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psnet.ahrq.gov/issue/lessons-unexpected-increased-mortality-after-implementation-commercially-sold-computerized
April 29, 2018 - Commentary
Lessons from "unexpected increased mortality after implementation of a commercially sold computerized physician order entry system."
Citation Text:
Sittig DF, Ash JS, Zhang J, et al. Lessons from "Unexpected increased mortality after implementation of a commercially sold com…
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psnet.ahrq.gov/issue/medication-injection-safety-knowledge-and-practices-among-anesthesiologists-new-york-state
August 25, 2021 - Study
Medication injection safety knowledge and practices among anesthesiologists: New York State, 2011.
Citation Text:
Gounder P, Beers R, Bornschlegel K, et al. Medication injection safety knowledge and practices among anesthesiologists: New York State, 2011. J Clin Anesth. 2013;25(7)…
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psnet.ahrq.gov/issue/sources-and-magnitude-error-preparing-morphine-infusions-nurse-patient-controlled-analgesia
January 07, 2015 - Study
Sources and magnitude of error in preparing morphine infusions for nurse–patient controlled analgesia in a UK paediatric hospital.
Citation Text:
Rashed AN, Tomlin S, Aguado V, et al. Sources and magnitude of error in preparing morphine infusions for nurse-patient controlled analge…
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psnet.ahrq.gov/issue/computer-alert-system-prevent-injury-adverse-drug-events-development-and-evaluation-community
November 01, 2016 - Study
Classic
A computer alert system to prevent injury from adverse drug events: development and evaluation in a community teaching hospital.
Citation Text:
Raschke RA, Gollihare B, Wunderlich TA, et al. A Computer Alert System to Prevent Injury From Adverse …
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psnet.ahrq.gov/issue/case-control-analysis-financial-cost-medication-errors-hospitalized-patients
January 15, 2025 - Study
Case-control analysis of the financial cost of medication errors in hospitalized patients.
Citation Text:
Pinilla J, Murillo C, Carrasco G, et al. Case-control analysis of the financial cost of medication errors in hospitalized patients. Eur J Health Econ. 2006;7(1):66-71.
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psnet.ahrq.gov/issue/evolution-rapid-response-system-voluntary-mandatory-activation
June 07, 2023 - Commentary
Evolution of a rapid response system from voluntary to mandatory activation.
Citation Text:
Jones CM, Bleyer AJ, Petree B. Evolution of a rapid response system from voluntary to mandatory activation. Jt Comm J Qual Patient Saf. 2010;36(6):266-70, 241.
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psnet.ahrq.gov/issue/improving-quality-written-prescriptions-general-hospital-influence-10-years-serial-audits-and
August 24, 2022 - Study
Improving the quality of written prescriptions in a general hospital: the influence of 10 years of serial audits and targeted interventions.
Citation Text:
Gommans J, McIntosh P, Bee S, et al. Improving the quality of written prescriptions in a general hospital: the influence of …
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psnet.ahrq.gov/issue/getting-underuse-interpreters-resident-physicians
February 21, 2018 - Study
Getting by: underuse of interpreters by resident physicians.
Citation Text:
Diamond LC, Schenker Y, Curry LA, et al. Getting by: underuse of interpreters by resident physicians. J Gen Intern Med. 2009;24(2):256-62. doi:10.1007/s11606-008-0875-7.
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psnet.ahrq.gov/issue/how-often-do-physicians-review-medication-charts-ward-rounds
September 23, 2020 - Study
How often do physicians review medication charts on ward rounds?
Citation Text:
Looi KL, Black PN. How often do physicians review medication charts on ward rounds? BMC Clin Pharmacol. 2008;8:9. doi:10.1186/1472-6904-8-9.
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psnet.ahrq.gov/issue/system-safety-approach-assessing-risks-sepsis-treatment-process
February 03, 2021 - Study
A system safety approach to assessing risks in the sepsis treatment process.
Citation Text:
Kaya GK. A system safety approach to assessing risks in the sepsis treatment process. Appl Ergon. 2021;94:103408. doi:10.1016/j.apergo.2021.103408.
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psnet.ahrq.gov/issue/how-should-medication-errors-be-defined-development-and-test-definition
June 27, 2011 - Study
How should medication errors be defined? Development and test of a definition.
Citation Text:
Lisby M, Nielsen LP, Brock B, et al. How should medication errors be defined? Development and test of a definition. Scand J Public Health. 2012;40(2):203-10. doi:10.1177/1403494811435489.…
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psnet.ahrq.gov/issue/medication-errors-associated-transition-insulin-pens-insulin-vials
May 29, 2019 - Study
Medication errors associated with transition from insulin pens to insulin vials.
Citation Text:
Trimble AN, Bishop B, Rampe N. Medication errors associated with transition from insulin pens to insulin vials. Am J Health Syst Pharm. 2017;74(2):70-75. doi:10.2146/ajhp150726.
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psnet.ahrq.gov/issue/work-overload-related-increased-risk-error-during-chemotherapy-preparation
June 30, 2011 - Study
Work overload is related to increased risk of error during chemotherapy preparation.
Citation Text:
Carrez L, Bouchoud L, Fleury S, et al. Work overload is related to increased risk of error during chemotherapy preparation. J Oncol Pharm Pract. 2019;25(6):1456-1466. doi:10.1177/107…
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psnet.ahrq.gov/issue/potential-risk-medication-discrepancies-and-reconciliation-errors-admission-and-discharge
March 09, 2022 - Study
Potential risk of medication discrepancies and reconciliation errors at admission and discharge from an inpatient medical service.
Citation Text:
Climente-Martí M, García-Mañón ER, Artero-Mora A, et al. Potential risk of medication discrepancies and reconciliation errors at admis…
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psnet.ahrq.gov/issue/right-medication-right-dose-right-patient-right-time-and-right-route-how-do-we-select-right
March 02, 2016 - Commentary
Right medication, right dose, right patient, right time, and right route: how do we select the right patient-controlled analgesia (PCA) device?
Citation Text:
Ladak SSJ, Chan VWS, Easty T, et al. Right medication, right dose, right patient, right time, and right route: how d…
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psnet.ahrq.gov/issue/exaggerated-benefits-failure
November 09, 2022 - Study
The exaggerated benefits of failure.
Citation Text:
Eskreis-Winkler L, Woolley K, Erensoy E, et al. The exaggerated benefits of failure. J Exp Psychol Gen. 2024;153(7):1920-1937. doi:10.1037/xge0001610.
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psnet.ahrq.gov/issue/nonopioid-directives-unintended-consequences-operating-room
September 07, 2022 - Commentary
Nonopioid directives: unintended consequences in the operating room.
Citation Text:
Bicket MC, Waljee JF, Hilliard P. Nonopioid directives: unintended consequences in the operating room. JAMA Health Forum. 2022;3(6):e221356. doi:10.1001/jamahealthforum.2022.1356.
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psnet.ahrq.gov/issue/maximizing-student-potential-lessons-pharmacy-programs-patient-safety-movement
October 23, 2024 - Commentary
Maximizing student potential: lessons for pharmacy programs from the patient safety movement.
Citation Text:
Abebe E, Bao A, Kokkinias P, et al. Maximizing student potential: lessons for pharmacy programs from the patient safety movement. Explor Res Clin Soc Pharm. 2023;9:1002…
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psnet.ahrq.gov/issue/effect-physicians-long-term-use-cpoe-their-test-management-work-practices
March 23, 2011 - Study
The effect of physicians' long-term use of CPOE on their test management work practices.
Citation Text:
Callen JL, Westbrook JI, Braithwaite J. The effect of physicians' long-term use of CPOE on their test management work practices. J Am Med Inform Assoc. 2006;13(6):643-52.
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psnet.ahrq.gov/issue/understanding-handling-drug-safety-alerts-simulation-study
March 04, 2011 - Study
Understanding handling of drug safety alerts: a simulation study.
Citation Text:
van der Sijs H, van Gelder T, Vulto A, et al. Understanding handling of drug safety alerts: a simulation study. Int J Med Inform. 2010;79(5). doi:10.1016/j.ijmedinf.2010.01.008.
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