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psnet.ahrq.gov/web-mm/slow-down-right-drug-wrong-formulation
October 13, 2018 - Slow Down: Right Drug, Wrong Formulation
Citation Text:
Amato MG, Schiff G. Slow Down: Right Drug, Wrong Formulation. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2018.
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psnet.ahrq.gov/web-mm/consequences-miscommunication-regarding-possible-artifact
May 11, 2019 - SPOTLIGHT CASE
The Consequences of Miscommunication Regarding a Possible Artifact
Citation Text:
Gwal K. The Consequences of Miscommunication Regarding a Possible Artifact. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 20…
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psnet.ahrq.gov/web-mm/navigating-complications-unintended-journey-guidewire-during-dialysis-catheter-placement
February 23, 2022 - Navigating Complications: The Unintended Journey of a Guidewire During Dialysis Catheter Placement
Citation Text:
Vuyyuru S, Kapa N. Navigating Complications: The Unintended Journey of a Guidewire During Dialysis Catheter Placement. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Qualit…
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psnet.ahrq.gov/web-mm/weight-and-height-juxtaposition-electronic-medical-record-causing-accidental-medication
March 15, 2023 - Weight and Height Juxtaposition in the Electronic Medical Record Causing an Accidental Medication Overdose
Citation Text:
Jain NP, Dakwa D. Weight and Height Juxtaposition in the Electronic Medical Record Causing an Accidental Medication Overdose. PSNet [internet]. Rockville (MD): Agency for Healthcare Rese…
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psnet.ahrq.gov/web-mm/code-status-confusion
September 01, 2006 - SPOTLIGHT CASE
Code Status Confusion
Citation Text:
Lo B, Tulsky JA. Code Status Confusion. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2003.
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psnet.ahrq.gov/web-mm/when-looks-arent-all-they-appear-be-medication-error-uncommon-indication
July 02, 2019 - When Looks Aren’t All They Appear to Be: A Medication Error in an Uncommon Indication
Citation Text:
Ton K. When Looks Aren’t All They Appear to Be: A Medication Error in an Uncommon Indication . PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human…
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psnet.ahrq.gov/web-mm/coming-undone-failure-closure-device
April 01, 2006 - Coming Undone: Failure of Closure Device
Citation Text:
Baez-Escudero JL, Levine GN. Coming Undone: Failure of Closure Device. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2007.
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psnet.ahrq.gov/node/41633/psn-pdf
January 01, 2013 - Determinants of success of quality improvement
collaboratives: what does the literature show?
December 31, 2012
Hulscher M, Schouten LMT, Grol R, et al. Determinants of success of quality improvement collaboratives:
what does the literature show? BMJ Qual Saf. 2013;22(1):19-31. doi:10.1136/bmjqs-2011-000651.
https…
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psnet.ahrq.gov/node/40547/psn-pdf
June 29, 2011 - What context features might be important determinants of
the effectiveness of patient safety practice interventions?
June 29, 2011
Taylor SL, Dy SM, Foy R, et al. What context features might be important determinants of the effectiveness
of patient safety practice interventions? BMJ Qual Saf. 2011;20(7):611-7. doi:…
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psnet.ahrq.gov/node/49394/psn-pdf
April 01, 2003 - psnet.ahrq.gov//#references
https://psnet.ahrq.gov//#references
https://psnet.ahrq.gov//#references
used to determine … considering induction, the physicians now weighed options of either proceeding
with an amniocentesis to determine
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psnet.ahrq.gov/node/47154/psn-pdf
May 23, 2018 - Comparison of military and civilian methods for
determining potentially preventable deaths: a systematic
review.
May 23, 2018
Janak JC, Sosnov JA, Bares JM, et al. Comparison of Military and Civilian Methods for Determining
Potentially Preventable Deaths: A Systematic Review. JAMA Surg. 2018;153(4):367-375.
doi:1…
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psnet.ahrq.gov/node/37207/psn-pdf
September 09, 2008 - Publicly available hospital comparison web sites:
determination of useful, valid, and appropriate
information for comparing surgical quality.
September 9, 2008
Leonardi MJ, McGory ML, Ko CY. Publicly available hospital comparison web sites: determination of useful,
valid, and appropriate information for comparing …
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psnet.ahrq.gov/node/41067/psn-pdf
February 10, 2012 - Determining the safety of office-based surgery: what 10
years of Florida data and 6 years of Alabama data reveal.
February 10, 2012
Starling J, Thosani MK, Coldiron BM. Determining the safety of office-based surgery: what 10 years of
Florida data and 6 years of Alabama data reveal. Dermatol Surg. 2012;38(2):171-7. …
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psnet.ahrq.gov/node/36954/psn-pdf
February 24, 2011 - Patient safety knowledge and its determinants in medical
trainees.
February 24, 2011
Kerfoot P, Conlin PR, Travison T, et al. Patient safety knowledge and its determinants in medical trainees.
J Gen Intern Med. 2007;22(8):1150-4.
https://psnet.ahrq.gov/issue/patient-safety-knowledge-and-its-determinants-medical-tr…
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psnet.ahrq.gov/node/39141/psn-pdf
June 27, 2011 - Determination of health-care teamwork training
competencies: a Delphi study.
June 27, 2011
Clay-Williams R, Braithwaite J. Determination of health-care teamwork training competencies: a Delphi
study. Int J Qual Health Care. 2009;21(6):433-40. doi:10.1093/intqhc/mzp042.
https://psnet.ahrq.gov/issue/determination-he…
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psnet.ahrq.gov/node/43533/psn-pdf
August 28, 2017 - Organizational, cultural, and psychological determinants
of smart infusion pump work arounds: a study of 3 U.S.
health systems.
August 28, 2017
Dunford BB, Perrigino M, Tucker SJ, et al. Organizational, Cultural, and Psychological Determinants of
Smart Infusion Pump Work Arounds: A Study of 3 U.S. Health Systems. …
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psnet.ahrq.gov/node/37566/psn-pdf
February 27, 2008 - Determinants of adverse events in hospitals—the
potential role of patient safety culture.
February 27, 2008
Kline TJB, Willness C, Ghali WA. Determinants of adverse events in hospitals--the potential role of patient
safety culture. J Healthc Qual. 2008;30(1):11-7.
https://psnet.ahrq.gov/issue/determinants-adverse-…
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psnet.ahrq.gov/node/40599/psn-pdf
November 23, 2011 - Organizational climate determinants of resident safety
culture in nursing homes.
November 23, 2011
Arnetz JE, Zhdanova LS, Elsouhag D, et al. Organizational climate determinants of resident safety culture
in nursing homes. Gerontologist. 2011;51(6):739-49. doi:10.1093/geront/gnr053.
https://psnet.ahrq.gov/issue/or…
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psnet.ahrq.gov/node/35305/psn-pdf
June 30, 2011 - Drug administration errors and their determinants in
pediatric in-patients.
June 30, 2011
Prot S, Fontan JE, Alberti C, et al. Drug administration errors and their determinants in pediatric in-patients.
International Journal for Quality in Health Care. 2005;17(5). doi:10.1093/intqhc/mzi066.
https://psnet.ahrq.gov/…
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psnet.ahrq.gov/node/45372/psn-pdf
November 18, 2016 - Determinants of patient–oncologist prognostic
discordance in advanced cancer.
November 18, 2016
Gramling R, Fiscella K, Xing G, et al. Determinants of Patient-Oncologist Prognostic Discordance in
Advanced Cancer. JAMA Oncol. 2016;2(11):1421-1426. doi:10.1001/jamaoncol.2016.1861.
https://psnet.ahrq.gov/issue/determ…