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Primers

Guides for key topics in patient safety through context, epidemiology, and relevant AHRQ PSNet content. The Patient Safety 101 Primer provides an overview of the patient safety field and covers key definitions and concepts.

Latest Primers

Jennifer J. Edwards, MS, RN, CHSE; Amy Nichols, EdD, RN, CNS, CHSE, ANEF; and Deb Bakerjian, PhD, APRN, FAANP, FGSA, FAAN |

Simulation training has become a key component of the patient safety movement and healthcare professional education. Simulation is increasingly being used to improve clinical and teamwork skills in a variety of health care environments. As its grown in use over the past decade,... Read More

Grace O'Malley, PhD, Ulfat Shaikh, MD, MPH, MS and James Marcin, MD, MPH |

The rapid expansion of telehealth and the variation in implementation of new models of care into medical practice has resulted in emerging concerns regarding patient safety. This primer summarizes these concerns – including diagnostic errors, medication errors, and... Read More

Peter Yellowlees, MBBS, MD and Margaret Rea, PhD |

Burnout is an occupational phenomenon that is highly prevalent among health care professionals. Current work focuses on understanding burnout and clinician well-being as system-level concerns that can adversely influence safety, quality, and organizational performance.

Vanessa McElroy, MSN, PHN, ACM-RN, IQCI, Ron Billano Ordona, DNP, FNP-BC, GS-C, and Deb Bakerjian, PhD, APRN, FAAN, FAANP, FGSA |

Post-acute transitions – which involve patients being discharged from the hospital to home-based or community care environments – are associated with patient safety risks, often due to poor communication and fragmented care. This... Read More

All Primers (62)

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The list of never events has expanded over time to include adverse events that are unambiguous, serious, and usually preventable. While most are rare, when never events occur, they are devastating to patients and indicate serious underlying organizational safety problems.
Unintended inconsistencies in medication regimens occur with any transition in care. Medication reconciliation refers to the process of avoiding such inadvertent inconsistencies by reviewing the patient's current medication regimen and comparing it with the regimen being considered for the new setting of care.