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psnet.ahrq.gov/issue/oxytocin-high-alert-medication-implications-perinatal-patient-safety
September 29, 2010 - Study
Oxytocin as a high-alert medication: implications for perinatal patient safety.
Citation Text:
Simpson KR, Knox E. Oxytocin as a high-alert medication: implications for perinatal patient safety. MCN Am J Matern Child Nurs. 2009;34(1):8-15; quiz 16-7. doi:10.1097/01.NMC.0000343859…
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psnet.ahrq.gov/issue/relationship-between-performance-measurement-and-accreditation-implications-quality-care-and
March 13, 2013 - Study
Relationship between performance measurement and accreditation: implications for quality of care and patient safety.
Citation Text:
Miller MR, Pronovost P, Donithan M, et al. Relationship between performance measurement and accreditation: implications for quality of care and pati…
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psnet.ahrq.gov/issue/factors-contributing-medication-errors-made-when-using-computerized-order-entry-pediatrics
May 08, 2017 - Review
Factors contributing to medication errors made when using computerized order entry in pediatrics: a systematic review.
Citation Text:
Tolley CL, Forde NE, Coffey KL, et al. Factors contributing to medication errors made when using computerized order entry in pediatrics: a systemat…
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psnet.ahrq.gov/node/33686/psn-pdf
August 01, 2009 - So even if
you had measurement and even if you had choice on the part of the patients and the payers … can piggyback, employers can piggyback, patients can piggyback—on the combination of
measurement and choice
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psnet.ahrq.gov/node/33848/psn-pdf
December 01, 2017 - The Evolution of Patient Safety in Surgery
December 1, 2017
Wachter R. The Evolution of Patient Safety in Surgery. PSNet [internet]. 2017.
https://psnet.ahrq.gov/perspective/evolution-patient-safety-surgery
Perspective
In 1979, 20 years before the Institute of Medicine's To Err Is Human report (1) catalyzed the cr…
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psnet.ahrq.gov/node/49520/psn-pdf
September 01, 2006 - DNR in the OR and Afterwards
September 1, 2006
Lo B. DNR in the OR and Afterwards. PSNet [internet]. 2006.
https://psnet.ahrq.gov/web-mm/dnr-or-and-afterwards
The Case
An 85-year-old woman with dementia took a mechanical fall at her skilled nursing facility (SNF) and
suffered a fractured femur. After initial eval…
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psnet.ahrq.gov/issue/root-causes-adverse-drug-events-hospitals-and-artificial-intelligence-capabilities-prevention
May 20, 2020 - Study
Root causes of adverse drug events in hospitals and artificial intelligence capabilities for prevention.
Citation Text:
Gordo C, Núñez‐Córdoba JM, Mateo R. Root causes of adverse drug events in hospitals and artificial intelligence capabilities for prevention. J Adv Nurs. 2021;77(7…
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psnet.ahrq.gov/node/866343/psn-pdf
December 31, 2024 - condition of her kidneys.4
As a combined alpha/beta adrenergic blocker, labetalol is seen as an attractive choice … better why the clinicians on both ends of the admission decision felt comfortable with such a risky choice
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psnet.ahrq.gov/issue/spreading-medication-administration-intervention-organizationwide-six-hospitals
January 03, 2017 - Study
Spreading a medication administration intervention organizationwide in six hospitals.
Citation Text:
Kliger J, Singer SJ, Hoffman F, et al. Spreading a medication administration intervention organizationwide in six hospitals. Jt Comm J Qual Patient Saf. 2012;38(2):51-60.
Copy C…
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psnet.ahrq.gov/issue/integrated-approach-reduce-perinatal-adverse-events-standardized-processes-interdisciplinary
September 01, 2018 - Study
Integrated approach to reduce perinatal adverse events: standardized processes, interdisciplinary teamwork training, and performance feedback.
Citation Text:
Riley W, Begun JW, Meredith L, et al. Integrated Approach to Reduce Perinatal Adverse Events: Standardized Processes, Interd…
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psnet.ahrq.gov/curated-library/value-and-patient-safety
May 01, 2013 - on medical decision-making, for both patients and providers without actually restricting individual choice
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psnet.ahrq.gov/innovations-exchange
May 01, 2021 - on medical decision-making, for both patients and providers without actually restricting individual choice
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psnet.ahrq.gov/issue/computerized-prescribing-alerts-and-group-academic-detailing-reduce-use-potentially
July 10, 2008 - Study
Computerized prescribing alerts and group academic detailing to reduce the use of potentially inappropriate medications in older people.
Citation Text:
Simon SR, Smith DH, Feldstein AC, et al. Computerized prescribing alerts and group academic detailing to reduce the use of poten…
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psnet.ahrq.gov/web-mm/weighing-surgical-safety
August 04, 2021 - although using only an epidural for both intra- and postoperative analgesia may have been a better choice … currently divided as to which muscle relaxant is best for tracheal intubation for obese patients—the choice
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psnet.ahrq.gov/web-mm/i-just-want-go-home-understanding-deliriums-impact-treatment-preferences
December 18, 2019 - ideally should be able to understand the choices being considered, assess the likely consequences of each choice
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psnet.ahrq.gov/issue/assessing-state-safe-medication-practices-using-ismp-medication-safety-self-assessment
March 02, 2016 - Study
Assessing the state of safe medication practices using the ISMP Medication Safety Self Assessment for Hospitals: 2000 and 2011.
Citation Text:
Vaida AJ, Lamis RL, Smetzer JL, et al. Assessing the State of Safe Medication Practices Using the ISMP Medication Safety Self Assessment ® …
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psnet.ahrq.gov/issue/safe-sound-patient-safety-meets-evidence-based-medicine
March 13, 2013 - Commentary
Classic
Safe but sound: patient safety meets evidence-based medicine.
Citation Text:
Shojania KG, Duncan BW, McDonald KM, et al. Safe but Sound. JAMA. 2003;288(4):508-513. doi:10.1001/jama.288.4.508.
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Format:
DOI Google Sc…
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psnet.ahrq.gov/issue/use-temporary-names-newborns-and-associated-risks
December 21, 2017 - Study
Use of temporary names for newborns and associated risks.
Citation Text:
Adelman JS, Aschner JL, Schechter CB, et al. Use of Temporary Names for Newborns and Associated Risks. Pediatrics. 2015;136(2):327-333. doi:10.1542/peds.2015-0007.
Copy Citation
Format:
DOI Googl…
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psnet.ahrq.gov/perspective/conversation-sharon-k-inouye-md-mph
December 01, 2012 - Sedation choice: Sedative drugs are commonly used in critically ill patients to reduce the work of breathing … the duration of delirium when compared with benzodiazepines.( 12,13 ) Sometimes, however, the best "choice … C
Choice of Sedation
Avoid benzodiazepines.
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psnet.ahrq.gov/node/49515/psn-pdf
July 01, 2006 - Over Not So Easy
July 1, 2006
Cucina R. Over Not So Easy. PSNet [internet]. 2006.
https://psnet.ahrq.gov/web-mm/over-not-so-easy
The Case
A 62-year-old woman with end-stage liver disease was hospitalized for recurrent variceal bleeding. On
admission, she reported allergies to a number of medications as well as a …