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psnet.ahrq.gov/node/37558/psn-pdf
July 05, 2013 - Patient safety and quality improvement.
July 5, 2013
Agency for Healthcare Research and Quality. Fed Register. February 12, 2008;73(29):8112-8183.
https://psnet.ahrq.gov/issue/patient-safety-and-quality-improvement
These proposed rules seek to support the implementation of portions of the Patient Safety and Quality…
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psnet.ahrq.gov/node/41861/psn-pdf
September 27, 2017 - Surgeon commitment to trauma care decreases missed
injuries.
September 27, 2017
Lin Y-K, Lin C-J, Chan H-M, et al. Surgeon commitment to trauma care decreases missed injuries. Injury.
2014;45(1):83-7. doi:10.1016/j.injury.2012.10.019.
https://psnet.ahrq.gov/issue/surgeon-commitment-trauma-care-decreases-missed-inj…
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psnet.ahrq.gov/node/36968/psn-pdf
February 15, 2011 - The hospital discharge: a review of a high risk care
transition with highlights of a reengineered discharge
process.
February 15, 2011
Greenwald JL, Denham CR, Jack BW. The Hospital Discharge. J Patient Saf. 2008;3(2).
doi:10.1097/01.jps.0000236916.94696.12.
https://psnet.ahrq.gov/issue/hospital-discharge-review…
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psnet.ahrq.gov/node/47371/psn-pdf
September 26, 2018 - When I say…diagnostic error.
September 26, 2018
Hautz WE. When I say… diagnostic error. Med Educ. 2018. doi:10.1111/medu.13602.
https://psnet.ahrq.gov/issue/when-i-saydiagnostic-error
Inconsistent terminology use in research, education, and measurement strategy development hinders
progress and understanding in eme…
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psnet.ahrq.gov/node/38324/psn-pdf
January 14, 2009 - Effectiveness of random and focused review in detecting
surgical pathology error.
January 14, 2009
Raab SS, Grzybicki DM, Mahood LK, et al. Effectiveness of random and focused review in detecting
surgical pathology error. Am J Clin Pathol. 2008;130(6):905-12. doi:10.1309/AJCPPIA5D7MYKDWF.
https://psnet.ahrq.gov/is…
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psnet.ahrq.gov/node/36562/psn-pdf
January 12, 2011 - Increasing patient safety and efficiency in transfusion
therapy using formal process definitions.
January 12, 2011
Henneman EA, Avrunin GS, Clarke LA, et al. Increasing patient safety and efficiency in transfusion therapy
using formal process definitions. Transfus Med Rev. 2007;21(1):49-57.
https://psnet.ahrq.gov/…
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psnet.ahrq.gov/node/34992/psn-pdf
September 29, 2017 - Lessons from the war on cancer: the need for basic
research on safety.
September 29, 2017
Cook RI. J Patient Saf. 2005.1(1):7-8
https://psnet.ahrq.gov/issue/lessons-war-cancer-need-basic-research-safety
The author examines parallels between President Nixon's "War on Cancer" and the work of patient safety
today, p…
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psnet.ahrq.gov/node/41593/psn-pdf
August 15, 2012 - Facility-level variation in potentially inappropriate
prescribing for older veterans.
August 15, 2012
Gellad WF, Good CB, Amuan ME, et al. Facility-level variation in potentially inappropriate prescribing for
older veterans. J Am Geriatr Soc. 2012;60(7):1222-9. doi:10.1111/j.1532-5415.2012.04042.x.
https://psnet.a…
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psnet.ahrq.gov/node/40569/psn-pdf
June 29, 2011 - Inappropriate medications in elderly ICU survivors: where
to intervene?
June 29, 2011
Morandi A, Vasilevskis EE, Pandharipande PP, et al. Inappropriate medications in elderly ICU survivors:
where to intervene? Arch Intern Med. 2011;171(11):1032-4. doi:10.1001/archinternmed.2011.233.
https://psnet.ahrq.gov/issue/in…
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psnet.ahrq.gov/perspective/how-does-infection-prevention-fit-safety-program
March 01, 2014 - First, and as described above, it was essential to define the composition, scope, and operational funding … Can you define what that means?
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psnet.ahrq.gov/perspective/becoming-certified-professional-patient-safety-pharmacists-perspective
June 01, 2016 - There are ways to start to define the core characteristics of people who have expertise in this area. … Looking at the evolution of patient safety science over the last 20–25 years, we have really started to define
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psnet.ahrq.gov/perspective/conversation-alison-holmes-md-mph
March 01, 2014 - Can you define what that means? … First, and as described above, it was essential to define the composition, scope, and operational funding
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psnet.ahrq.gov/node/42929/psn-pdf
February 05, 2014 - Do no harm: is it time to rethink the Hippocratic Oath?
February 5, 2014
Walton M, Kerridge I. Do no harm: is it time to rethink the Hippocratic Oath? Med Educ. 2014;48(1):17-27.
doi:10.1111/medu.12275.
https://psnet.ahrq.gov/issue/do-no-harm-it-time-rethink-hippocratic-oath
This commentary discusses how health ca…
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psnet.ahrq.gov/node/43031/psn-pdf
March 12, 2014 - WARNING health IT may be hazardous to your healthcare.
March 12, 2014
Dimick C.
https://psnet.ahrq.gov/issue/warning-health-it-may-be-hazardous-your-healthcare
This article relates the development of a taxonomy that hospitals and vendors can use to detect, sort, and
analyze risks associated with health information…
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psnet.ahrq.gov/node/43376/psn-pdf
January 16, 2017 - Resilience and resilience engineering in health care.
January 16, 2017
Fairbanks RJ, Wears RL, Woods DD, et al. Resilience and resilience engineering in health care. Jt Comm J
Qual Patient Saf. 2014;40(8):376-383.
https://psnet.ahrq.gov/issue/resilience-and-resilience-engineering-health-care
Resilience is a charac…
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psnet.ahrq.gov/node/34788/psn-pdf
March 28, 2005 - Cost of medication-related problems at a university
hospital.
March 28, 2005
Schneider PJ; Gift MG; Lee YP; Rothermich EA; Sill BE
https://psnet.ahrq.gov/issue/cost-medication-related-problems-university-hospital
This study used retrospective chart review to determine estimated costs of defined medication-related
…
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psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.308_slideshow.ppt
October 01, 2013 - Credits
Objectives
At the conclusion of this educational activity, participants should be able to:
Define
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psnet.ahrq.gov/node/49751/psn-pdf
January 01, 2016 - A more robust study using a rigorous research design is needed to define the
true benefit of patient
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psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.272_slideshow.ppt
July 01, 2012 - perform procedures
Understand how simulation can be used to ensure trainees are competent in procedures
Define
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psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.323_slideshow.ppt
May 01, 2014 - participants should be able to:
Appreciate that medication discrepancies are common across the care continuum
Define