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psnet.ahrq.gov/issue/designing-and-evaluating-automated-system-real-time-medication-administration-error-detection
November 04, 2020 - Study
Designing and evaluating an automated system for real-time medication administration error detection in a neonatal intensive care unit.
Citation Text:
Ni Y, Lingren T, Hall ES, et al. Designing and evaluating an automated system for real-time medication administration error detecti…
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www.ahrq.gov/news/newsroom/case-studies/202101.html
June 01, 2021 - Duke’s Private Diagnostic Clinic Used TeamSTEPPS to Improve Teamwork and Communications
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June 2021
Eighty to 90 percent of medical center leaders at Private Diagnostic Clinic (PDC), a multispecialty physician practice affiliated with Duke Health, reported fewer communications b…
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psnet.ahrq.gov/issue/patient-safety-incidents-during-covid-19-health-crisis-france-exploratory-sequential-multi
February 05, 2020 - Study
Patient-safety incidents during COVID-19 health crisis in France: An exploratory sequential multi-method study in primary care.
Citation Text:
Patient-safety incidents during COVID-19 health crisis in France: An exploratory sequential multi-method study in primary care. Fournier JP…
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psnet.ahrq.gov/issue/patterns-error-interpretive-pathology
April 07, 2021 - Study
Patterns of error in interpretive pathology.
Citation Text:
Packer MDC, Ravinsky E, Azordegan N. Patterns of error in interpretive pathology. Am J Clin Pathol. 2022;157(5):767-773. doi:10.1093/ajcp/aqab190.
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psnet.ahrq.gov/issue/flying-lessons-clinicians-developing-system-2-practice
April 24, 2018 - Commentary
Flying lessons for clinicians: developing system 2 practice.
Citation Text:
Gregoire JN, Alfes CM, Reimer AP, et al. Flying Lessons for Clinicians: Developing System 2 Practice. Air Med J. 2017;36(3):135-137. doi:10.1016/j.amj.2017.02.003.
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psnet.ahrq.gov/issue/improving-clinician-well-being-and-patient-safety-through-human-centered-design
April 29, 2018 - Commentary
Improving clinician well-being and patient safety through human-centered design.
Citation Text:
Benishek LE, Kachalia A, Daugherty Biddison L. Improving clinician well-being and patient safety through human-centered design. JAMA. 2023;329(14):1149-1150. doi:10.1001/jama.2023.2…
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psnet.ahrq.gov/issue/reduced-duty-hours-model-senior-internal-medicine-residents-qualitative-analysis-residents
June 25, 2014 - Study
A reduced duty hours model for senior internal medicine residents: a qualitative analysis of residents' experiences and perceptions.
Citation Text:
Mathew R, Gundy S, Ulic D, et al. A Reduced Duty Hours Model for Senior Internal Medicine Residents: A Qualitative Analysis of Residen…
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psnet.ahrq.gov/issue/reducing-ambulatory-central-line-associated-bloodstream-infections-family-centered-approach
February 15, 2023 - Study
Reducing ambulatory central line-associated bloodstream infections: a family-centered approach.
Citation Text:
Wong CI, Ilowite M, Yan A, et al. Reducing ambulatory central line‐associated bloodstream infections: a family‐centered approach. Pediatr Blood Cancer. 2024;71(8):e31064. …
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psnet.ahrq.gov/issue/espen-guideline-hospital-nutrition
February 17, 2015 - Organizational Policy/Guidelines
ESPEN guideline on hospital nutrition.
Citation Text:
Thibault R, Abbasoglu O, Ioannou E, et al. ESPEN guideline on hospital nutrition. Clin Nutr. 2021;40(12):5684-5709. doi:10.1016/j.clnu.2021.09.039.
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psnet.ahrq.gov/issue/reducing-potential-errors-associated-insulin-administration-integrative-review
March 31, 2021 - Review
Reducing potential errors associated with insulin administration: an integrative review.
Citation Text:
Alqahtani N. Reducing potential errors associated with insulin administration: an integrative review. J Eval Clin Pract. 2022;28(6):1037-1049. doi:10.1111/jep.13668.
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psnet.ahrq.gov/issue/validation-and-use-second-victim-experience-and-support-tool-questionnaire-scoping-review
July 09, 2008 - Review
Validation and use of the Second Victim Experience and Support Tool questionnaire: a scoping review.
Citation Text:
Dato Md Yusof YJ, Ng QX, Teoh SE, et al. Validation and use of the Second Victim Experience and Support Tool questionnaire: a scoping review. Public Health. 2023;223…
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psnet.ahrq.gov/issue/its-sending-message-bottle-qualitative-study-consequences-one-way-communication-technologies
December 02, 2020 - Study
It's like sending a message in a bottle: a qualitative study of the consequences of one-way communication technologies in hospitals.
Citation Text:
Lafferty M, Harrod M, Krein SL, et al. It’s like sending a message in a bottle: a qualitative study of the consequences of one-way com…
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psnet.ahrq.gov/issue/errors-detected-pediatric-oral-liquid-medication-doses-prepared-automated-workflow-management
June 22, 2009 - Study
Errors detected in pediatric oral liquid medication doses prepared in an automated workflow management system.
Citation Text:
Bledsoe S, Van Buskirk A, Falconer J, et al. Errors detected in pediatric oral liquid medication doses prepared in an automated workflow management system. …
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psnet.ahrq.gov/issue/understanding-informal-aspects-medication-processes-maintain-patient-safety-hospitals
March 06, 2024 - Study
Understanding the informal aspects of medication processes to maintain patient safety in hospitals: a sociotechnical ethnographic study in paediatric units.
Citation Text:
Sutherland AB, Phipps DL, Grant S, et al. Understanding the informal aspects of medication processes to mainta…
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psnet.ahrq.gov/issue/development-core-drug-list-towards-improving-prescribing-education-and-reducing-errors-uk
April 13, 2022 - Study
Development of a core drug list towards improving prescribing education and reducing errors in the UK.
Citation Text:
Baker E, Pryce Roberts A, Wilde K, et al. Development of a core drug list towards improving prescribing education and reducing errors in the UK. Br J Clin Pharmac…
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psnet.ahrq.gov/issue/predictors-medication-errors-among-elderly-hospital-patients
September 23, 2020 - Study
Predictors of medication errors among elderly hospital patients.
Citation Text:
Picone DM, Titler MG, Dochterman J, et al. Predictors of medication errors among elderly hospitalized patients. Am J Med Qual. 2008;23(2):115-127. doi:10.1177/1062860607313143.
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psnet.ahrq.gov/issue/managing-cognitive-biases-during-disaster-response-development-aide-memoire
November 16, 2022 - Review
Managing cognitive biases during disaster response: the development of an aide memoire.
Citation Text:
Brooks B, Curnin S, Owen C, et al. Managing cognitive biases during disaster response: the development of an aide memoire. Cogn Tech Work. 2020;22(2):249–261. doi:10.1007/s10111-…
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psnet.ahrq.gov/issue/errors-drug-computations-during-newborn-intensive-care
December 15, 2021 - Study
Errors in drug computations during newborn intensive care.
Citation Text:
Perlstein PH, Callison C, White M, et al. Errors in Drug Computations During Newborn Intensive Care. Arch Pediatr Adolesc Med. 1979;133(4):376-379. doi:10.1001/archpedi.1979.02130040030006.
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psnet.ahrq.gov/issue/partners-our-care-patient-safety-patient-perspective
December 04, 2016 - Study
Partners in our care: patient safety from a patient perspective.
Citation Text:
Hovey RB, Morck A, Nettleton S, et al. Partners in our care: patient safety from a patient perspective. Qual Saf Health Care. 2010;19(6):e59. doi:10.1136/qshc.2008.030908.
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psnet.ahrq.gov/issue/optimizing-use-dose-error-reduction-software-intravenous-infusion-pumps
August 02, 2015 - Study
Optimizing the use of dose error reduction software on intravenous infusion pumps.
Citation Text:
Hughes K, Cole M, Tims D, et al. Optimizing the use of dose error reduction software on intravenous infusion pumps. Hosp Pediatr. 2024;14(6):448-454. doi:10.1542/hpeds.2023-007385.
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