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psnet.ahrq.gov/node/73470/psn-pdf
July 07, 2021 - Hospital quality-review spending and patient safety: a
longitudinal analysis using instrumental variables.
July 7, 2021
Dynan L, Smith RB. Hospital quality-review spending and patient safety: a longitudinal analysis using
instrumental variables. Health Serv Outcomes Res Methodol. 2021. doi:10.1007/s10742-021-00251-…
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psnet.ahrq.gov/node/45848/psn-pdf
November 19, 2018 - New Horizons in Patient Safety: Understanding
Communication: Case Studies for Physicians.
November 19, 2018
Hannawa AF, Wu AW, Juhasz RS, eds. Berlin, Germany: DeGruyter; 2017. ISBN: 9783110455014.
https://psnet.ahrq.gov/issue/new-horizons-patient-safety-understanding-communication-case-studies-
physicians
Poor c…
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psnet.ahrq.gov/node/46530/psn-pdf
February 03, 2018 - Identifying and characterizing preventable adverse drug
events for prioritizing pharmacist intervention in
hospitals.
February 3, 2018
Jeon N, Staley B, Johns T, et al. Identifying and characterizing preventable adverse drug events for
prioritizing pharmacist intervention in hospitals. Am J Health Syst Pharm. 2017…
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psnet.ahrq.gov/node/60359/psn-pdf
May 20, 2020 - Incorrect use of smart infusion pump in the operating
room (OR) leads to milrinone overdose.
May 20, 2020
ISMP Medication Safety Alert! Acute care edition. May 7, 2020;25(9).
https://psnet.ahrq.gov/issue/incorrect-use-smart-infusion-pump-operating-room-or-leads-milrinone-
overdose
Lack of familiarity with sm…
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psnet.ahrq.gov/node/46388/psn-pdf
September 24, 2017 - Recognizing and responding to the "toxic" work
environment: worker safety, patient safety, and
abuse/neglect in nursing homes.
September 24, 2017
Pickering CEZ, Nurenberg K, Schiamberg L. Recognizing and Responding to the "Toxic" Work
Environment: Worker Safety, Patient Safety, and Abuse/Neglect in Nursing Homes. …
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psnet.ahrq.gov/node/865583/psn-pdf
April 17, 2024 - Impact of repeated reimbursement penalties on hospital
total quality scores.
April 17, 2024
Brewer A, Hughes MC, Patel KN. Impact of repeated reimbursement penalties on hospital total quality
scores. J Patient Saf. 2024;20(3):198-201. doi:10.1097/pts.0000000000001199.
https://psnet.ahrq.gov/issue/impact-repeated-r…
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psnet.ahrq.gov/node/72600/psn-pdf
December 23, 2020 - Improving hospital safety culture for falls prevention
through interdisciplinary health education.
December 23, 2020
Lopez-Jeng C, Eberth SD. Improving hospital safety culture for falls prevention through interdisciplinary
health education. Health Promot Pract. 2020;21(6):918-925. doi:10.1177/1524839919840337.
htt…
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psnet.ahrq.gov/node/47400/psn-pdf
November 28, 2018 - Impact of the communication and patient hand-off tool
SBAR on patient safety: a systematic review.
November 28, 2018
Müller M, Jürgens J, Redaèlli M, et al. Impact of the communication and patient hand-off tool SBAR on
patient safety: a systematic review. BMJ Open. 2018;8(8):e022202. doi:10.1136/bmjopen-2018-022202…
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psnet.ahrq.gov/node/44619/psn-pdf
November 04, 2015 - Seeing through Google Glass: using an innovative
technology to improve medication safety behaviors in
undergraduate nursing students.
November 4, 2015
Schneidereith T. Seeing Through Google Glass: Using an Innovative Technology to Improve Medication
Safety Behaviors in Undergraduate Nursing Students. Nurs Educ Per…
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psnet.ahrq.gov/node/46643/psn-pdf
January 10, 2018 - The role of checklists and human factors for improved
patient safety in plastic surgery.
January 10, 2018
Oppikofer C, Schwappach DLB. The Role of Checklists and Human Factors for Improved Patient Safety in
Plastic Surgery. Plast Reconstr Surg. 2017;140(6):812e-817e. doi:10.1097/PRS.0000000000003892.
https://psnet…
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psnet.ahrq.gov/node/41166/psn-pdf
February 29, 2012 - Triangulating case-finding tools for patient safety
surveillance: a cross-sectional case study of
puncture/laceration.
February 29, 2012
Taylor JA, Gerwin D, Morlock L, et al. Triangulating case-finding tools for patient safety surveillance: a
cross-sectional case study of puncture/laceration. Inj Prev. 2011;17(6)…
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psnet.ahrq.gov/node/47219/psn-pdf
July 25, 2018 - Preparing clinicians for transitioning patients across care
settings and into the home through simulation.
July 25, 2018
Molloy MA, Cary MP, Brennan-Cook J, et al. Preparing Clinicians for Transitioning Patients Across Care
Settings and Into the Home Through Simulation. Home Healthc Now. 2018;36(4):225-231.
doi:10…
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psnet.ahrq.gov/node/41606/psn-pdf
February 01, 2019 - Safe use of opioids in hospitals.
December 23, 2016
Sentinel Event Alert. 2012;49:1-5.
https://psnet.ahrq.gov/issue/safe-use-opioids-hospitals
Opioid pain medications are considered high-risk medications due to the potential for respiratory
depression and other adverse effects. Because these medications are freque…
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psnet.ahrq.gov/node/866251/psn-pdf
July 10, 2024 - A systematic review and meta-analysis of artificial
intelligence versus clinicians for skin cancer diagnosis.
July 10, 2024
Salinas MP, Sepúlveda J, Hidalgo L, et al. A systematic review and meta-analysis of artificial intelligence
versus clinicians for skin cancer diagnosis. NPJ Digit Med. 2024;7(1):125. doi:10.10…
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psnet.ahrq.gov/node/36964/psn-pdf
March 24, 2011 - Patients use an internet technology to report when things
go wrong.
March 24, 2011
Wasson JH, MacKenzie TA, Hall M. Patients use an internet technology to report when things go wrong.
Qual Saf Health Care. 2007;16(3):213-5.
https://psnet.ahrq.gov/issue/patients-use-internet-technology-report-when-things-go-wrong
…
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psnet.ahrq.gov/node/844783/psn-pdf
September 04, 2019 - A lethal hidden curriculum—death of a medical student
from opioid use disorder.
September 4, 2019
Lucey CR, Jones L, Eastburn A. A Lethal Hidden Curriculum - Death of a Medical Student from Opioid Use
Disorder. N Engl J Med. 2019;381(9):793-795. doi:10.1056/NEJMp1901537.
https://psnet.ahrq.gov/issue/lethal-hidden-…
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psnet.ahrq.gov/node/839315/psn-pdf
January 01, 2024 - Six major steps to make investigations of suicide valuable
for learning and prevention.
November 2, 2022
Fröding E, Vincent C, Andersson-Gäre B, et al. Six major steps to make investigations of suicide valuable
for learning and prevention. Arch Suicide Res. 2024;28(1):1-19. doi:10.1080/13811118.2022.2133652.
https…
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psnet.ahrq.gov/node/45449/psn-pdf
October 29, 2017 - Situational awareness—what it means for clinicians, its
recognition and importance in patient safety.
October 29, 2017
Green B, Parry D, Oeppen RS, et al. Situational awareness - what it means for clinicians, its recognition
and importance in patient safety. Oral Dis. 2017;23(6):721-725. doi:10.1111/odi.12547.
htt…
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psnet.ahrq.gov/node/37277/psn-pdf
July 28, 2010 - Drug selection errors in relation to medication labels: a
simulation study.
July 28, 2010
Garnerin P, Perneger T, Chopard P, et al. Drug selection errors in relation to medication labels: a
simulation study. Anaesthesia. 2007;62(11):1090-4.
https://psnet.ahrq.gov/issue/drug-selection-errors-relation-medication-lab…
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psnet.ahrq.gov/node/42156/psn-pdf
April 03, 2013 - The effect of a checklist on the quality of post-
anaesthesia patient handover: a randomized controlled
trial.
April 3, 2013
Salzwedel C, Bartz H-J, Kühnelt I, et al. The effect of a checklist on the quality of post-anaesthesia patient
handover: a randomized controlled trial. Int J Qual Health Care. 2013;25(2):176…