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.
Cleary M, Lees D, Lopez V. Issues Ment Health Nurs. 2018;39:980-982.
Effective apology behaviors improve opportunities for error resolution for clinicians, patients, and families. This commentary highlights the importance of expressing empathy, considering legal implications, and demonstrating individual, leadership, and organizational support of open disclosure.
Vrklevski LP, McKechnie L, OʼConnor N. J Patient Saf. 2018;14:41-48.
Root cause analysis is a longstanding approach to in-depth investigation of adverse events, with evidence supporting its use in identifying underlying causes of safety problems. Reviewing for mental health events, mostly suicides and homicides, researchers found that recommendations often echoed existing policy and were not implemented. While the authors assert that the method may not be helpful, their findings also emphasize the importance of implementing root cause analysis recommendations in order to augment safety.
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