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psnet.ahrq.gov/issue/raising-barcode-improving-medication-safety-behaviours-through-behavioural-science-informed
November 01, 2023 - February 23, 2022
Indication documentation and indication-based prescribing within electronic … November 1, 2023
Improving administration and documentation of enteral nutrition support
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psnet.ahrq.gov/issue/partnering-patients-and-families-living-chronic-conditions-coproduce-diagnostic-safety
October 27, 2021 - When doctors share visit notes with patients: a study of patient and doctor perceptions of documentation … Charting diagnostic safety: exploring patient-provider discordance in medical record documentation
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psnet.ahrq.gov/issue/secondary-use-data-support-medication-safety-hospital-setting-systematic-review-and-narrative
July 31, 2019 - July 31, 2019
The devil is in the detail: how a closed-loop documentation system for … September 14, 2022
Indication alerts to improve problem list documentation.
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psnet.ahrq.gov/issue/use-pediatric-injectable-medicines-guidelines-and-associated-medication-administration-errors
December 18, 2019 - December 18, 2019
Indication documentation and indication-based prescribing within electronic … December 9, 2020
The devil is in the detail: how a closed-loop documentation system for
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psnet.ahrq.gov/issue/what-extent-world-health-organizations-medication-safety-challenge-being-addressed-english
November 02, 2022 - October 28, 2020
The devil is in the detail: how a closed-loop documentation system for … July 31, 2013
Improving allergy documentation: a retrospective electronic health record
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psnet.ahrq.gov/issue/impact-inpatient-electronic-prescribing-system-prescribing-error-causation-qualitative
February 16, 2022 - July 29, 2020
The devil is in the detail: how a closed-loop documentation system for … September 1, 2016
High incidence of medication documentation errors in a Swiss university
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psnet.ahrq.gov/issue/frequency-and-types-patient-reported-errors-electronic-health-record-ambulatory-care-notes
June 05, 2019 - When doctors share visit notes with patients: a study of patient and doctor perceptions of documentation … Charting diagnostic safety: exploring patient-provider discordance in medical record documentation
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psnet.ahrq.gov/issue/using-who-international-classification-patient-safety-framework-identify-incident
January 15, 2020 - September 1, 2018
Efficiency and safety of speech recognition for documentation in the … July 30, 2018
Advance care planning documentation practices and accessibility in the
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psnet.ahrq.gov/issue/improving-accuracy-handoff-implementing-electronic-health-record-generated-tool-improvement
January 01, 2022 - Download Citation
Related Resources From the Same Author(s)
Improving allergy documentation … August 5, 2020
Hidden health IT hazards: a qualitative analysis of clinically meaningful documentation
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psnet.ahrq.gov/issue/nurses-attitudes-medical-emergency-team-service-teaching-hospital
November 16, 2022 - September 23, 2020
Documentation of clinical review and vital signs after major surgery … 2014
Developing a medical emergency team running sheet to improve clinical handoff and documentation
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psnet.ahrq.gov/node/865374/psn-pdf
March 27, 2024 - For example, during patient examinations and EHR documentation, the AI system can
suggest diagnoses … AI system can be listening along and completing the chart for them.8
This will not only reduce the documentation … it could also improve patient safety by
streamlining and standardizing data collection and reducing documentation … Given the success of AI
dictation and assisted documentation in other fields, its adaptation to healthcare … future, clinicians could be
assisted with many of their daily tasks, including risk prediction and documentation
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psnet.ahrq.gov/issue/medication-reconciliation-community-nonteaching-hospital
October 19, 2012 - January 30, 2013
Hospital discharge documentation and risk of rehospitalisation. … May 4, 2010
Accuracy of medication documentation in hospital discharge summaries: a retrospective
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psnet.ahrq.gov/issue/bedside-handover-quality-improvement-strategy-transform-care-bedside
October 27, 2010 - September 3, 2011
Improving documentation of a beta-blocker quality measure through an … anesthesia information management system and real-time notification of documentation errors.
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psnet.ahrq.gov/issue/hospitalized-patients-understanding-their-plan-care
June 11, 2010 - March 11, 2013
Hospital discharge documentation and risk of rehospitalisation. … June 29, 2011
Questionable hospital chart documentation practices by physicians.
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psnet.ahrq.gov/issue/governing-surgical-count-through-communication-interactions-implications-patient-safety
November 06, 2015 - Related Resources From the Same Author(s)
Failures in communication through documents and documentation … August 7, 2013
The role of documents and documentation in communication failure across
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psnet.ahrq.gov/issue/missing-link-dedicated-patient-safety-education-within-top-ranked-us-nursing-school-curricula
November 15, 2018 - June 28, 2023
Improving documentation of a beta-blocker quality measure through an anesthesia … information management system and real-time notification of documentation errors.
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psnet.ahrq.gov/primer/electronic-health-records
March 15, 2025 - appropriate alerts Lack of duplicate record detection capability Fragmentation of information; gaps in documentation … important alerts Simultaneous task performance Opening multiple records simultaneously can result in documentation … user actions in order processing Clinicians may not be aware of incomplete order submission process; documentation … September 1, 2018
Advance care planning documentation practices and accessibility in
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psnet.ahrq.gov/node/49756/psn-pdf
April 01, 2016 - Lost in Sign Out and Documentation
April 1, 2016
Detsky ME. Lost in Sign Out and Documentation. … https://psnet.ahrq.gov/web-mm/lost-sign-out-and-documentation
The Case
A 71-year-old man presented … https://psnet.ahrq.gov/web-mm/lost-sign-out-and-documentation
The case was reviewed in a multidisciplinary … curbside consultation, which provided the cardiology team with false reassurance and left
behind no documentation
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psnet.ahrq.gov/node/49479/psn-pdf
April 01, 2005 - For
example, a hospital might develop specialized documentation that integrates hypoglycemic medication … Custom documentation is common for higher-risk nursing tasks, such as
documenting patient-controlled … estimated at 16% of nursing time [2]) and either fragment the
nursing record or require redundant documentation … problems, the technique scales poorly, since it is impractical to implement on paper task-specific
documentation … Nursing documentation time during
implementation of an electronic medical record.
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psnet.ahrq.gov/node/50407/psn-pdf
October 02, 2019 - The authors review safety concerns in the office
setting, leadership and safety culture, documentation