectable medicines guidelines and
associated medication administration errors: a human
reliability analysis.
February 23, 2022
Jones MD, Clarke J, Feather C, et al. Use of pediatric injectable medicines guidelines and associated
medication administration errors: a human reliability analysis. Ann…
-
psnet.ahrq.gov/node/50802/psn-pdf
January 15, 2020 - Use of error management theory to quantify and
characterize residents' error recovery strategies.
January 15, 2020
Pugh CM, Law KE, Cohen ER, et al. Use of error management theory to quantify and characterize
residents’ error recovery strategies. Am J Surg. 2020;219(2):214-220. doi:10.1016/j.amjsurg.2019.11.013.
h…
-
psnet.ahrq.gov/node/838245/psn-pdf
January 01, 2023 - A novel study of situational awareness among out-of-
hospital providers during an online clinical simulation.
October 5, 2022
Hunter J, Porter M, Williams B. A novel study of situational awareness among out-of-hospital providers
during an online clinical simulation. Australas Emerg Care. 2023;26(1):96-103.
doi:10.…
-
psnet.ahrq.gov/node/43285/psn-pdf
July 16, 2014 - Outcomes of a quality improvement project for educating
nurses on medication administration and errors in
nursing homes.
July 16, 2014
Tenhunen ML, Tanner EK, Dahlen R. Outcomes of a quality improvement project for educating nurses on
medication administration and errors in nursing homes. J Contin Educ Nurs. 2014;…
-
psnet.ahrq.gov/node/46952/psn-pdf
January 01, 2019 - Perspectives on patient and family engagement with
reduction in harm: the forgotten voice.
December 21, 2018
Schenk EC, Bryant RA, Van Son CR, et al. Perspectives on Patient and Family Engagement With
Reduction in Harm: The Forgotten Voice. J Nurs Care Qual. 2019;34(1):73-79.
doi:10.1097/NCQ.0000000000000333.
htt…
-
psnet.ahrq.gov/node/44345/psn-pdf
October 05, 2015 - Apologies following an adverse medical event: the
importance of focusing on the consumer's needs.
October 5, 2015
Allan A, McKillop D, Dooley J, et al. Apologies following an adverse medical event: The importance of
focusing on the consumer's needs. Patient Educ Couns. 2015;98(9):1058-62.
doi:10.1016/j.pec.2015.06…
-
psnet.ahrq.gov/node/49410/psn-pdf
July 01, 2003 - A good example of this involvement is the training materials (mannequins, videos, handouts, CD-
ROMs