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psnet.ahrq.gov/node/74018/psn-pdf
October 27, 2021 - Anatomy of a medical device recall: how defective
products can slip through an outdated system.
October 27, 2021
Zipp R. Medical Tech Dive. October 18, 2021.
https://psnet.ahrq.gov/issue/anatomy-medical-device-recall-how-defective-products-can-slip-through-
outdated-system
This article highlights systems influenc…
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psnet.ahrq.gov/node/45961/psn-pdf
June 23, 2017 - Burden of hospitalizations related to adverse drug events
in the USA: a retrospective analysis from large inpatient
database.
June 23, 2017
Poudel DR, Acharya P, Ghimire S, et al. Burden of hospitalizations related to adverse drug events in the
USA: a retrospective analysis from large inpatient database. Pharmacoe…
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psnet.ahrq.gov/node/45341/psn-pdf
July 27, 2016 - How to avoid catastrophic events on the ward.
July 27, 2016
Bein B, Seewald S, Gräsner J-T. How to avoid catastrophic events on the ward. Best Pract Res Clin
Anaesthesiol. 2016;30(2):237-45. doi:10.1016/j.bpa.2016.04.003.
https://psnet.ahrq.gov/issue/how-avoid-catastrophic-events-ward
Hospitals require robust esca…
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psnet.ahrq.gov/node/73524/psn-pdf
July 21, 2021 - Intravenous admixture preparation considerations, Parts
9-A and 9-B: error prevention in intravenous admixture
preparation.
July 21, 2021
Allen LV, Jr. Int J Pharm Compd. 2021;25:131-139; 222-229.
https://psnet.ahrq.gov/issue/intravenous-admixture-preparation-considerations-parts-9-and-9-b-error-
prevention-…
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psnet.ahrq.gov/node/849612/psn-pdf
May 31, 2023 - Why do so many Black women die in pregnancy? One
reason: doctors don't take them seriously.
May 31, 2023
Stafford K. AP News. May 23, 2023.
https://psnet.ahrq.gov/issue/why-do-so-many-black-women-die-pregnancy-one-reason-doctors-dont-take-
them-seriously
Racial inequities and implicit bias undermine safe maternal…
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psnet.ahrq.gov/node/60736/psn-pdf
July 29, 2020 - Use of an electronic decision support tool to reduce
polypharmacy in elderly people with chronic diseases:
cluster randomised controlled trial.
July 29, 2020
Rieckert A, Reeves D, Altiner A, et al. Use of an electronic decision support tool to reduce polypharmacy in
elderly people with chronic diseases: cluster ra…
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psnet.ahrq.gov/node/46957/psn-pdf
May 17, 2018 - Improving communication with patients with limited
English proficiency.
May 17, 2018
Taira BR. Improving Communication With Patients With Limited English Proficiency. JAMA Int Med.
2018;178(5):605-606. doi:10.1001/jamainternmed.2018.0373.
https://psnet.ahrq.gov/issue/improving-communication-patients-limited-englis…
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psnet.ahrq.gov/node/47874/psn-pdf
April 10, 2019 - Evaluating the effect of data standardization and
validation on patient matching accuracy.
April 10, 2019
Grannis SJ, Xu H, Vest JR, et al. Evaluating the effect of data standardization and validation on patient
matching accuracy. J Am Med Inform Assoc. 2019;26(5):447-456. doi:10.1093/jamia/ocy191.
https://psnet.a…
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psnet.ahrq.gov/node/47832/psn-pdf
February 27, 2019 - Another round of the blame game: a paralyzing criminal
indictment that recklessly "overrides" just culture.
February 27, 2019
ISMP Medication Safety Alert! Acute Care Edition. February 14, 2019;24.
https://psnet.ahrq.gov/issue/another-round-blame-game-paralyzing-criminal-indictment-recklessly-
overrides-just-cultu…
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psnet.ahrq.gov/node/73373/psn-pdf
January 01, 2022 - State medical board regulation of compounding in
physician offices.
June 9, 2021
Reynolds KA, Hellquist K, Ibrahim SA, et al. State medical board regulation of compounding in physician
offices. Arch Dermatol Res. 2022;314(4):363-367. doi:10.1007/s00403-021-02237-8.
https://psnet.ahrq.gov/issue/state-medical-board-…
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psnet.ahrq.gov/node/44869/psn-pdf
November 18, 2016 - Fake and expired medications in simulation-based
education: an underappreciated risk to patient safety.
November 18, 2016
Torrie J, Cumin D, Sheridan J, et al. Fake and expired medications in simulation-based education: an
underappreciated risk to patient safety. BMJ Qual Saf. 2016;25(12):917-920. doi:10.1136/bmjqs…
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psnet.ahrq.gov/node/47694/psn-pdf
February 06, 2019 - association-pharmaceutical-industry-marketing-opioid-products-mortality-
opioid-related
Reducing opioid-related overdoses and deaths … association-pharmaceutical-industry-marketing-opioid-products-mortality-opioid-related
https://psnet.ahrq.gov/issue/increases-drug-and-opioid-overdose-deaths-united-states
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psnet.ahrq.gov/node/45615/psn-pdf
October 26, 2016 - mandatory-provider-review-and-pain-clinic-laws-reduce-amounts-opioids-
prescribed-and-overdose
Opioid-related harm, including overdose deaths … States with mandated review policies had
fewer opioid overdose deaths and lower amounts of opioids prescribed
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psnet.ahrq.gov/node/47266/psn-pdf
August 08, 2018 - outpatient-opioid-prescriptions-children-and-opioid-related-adverse-events
Reducing the incidence of opioid overdoses and overdose deaths … psnet.ahrq.gov/issue/opioid-overdose
https://psnet.ahrq.gov/issue/increases-drug-and-opioid-overdose-deaths-united-states
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psnet.ahrq.gov/node/41212/psn-pdf
March 14, 2012 - error in hospitals
using incident-reporting systems, patient complaints and
chart review of inpatient deaths … error in hospitals
using incident-reporting systems, patient complaints and chart review of inpatient deaths
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www.uspreventiveservicestaskforce.org/uspstf/recommendation/suicide-risk-in-adolescents-adults-and-older-adults-screening
May 20, 2014 - Rates of suicide attempts and deaths vary by sex, age, and race or ethnicity 1 . … per 100,000]) and those aged 55 to 59 years (47.8% [from 20.3 to 30.0 deaths per 100,000]). … rate in men increased by 39.6% (from 24.5 to 34.2 deaths per 100,000) 9 . … at a rate of 11.8 deaths per 100,000 persons 1 . … Deaths: Final Data for 2010. Natl Vital Stat Rep . 2013;61:1-117.
2.
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hcup-us.ahrq.gov/reports/factsandfigures/2007/exhibit5_3.jsp
January 01, 2007 - Four percent of stays resulted in in-hospital deaths and less than 1 percent were discharges against … Less than 1 percent of Medicaid, private insurance, and uninsured stays resulted in in-hospital deaths … For stays with Medicare as the primary payer, in-hospital deaths occurred in 4 percent of stays.
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psnet.ahrq.gov/node/44709/psn-pdf
November 18, 2016 - Prior studies have found that nearly 8% of deaths in
patients with major trauma may be preventable, … lost-information-during-handover-critically-injured-trauma-patients-mixed-methods-study
https://psnet.ahrq.gov/issue/classifying-errors-preventable-and-potentially-preventable-trauma-deaths
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psnet.ahrq.gov/node/38837/psn-pdf
June 28, 2011 - validity-selected-ahrq-patient-safety-indicators-based-va-national-surgical-quality
https://psnet.ahrq.gov/web-mm/deaths-not-foretold-are-unexpected-deaths-useful-patient-safety-signals
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psnet.ahrq.gov/issue/closing-deaths-door-legal-innovations-end-epidemic-healthcare-harm
January 27, 2021 - Book/Report
Closing Death’s Door: Legal Innovations to End the Epidemic of Healthcare Harm.
Citation Text:
Closing Death’s Door: Legal Innovations to End the Epidemic of Healthcare Harm. Saks M, Landsman S. New York, NY: Oxford University Press; 2021. ISBN: 9780190667986.
…