The PSNet Collection: All Content

The AHRQ PSNet Collection comprises an extensive selection of resources relevant to the patient safety community. These resources come in a variety of formats, including literature, research, tools, and Web sites. Resources are identified using the National Library of Medicine’s Medline database, various news and content aggregators, and the expertise of the AHRQ PSNet editorial and technical teams.

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Displaying 1 - 20 of 2746 Results

Patient Safety Risk Management Playbook.

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Chicago, IL: American Society for Healthcare Risk Management; 2015.

… Proactive risk management is an important component to improving the … Exploring principles of high reliability and enterprise risk management, this publication discusses how to develop a … … Chicago, IL: American Society for Healthcare Risk Management; 2015. … American Society for Healthcare Risk …

The growing role of the Patient Safety Officer: implications for risk managers.

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Chicago, IL: American Society of Healthcare Risk Management; 2004.

This report describes the development of the Patient Safety Officer (PSO), its role in health care, and how it might be most effectively implemented in organizations. Educational venues and opportunities to prepare an individual for the position are included in the text.

Risk Management Pearls for Medication Safety: Part I and Part II.

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Chicago, IL: American Society for Healthcare Risk Management; 2014.

… … Chicago, IL: American Society for Healthcare Risk Management; 2014. … American Society for Healthcare Risk Management; ASHRM …

Risk Management Pearls on Disclosure of Adverse Events.

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Amori GH. Chicago, IL: American Society for Healthcare Risk Management; 2006.

… … Amori GH. Chicago, IL: American Society for Healthcare Risk Management; 2006. … American Society for Healthcare Risk Management; ASHRM … G … Amori … G Amori …

Deep Dive: Safe Ambulatory Care, Strategies for Patient Safety & Risk Reduction.

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Plymouth Meeting, PA: ECRI Institute; 2019.

Outpatient safety is gaining traction as a focal point of analysis and improvement efforts. This patient safety organization analyzed 4,355 incident reports from outpatient providers to identify five areas of concern: diagnosis, medications, falls, privacy, and physical safety.

Report focuses on risk to patients from ED errors.

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Palmer J. Patient Saf Qual Healthcare. Sept/Oct 2019.

… Healthcare . Sept/Oct 2019. … Palmer J. Report focuses on risk to patients from ED errors. Patient Saf Qual Healthcare. …

Failure mode and effects analysis to reduce risk of heparin use.

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Pino FA, Weidemann DK, Schroeder LL, et al. Am J Health Syst Pharm. 2019;76:1972-1979.

… … Heparin – a commonly used anticoagulant – is a high-risk medication and a patient safety risk to both adults and children . This study used a …

Patient perception of fall risk and fall risk screening scores.

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Solares NP, Calero P, Connelly CD. J Nurs Care Qual. 2023;38:100-106.

Falls in inpatient healthcare settings are a common patient safety event. This study including 201 older inpatient adults evaluated the relationship between the Johns Hopkins Fall Risk score and patient perceptions of fall risk. Researchers found that the greater the patient’s confidence in their ability to perform a high fall-risk behavior, the lower the fall-risk score.

A hybrid methodology for modeling risk of adverse events in complex health-care settings.

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Kazemi R, Mosleh A, Dierks M. Risk Anal. 2017;37:421-440.

… Risk analysis : an official publication of the Society for Risk Analysis … Risk Anal … This study aimed to use modeling, a strategy to …

'Balancing risk, that is my life': The politics of risk in a hospital operating theatre department.

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McDonald R, Waring J, Harrison S. Health Risk Soc. 2005;7.

… Health, Risk & Society … Health Risk Soc … This study describes findings from a series of … and interviews to better understand the facets of clinical risk management policy. …

Combined proactive risk assessment: unifying proactive and reactive risk assessment techniques in health care.

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Bender JA, Kulju S, Soncrant C. Jt Comm J Qual Patient Saf. 2022;48:326-334.

Healthcare organizations use multiple proactive and reactive methods of investigating and preventing adverse events. This study combined proactive and reactive risk assessments into a Combined Proactive Risk Assessment (CPRA) to identify risks not detected by one method on its own. The four steps of CPRA are illustrated using the example of outpatient blood draws in the Veterans Health Administration.

TeamSTEPPS for health care risk managers: improving teamwork and communication.

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Cooke M. J Healthc Risk Manag. 2016;36:35-45.

… J Healthc Risk Manag … J Healthc Risk Manag … Hospitals utilize team training to improve … -derived educational intervention for health care risk managers . The authors found that training focused on …

From To Err Is Human to Improving Diagnosis in Health Care: the risk management perspective.

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Bunting RF, Groszkruger DP. J Healthc Risk Manag. 2016;35:10-23.

… Journal of healthcare risk management : the journal of the American Society for Healthcare Risk Management … J Healthc Risk Manag … This commentary provides an overview of the …

Deploying and measuring a risk and patient safety program.

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Orel H, McGroarty M, Marchegiani H. J Healthc Risk Manag. 2017;36:26-33.

… Journal of healthcare risk management : the journal of the American Society for Healthcare Risk Management … J Healthc Risk Manag … Risk management can contribute to proactive …

Improving risk management: from lame excuses to principled practice.

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Paté-Cornell E, Cox LA. Risk Anal. 2014;34:1228-39.

… Risk analysis : an official publication of the Society for Risk Analysis … Risk Anal … Explaining drawbacks associated with shifting …

A new frontier in healthcare risk management: working to reduce avoidable patient suffering.

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Card AJ, Klein VR. J Healthc Risk Manag. 2016;35:31-7.

… Journal of healthcare risk management : the journal of the American Society for Healthcare Risk Management … J Healthc Risk Manag … Patient harm related to health care can be …

Health care risk managers' consensus on the management of inappropriate behaviors among hospital staff.

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Zadeh SE, Haussmann R, Barton CD. J Healthc Risk Manag. 2019;38:32-42.

… Journal of healthcare risk management : the journal of the American Society for Healthcare Risk Management … J Healthc Risk Manag … Disruptive and unprofessional behavior creates …

The experiences of risk managers in providing emotional support for health care workers after adverse events.

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Edrees HH, Brock DM, Wu AW, et al. J Healthc Risk Manag. 2016;35:14-21.

… Journal of healthcare risk management : the journal of the American Society for Healthcare Risk Management … J Healthc Risk Manag … Second victims are health care workers who …

Prevalence of medication transfer errors in nephrology patients and potential risk factors.

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Ebbens MM, Errami H, Moes DJAR, et al. Eur J Intern Med. 2019;70:50-53.

… of internal medicine … Eur J Intern Med … Patients are at risk for medication errors during transitions of care , which … can result in patient harm. This study sought to identify risk factors for error in nephrology patients in the …

Risk managers' descriptions of programs to support second victims after adverse events.

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White AA, Brock DM, McCotter PI, et al. J Healthc Risk Manag. 2015;34:30-40.

… Journal of healthcare risk management : the journal of the American Society for Healthcare Risk Management … J Healthc Risk Manag … This AHRQ-funded study surveyed risk managers …

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