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psnet.ahrq.gov/node/49621/psn-pdf
March 01, 2011 - medications, fluids, and even tracking outputs in all infants and children should be
quantitatively calculated
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psnet.ahrq.gov/node/35772/psn-pdf
March 15, 2006 - Use of dimensional analysis to reduce medication errors.
March 15, 2006
Greenfield S; Whelan B; Cohn E.
https://psnet.ahrq.gov/issue/use-dimensional-analysis-reduce-medication-errors
The investigators tested second-year nursing students on medication dosage calculation and found that
those students who were taught…
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psnet.ahrq.gov/node/867524/psn-pdf
January 15, 2025 - Longitudinal analysis of culture of patient safety survey
results in surgical departments.
January 15, 2025
Butler LR, Lashani S, Mitchell C, et al. Longitudinal analysis of culture of patient safety survey results in
surgical departments. Front Health Serv. 2024;4:1419248. doi:10.3389/frhs.2024.1419248.
https://p…
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psnet.ahrq.gov/node/48135/psn-pdf
August 28, 2019 - What causes prescribing errors in children? Scoping
review.
August 28, 2019
Conn RL, Kearney O, Tully MP, et al. What causes prescribing errors in children? Scoping review. BMJ
Open. 2019;9(8):e028680. doi:10.1136/bmjopen-2018-028680.
https://psnet.ahrq.gov/issue/what-causes-prescribing-errors-children-scoping-rev…
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psnet.ahrq.gov/node/36846/psn-pdf
March 03, 2011 - Information technology cannot guarantee patient safety.
March 3, 2011
de Wildt SN, Verzijden R, van den Anker JN, et al. Information technology cannot guarantee patient safety.
BMJ. 2007;334(7598):851-2.
https://psnet.ahrq.gov/issue/information-technology-cannot-guarantee-patient-safety
The authors provide a case …
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psnet.ahrq.gov/node/74846/psn-pdf
February 16, 2022 - Weight-based Medication Errors in Children.
February 16, 2022
Farnborough, UK: Healthcare Safety Investigation Branch; February 2022.
https://psnet.ahrq.gov/issue/weight-based-medication-errors-children
Weight-calculation errors can result in pediatric patient harm as they affect medication prescribing,
dispensing…
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psnet.ahrq.gov/node/47894/psn-pdf
April 03, 2019 - What does safety commitment mean to leaders? A multi-
method investigation.
April 3, 2019
Fruhen LS, Griffin MA, Andrei DM. What does safety commitment mean to leaders? A multi-method
investigation. J Safety Res. 2019;68:203-214. doi:10.1016/j.jsr.2018.12.011.
https://psnet.ahrq.gov/issue/what-does-safety-commitme…
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psnet.ahrq.gov/node/35954/psn-pdf
August 02, 2010 - Decreasing errors in pediatric continuous intravenous
infusions.
August 2, 2010
Lehmann CU, Kim G, Gujral R, et al. Decreasing errors in pediatric continuous intravenous infusions.
Pediatr Crit Care Med. 2006;7(3):225-30.
https://psnet.ahrq.gov/issue/decreasing-errors-pediatric-continuous-intravenous-infusions
Th…
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psnet.ahrq.gov/node/864847/psn-pdf
March 20, 2024 - Inter-hospital transfer is an independent risk factor for
hospital-associated infection.
March 20, 2024
Gardner C, Rubinfeld IS, Gupta AH, et al. Inter-hospital transfer is an independent risk factor for hospital-
associated infection. Surg Infect (Larchmt). 2024;25(2):125-132. doi:10.1089/sur.2023.077.
https://ps…
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psnet.ahrq.gov/web-mm/hazards-loading-doses
December 01, 2003 - Hazards of Loading Doses
Citation Text:
Mucksavage JJ, Tesoro EP. Hazards of Loading Doses. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2017.
Copy Citation
Format:
Google Scholar BibTeX EndNote X3 XML EndNote 7 XML E…
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psnet.ahrq.gov/node/44188/psn-pdf
June 03, 2015 - The fate of pediatric prescriptions in community
pharmacies.
June 3, 2015
Condren ME, Desselle SP. The fate of pediatric prescriptions in community pharmacies. J Patient Saf.
2015;11(2):79-88. doi:10.1097/PTS.0b013e3182948a7d.
https://psnet.ahrq.gov/issue/fate-pediatric-prescriptions-community-pharmacies
The need…
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psnet.ahrq.gov/node/42216/psn-pdf
June 28, 2013 - Simulation for ward processes of surgical care.
June 28, 2013
Pucher PH, Darzi A, Aggarwal R. Simulation for ward processes of surgical care. Am J Surg.
2013;206(1):96-102. doi:10.1016/j.amjsurg.2012.08.013.
https://psnet.ahrq.gov/issue/simulation-ward-processes-surgical-care
This commentary describes one hospital…
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psnet.ahrq.gov/node/73417/psn-pdf
June 23, 2021 - Classification of failures in the perception of
conversational agents (CAs) and their implications on
patient safety.
June 23, 2021
Aftab H, Shah SHH, Habli I. Classification of failures in the perception of conversational agents (CAs) and
their implications on patient safety. Stud Health Technol Inform. 2021;281:…
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psnet.ahrq.gov/web-mm/eptifibatide-epilogue
March 04, 2011 - Eptifibatide Epilogue
Citation Text:
Churchill WW, Fiumara K. Eptifibatide Epilogue. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2009.
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Format:
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psnet.ahrq.gov/web-mm/dont-wait-collect-accurate-weight-case-subtherapeutic-insulin-therapy
July 01, 2008 - Don’t Wait to Collect an Accurate Weight: A Case of Subtherapeutic Insulin Therapy
Citation Text:
Newton B, Seitz R. Don’t Wait to Collect an Accurate Weight: A Case of Subtherapeutic Insulin Therapy. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and H…
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psnet.ahrq.gov/node/34783/psn-pdf
March 28, 2005 - The organizational and intraorganizational development
of disasters.
March 28, 2005
Turner BA. The Organizational and Interorganizational Development of Disasters. Adm Sci Q.
1976;21(3):378. doi:10.2307/2391850.
https://psnet.ahrq.gov/issue/organizational-and-intraorganizational-development-disasters
This article…
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psnet.ahrq.gov/node/60003/psn-pdf
January 01, 2021 - Systemic causes of in-hospital intravenous medication
errors: a systematic review.
March 4, 2020
Kuitunen S, Niittynen I, Airaksinen M, et al. Systemic causes of in-hospital intravenous medication errors: a
systematic review. J Patient Saf. 2021;17(8):e1660-e1668. doi:10.1097/pts.0000000000000632.
https://psnet.ah…
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psnet.ahrq.gov/node/35697/psn-pdf
July 12, 2010 - An overview of intravenous-related medication
administration errors as reported to MEDMARX(R), a
national medication error-reporting program.
July 12, 2010
Hicks RW, Becker SC. An overview of intravenous-related medication administration errors as reported to
MEDMARX, a national medication error-reporting program.…
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psnet.ahrq.gov/node/867230/psn-pdf
December 04, 2024 - Adaption of a trigger tool to identify harmful incidents, no
harm incidents, and near misses in prehospital
emergency care of children.
December 4, 2024
Packendorff N, Magnusson C, Axelsson C, et al. Adaption of a trigger tool to identify harmful incidents, no
harm incidents, and near misses in prehospital emergen…
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psnet.ahrq.gov/node/36367/psn-pdf
April 11, 2011 - Emergency medical services system changes reduce
pediatric epinephrine dosing errors in the prehospital
setting.
April 11, 2011
Kaji AH, Gausche-Hill M, Conrad H, et al. Emergency medical services system changes reduce pediatric
epinephrine dosing errors in the prehospital setting. Pediatrics. 2006;118(4):1493-150…