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9741. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/43292/psn-pdf
      January 07, 2015 - Clinical decision support for atypical orders: detection and warning of atypical medication orders submitted … Clinical decision support for atypical orders: detection and warning of atypical medication orders submitted … https://psnet.ahrq.gov/issue/clinical-decision-support-atypical-orders-detection-and-warning-atypical … https://psnet.ahrq.gov/issue/clinical-decision-support-atypical-orders-detection-and-warning-atypical-medication-orders … https://psnet.ahrq.gov/issue/clinical-decision-support-systems-could-be-modified-reduce-alert-fatigue-while-still

9742. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/35813/psn-pdf
      April 06, 2011 - Simulation based teamwork training for emergency department staff: does it improve clinical team performance … Simulation based teamwork training for emergency department staff: does it improve clinical team performance … psnet.ahrq.gov/issue/simulation-based-teamwork-training-emergency-department-staff-does-it- improve-clinical-team … previously described with an intervention focused on putting participants through a series of simulated clinical … /psnet.ahrq.gov/issue/simulation-based-teamwork-training-emergency-department-staff-does-it-improve-clinical-team

9743. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/34939/psn-pdf
      June 16, 2011 - The effect of executive walk rounds on nurse safety climate attitudes: a randomized trial of clinical … The effect of executive walk rounds on nurse safety climate attitudes: a randomized trial of clinical … psnet.ahrq.gov/issue/effect-executive-walk-rounds-nurse-safety-climate-attitudes-randomized-trial- clinical-units … This study targeted more than 20 clinical units to determine the impact of EWRs on perceived safety … //psnet.ahrq.gov/issue/effect-executive-walk-rounds-nurse-safety-climate-attitudes-randomized-trial-clinical-units

9744. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/36911/psn-pdf
      September 01, 2011 - Managing clinical failure: a complex adaptive system perspective. … Managing clinical failure: a complex adaptive system perspective. … https://psnet.ahrq.gov/issue/managing-clinical-failure-complex-adaptive-system-perspective The investigators … interviewed clinicians and managers to assess how knowledge is captured in a clinical setting.  … https://psnet.ahrq.gov/issue/managing-clinical-failure-complex-adaptive-system-perspective

9745. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/35062/psn-pdf
      June 22, 2009 - Blurring the boundaries: scenario-based simulation in a clinical setting.   … Blurring the boundaries: scenario-based simulation in a clinical setting. … https://psnet.ahrq.gov/issue/blurring-boundaries-scenario-based-simulation-clinical-setting This study … explored the feasibility of using scenario-based simulation for clinical procedures training, providing … https://psnet.ahrq.gov/issue/blurring-boundaries-scenario-based-simulation-clinical-setting

9746. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/36344/psn-pdf
      February 17, 2011 - Clinical problem-solving. Lost in transcription. … Clinical problem-solving. Lost in transcription. N Engl J Med. 2006;355(14):1487-91. … https://psnet.ahrq.gov/issue/clinical-problem-solving-lost-transcription This case involves an iatrogenic … underscore the importance of including medical error in the differential diagnosis when unexpected clinical … https://psnet.ahrq.gov/issue/clinical-problem-solving-lost-transcription https://psnet.ahrq.gov//#iatrogenic

9747. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/36097/psn-pdf
      July 12, 2006 - Clinical Lab Quality: CMS and Survey Organization Oversight Should Be Strengthened. … https://psnet.ahrq.gov/issue/clinical-lab-quality-cms-and-survey-organization-oversight-should-be- strengthened … This government report found that the clinical laboratory survey process is flawed, allowing safety … https://psnet.ahrq.gov/issue/clinical-lab-quality-cms-and-survey-organization-oversight-should-be-strengthened … https://psnet.ahrq.gov/issue/clinical-lab-quality-cms-and-survey-organization-oversight-should-be-strengthened

9748. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/42523/psn-pdf
      October 08, 2013 - Patient safety in clinical research articles. … Patient safety in clinical research articles. … https://psnet.ahrq.gov/issue/patient-safety-clinical-research-articles This commentary recommends including … information in clinical articles on how to apply research results to patient safety to help drive improvement … https://psnet.ahrq.gov/issue/patient-safety-clinical-research-articles https://psnet.ahrq.gov/issue/organising-manuscript-reporting-quality-improvement-or-patient-safety-research

9749. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49850/psn-pdf
      January 01, 2019 - purpose, which include facilitating standard clinical workflows (e.g., hospital admission, transfer, … Order sets are a form of clinical decision support and can contribute to patient harm when not properly … To optimize clinical decision support, the order set should have been designed to provide guidance as … https://psnet.ahrq.gov//#references Brian Clay, MD Health Sciences Clinical Professor of Medicine, … Transfusing wisely: clinical decision support improves blood transfusion practices.

9750. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/38862/psn-pdf
      August 12, 2009 - Resilience in healthcare and clinical handover. … Resilience in healthcare and clinical handover. … https://psnet.ahrq.gov/issue/resilience-healthcare-and-clinical-handover This commentary introduces … resilience and shares insights on how it can be applied in health care by describing its application in the clinical … https://psnet.ahrq.gov/issue/resilience-healthcare-and-clinical-handover https://psnet.ahrq.gov/issue

9751. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/39660/psn-pdf
      September 24, 2016 - The impact of interruptions on clinical task completion. … The impact of interruptions on clinical task completion. … https://psnet.ahrq.gov/issue/impact-interruptions-clinical-task-completion This study of emergency physicians … found that interruptions while performing clinical tasks were common and often resulted in the task … https://psnet.ahrq.gov/issue/impact-interruptions-clinical-task-completion https://psnet.ahrq.gov/issue

9752. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/42356/psn-pdf
      July 22, 2013 - Clinical supervisors: are they the key to making care safer? … Clinical supervisors: are they the key to making care safer? … https://psnet.ahrq.gov/issue/clinical-supervisors-are-they-key-making-care-safer This commentary discusses … the need to educate clinical supervisors on patient safety competencies to ensure trainees observe … https://psnet.ahrq.gov/issue/clinical-supervisors-are-they-key-making-care-safer https://psnet.ahrq.gov

9753. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/38403/psn-pdf
      February 11, 2009 - Frequency, types, and potential clinical significance of medication-dispensing errors. … Frequency, types, and potential clinical significance of medication- dispensing errors. … https://psnet.ahrq.gov/issue/frequency-types-and-potential-clinical-significance-medication-dispensing … https://psnet.ahrq.gov/issue/frequency-types-and-potential-clinical-significance-medication-dispensing-errors … https://psnet.ahrq.gov/issue/frequency-types-and-potential-clinical-significance-medication-dispensing-errors

9754. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/40973/psn-pdf
      November 30, 2011 - A clinical nurse specialist intervention to facilitate safe transfer from ICU. … A clinical nurse specialist intervention to facilitate safe transfer from ICU. … https://psnet.ahrq.gov/issue/clinical-nurse-specialist-intervention-facilitate-safe-transfer-icu This … commentary describes a formal assessment, consultation, and follow-up initiative led by a clinical … https://psnet.ahrq.gov/issue/clinical-nurse-specialist-intervention-facilitate-safe-transfer-icu https

9755. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/37815/psn-pdf
      June 18, 2008 - A 2-year study of patient safety competency assessment in 29 clinical laboratories. … A 2-Year Study of Patient Safety Competency Assessment in 29 Clinical Laboratories. … https://psnet.ahrq.gov/issue/2-year-study-patient-safety-competency-assessment-29-clinical-laboratories … A web-based questionnaire was used to assess patient safety knowledge among clinical laboratory staff … https://psnet.ahrq.gov/issue/2-year-study-patient-safety-competency-assessment-29-clinical-laboratories

9756. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/38388/psn-pdf
      February 04, 2009 - The impact of declining clinical autopsy: need for revised healthcare policy. … The impact of declining clinical autopsy: need for revised healthcare policy. … https://psnet.ahrq.gov/issue/impact-declining-clinical-autopsy-need-revised-healthcare-policy This review … discusses how autopsy rates for patients are at an all-time low, while major errors in clinical diagnoses … https://psnet.ahrq.gov/issue/impact-declining-clinical-autopsy-need-revised-healthcare-policy

9757. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/36651/psn-pdf
      January 05, 2017 - Conscious sedation on a general ward: the MET and clinical governance. … Conscious sedation on a general ward: the MET and clinical governance. … https://psnet.ahrq.gov/issue/conscious-sedation-general-ward-met-and-clinical-governance The authors … to manage a difficult airway in an elderly patient and the subsequent review of the incident by the clinical … https://psnet.ahrq.gov/issue/conscious-sedation-general-ward-met-and-clinical-governance https://psnet.ahrq.gov

9758. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/36950/psn-pdf
      September 09, 2011 - Integrating quality and safety content into clinical teaching in the acute care setting. … Integrating quality and safety content into clinical teaching in the acute care setting. … https://psnet.ahrq.gov/issue/integrating-quality-and-safety-content-clinical-teaching-acute-care-setting … The authors discuss integrating safety and quality education into daily clinical practice and provide … https://psnet.ahrq.gov/issue/integrating-quality-and-safety-content-clinical-teaching-acute-care-setting

9759. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/40516/psn-pdf
      July 15, 2013 - Characteristics of unsafe undergraduate nursing students in clinical practice: an integrative literature … Characteristics of unsafe undergraduate nursing students in clinical practice: an integrative literature … https://psnet.ahrq.gov/issue/characteristics-unsafe-undergraduate-nursing-students-clinical-practice- … https://psnet.ahrq.gov/issue/characteristics-unsafe-undergraduate-nursing-students-clinical-practice-integrative … https://psnet.ahrq.gov/issue/characteristics-unsafe-undergraduate-nursing-students-clinical-practice-integrative

9760. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/42267/psn-pdf
      September 12, 2016 - Clinical dilemmas and a review of strategies to manage drug shortages. … Clinical dilemmas and a review of strategies to manage drug shortages. … https://psnet.ahrq.gov/issue/clinical-dilemmas-and-review-strategies-manage-drug-shortages Drug shortages … have been shown to have serious clinical consequences for affected patients. … https://psnet.ahrq.gov/issue/clinical-dilemmas-and-review-strategies-manage-drug-shortages https://psnet.ahrq.gov