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psnet.ahrq.gov/web-mm/when-meds-dont-reach-bed
May 16, 2022 - When the Meds Don’t Reach the Bed
Citation Text:
Molla M, Le K, Mendoza P. When the Meds Don’t Reach the Bed. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2020.
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psnet.ahrq.gov/innovation/team-developed-care-plan-and-ongoing-care-management-social-workers-and-nurse
July 23, 2024 - Team-Developed Care Plan and Ongoing Care Management by Social Workers and Nurse Practitioners Result in Better Outcomes and Reduced Acute Care Utilization in Low-Income Seniors and other High-Risk Populations
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August 04, 2021 - Unlocking Solutions in Imaging: Working Together to
Learn from Failings in the NHS.
August 4, 2021
Manchester, UK: Parliamentary and Health Service Ombudsman; 2021. ISBN 9781528627016.
https://psnet.ahrq.gov/issue/unlocking-solutions-imaging-working-together-learn-failings-nhs
Lack of appropriate follow up o…
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psnet.ahrq.gov/node/847056/psn-pdf
April 05, 2023 - Early diagnosis of cancer: systems approach to support
clinicians in primary care.
April 5, 2023
Black GB, Lyratzopoulos G, Vincent CA, et al. Early diagnosis of cancer: systems approach to support
clinicians in primary care. BMJ. 2023;380:e071225. doi:10.1136/bmj-2022-071225.
https://psnet.ahrq.gov/issue/early-di…
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psnet.ahrq.gov/node/73963/psn-pdf
October 13, 2021 - Patient perceptions of safety in primary care: a qualitative
study to inform care.
October 13, 2021
Lasser EC, Heughan JA-A, Lai AY, et al. Patient perceptions of safety in primary care: a qualitative study to
inform care. Curr Med Res Opin. 2021;37(11):1991-1999. doi:10.1080/03007995.2021.1976736.
https://psnet.a…
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psnet.ahrq.gov/node/851067/psn-pdf
June 28, 2023 - Assessing medication safety in settings not designated
solely for pediatric patients.
June 28, 2023
ISMP Medication Safety Alert! Acute care edition. June 15, 2023;28(12);1-5.
https://psnet.ahrq.gov/issue/assessing-medication-safety-settings-not-designated-solely-pediatric-patients
Pediatric patients are at increa…
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psnet.ahrq.gov/node/48129/psn-pdf
August 14, 2019 - When there's no one to whom an error can be disclosed,
how should an error be handled?
August 14, 2019
Chiu RG. When There's No One to Whom an Error Can Be Disclosed, How Should an Error Be Handled?
AMA J Ethics. 2019;21(7):E553-558. doi:10.1001/amajethics.2019.553.
https://psnet.ahrq.gov/issue/when-theres-no-one-…
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psnet.ahrq.gov/node/850348/psn-pdf
June 14, 2023 - Approaches to improving patient safety in integrated
care: a scoping review.
June 14, 2023
Lalani M, Wytrykowski S, Hogan H. Approaches to improving patient safety in integrated care: a scoping
review. BMJ Open. 2023;13(4):e067441. doi:10.1136/bmjopen-2022-067441.
https://psnet.ahrq.gov/issue/approaches-improving-…
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psnet.ahrq.gov/node/72605/psn-pdf
December 23, 2020 - Society for Maternal-Fetal Medicine Special Statement: a
maternal transport briefing form and checklist.
December 23, 2020
Gibson KS, McLean D. Society for Maternal-Fetal Medicine Special Statement: A maternal transport
briefing form and checklist. Am J Obstet Gynecol. 2020;223(5):B12-B15. doi:10.1016/j.ajog.2020.0…
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psnet.ahrq.gov/node/47369/psn-pdf
April 08, 2019 - Why do hundreds of US women die annually in
childbirth?
April 8, 2019
Slomski A. Why Do Hundreds of US Women Die Annually in Childbirth? JAMA. 2019;321(13):1239-1241.
doi:10.1001/jama.2019.0714.
https://psnet.ahrq.gov/issue/why-do-hundreds-us-women-die-annually-childbirth
Maternal mortality is a sentinel event th…
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psnet.ahrq.gov/node/47262/psn-pdf
August 22, 2018 - The Case for Medication Safety Officers (MSO).
August 22, 2018
Horsham, PA: Institute for Safe Medication Practices; 2018.
https://psnet.ahrq.gov/issue/case-medication-safety-officers-mso
Medication safety is a concern in various settings across an organization. This white paper discusses the
role of a medication …
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psnet.ahrq.gov/node/42875/psn-pdf
January 22, 2014 - Communication in the operating theatre.
January 22, 2014
Weldon S-M, Korkiakangas T, Bezemer J, et al. Communication in the operating theatre. Br J Surg.
2013;100(13):1677-88. doi:10.1002/bjs.9332.
https://psnet.ahrq.gov/issue/communication-operating-theatre
This systematic review of communication in the operating…
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psnet.ahrq.gov/node/36879/psn-pdf
June 13, 2011 - Medication Safety and Hospital Referrals: A Report by the
Health and Disability Commissioner.
June 13, 2011
Paterson R. Auckland, NZ; Office of the Health and Disability Commissioner: April 2007.
https://psnet.ahrq.gov/issue/medication-safety-and-hospital-referrals-report-health-and-disability-
commissioner
…
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psnet.ahrq.gov/node/38287/psn-pdf
February 06, 2009 - Teamwork and patient safety in dynamic domains of
healthcare: a review of the literature.
February 6, 2009
Manser T. Teamwork and patient safety in dynamic domains of healthcare: a review of the literature. Acta
Anaesthesiol Scand. 2009;53(2):143-51. doi:10.1111/j.1399-6576.2008.01717.x.
https://psnet.ahrq.gov/iss…
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psnet.ahrq.gov/node/34634/psn-pdf
March 07, 2005 - Strategic Alliance For Error Reduction in California
Healthcare (SAFER).
March 7, 2005
University of California Medical Centers at San Francisco; University of California Medical Centers at Davis.
https://psnet.ahrq.gov/issue/strategic-alliance-error-reduction-california-healthcare-safer
The Strategic Alliance For…
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psnet.ahrq.gov/node/33694/psn-pdf
April 01, 2010 - In Conversation with…Janet Corrigan, PhD, MBA
April 1, 2010
In Conversation with…Janet Corrigan, PhD, MBA. PSNet [internet]. 2010.
https://psnet.ahrq.gov/perspective/conversation-withjanet-corrigan-phd-mba
Editor's note: Janet M. Corrigan, PhD, MBA, is president and CEO of the National Quality Forum (NQF), a
priva…
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psnet.ahrq.gov/node/34934/psn-pdf
March 11, 2011 - Exploring barriers and facilitators to the use of
computerized clinical reminders.
March 11, 2011
Saleem JJ, Patterson ES, Militello LG, et al. Exploring barriers and facilitators to the use of computerized
clinical reminders. J Am Med Inform Assoc. 2005;12(4):438-47.
https://psnet.ahrq.gov/issue/exploring-barrier…
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psnet.ahrq.gov/web-mm/communication-failure-whos-charge
April 01, 2018 - Communication Failure—Who's in Charge?
Citation Text:
Fackler J, Schwartz JM. Communication Failure—Who's in Charge?. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2011.
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psnet.ahrq.gov/node/72543/psn-pdf
December 09, 2020 - Effects of interorganisational information technology
networks on patient safety: a realist synthesis.
December 9, 2020
Keen J, Abdulwahid MA, King N, et al. Effects of interorganisational information technology networks on
patient safety: a realist synthesis. BMJ Open. 2020;10(10):e036608. doi:10.1136/bmjopen-2019…
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psnet.ahrq.gov/node/61027/psn-pdf
October 14, 2020 - COVID-19: the dark side and the sunny side for patient
safety.
October 14, 2020
Wu AW, Sax H, Letaief M, et al. COVID-19: the dark side and the sunny side for patient safety. J Patient
Saf Risk Manag. 2020;25(4):137-141. doi:10.1177/2516043520957116.
https://psnet.ahrq.gov/issue/covid-19-dark-side-and-sunny-side-p…