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psnet.ahrq.gov/web-mm/perils-cross-coverage
September 22, 2010 - Without a foundation to build a shared mental model, adequate clinical documentation and written signouts … Despite this, few curricula target written signout documentation. … electronic signout platforms (with or without EHR integration) can standardize and improve clinical documentation … Unfortunately, the same dangers that plague electronic documentation, such as copy and paste errors, … Use of night float and coverage teams requires corresponding investments to improve clinical documentation
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psnet.ahrq.gov/node/41974/psn-pdf
February 01, 2013 - integrating information technology into health care has been the copy-
and-paste phenomenon in clinical documentation—the
-
psnet.ahrq.gov/node/46904/psn-pdf
August 20, 2018 - tested a bedside pediatric early warning system, which included an illness
severity score, standardized documentation
-
psnet.ahrq.gov/node/45608/psn-pdf
October 27, 2016 - Taken together, these results demonstrate
important inaccuracy in vital sign documentation in the intensive
-
psnet.ahrq.gov/node/49562/psn-pdf
May 01, 2008 - time out is conducted varies considerably from
institution to institution—in timing, content, and documentation … the procedure, some have suggested that a debriefing occur after the procedure as
well.(1)
Finally, documentation … Finally, it would seem appropriate for all members of the team to perform
documentation of the time … In the future, all documentation should be
electronic, making it easy to confirm retrospectively that
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psnet.ahrq.gov/node/49598/psn-pdf
February 01, 2010 - medication-reconciliation-pitfalls
The Commentary
This error involves a system failure in the proper identification, documentation … Electronic documentation of handling of home medications can be customized in
most automated dispensing … By combining
technology solutions—standardized approaches to review, documentation, and handling of
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psnet.ahrq.gov/node/46851/psn-pdf
January 23, 2019 - Prodigious
documentation requirements, escalating productivity demands, and deleterious organizational
-
psnet.ahrq.gov/node/44374/psn-pdf
August 12, 2015 - adoption-technology-improve-medication-safety-perspectives-pharmacy-directors
https://psnet.ahrq.gov/issue/high-incidence-medication-documentation-errors-swiss-university-hospital-due-handwritten
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psnet.ahrq.gov/node/46236/psn-pdf
April 03, 2018 - overall satisfaction with the decision tool, but they
noted that it required inputting more clinical documentation
-
psnet.ahrq.gov/node/44542/psn-pdf
December 22, 2018 - prevalence-medical-error-related-end-life-communication-canadian-hospitals-
results
Discordance between patient preferences for end-of-life care and documentation
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psnet.ahrq.gov/node/42177/psn-pdf
November 23, 2016 - When there was chart documentation, it did not match the patients'
expressed wishes more than two-thirds
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psnet.ahrq.gov/node/38710/psn-pdf
September 14, 2009 - emergency department visits, or adverse events with use of the
software compared with usual written documentation
-
psnet.ahrq.gov/node/41266/psn-pdf
January 03, 2017 - The
investigators included formal documentation of any defects (concerns or problems arising at any
-
psnet.ahrq.gov/issue/tutorial-ahrq-sopsr-data-entry-and-analysis-tool
December 10, 2024 - Improving Health IT Safety Through the Use of Natural Language Processing to Improve Accuracy of EHR Documentation
-
psnet.ahrq.gov/node/50755/psn-pdf
December 18, 2019 - Needed/Quality Improvement Approach
A low risk, high value system change to target is malnutrition documentation … which is a potentially costly mistake.28,30 One retrospective study found that missing malnutrition
documentation … patients represented a loss of $30,000 in reimbursement.30 To begin the process
of improving malnutrition documentation … Society for Parenteral and Enteral
Nutrition: characteristics recommended for the identification and documentation … Achievements in improving documentation to depict a more accurate clinical
representation of patients
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psnet.ahrq.gov/node/42923/psn-pdf
September 26, 2017 - Despite these developments, the survey
also reveals many areas for improvement, such as accurate documentation
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psnet.ahrq.gov/node/45797/psn-pdf
October 31, 2017 - such as failure to elicit sufficient family history, incomplete
physical examination performance or documentation
-
psnet.ahrq.gov/node/39730/psn-pdf
December 21, 2014 - This study explored a less understood risk for wrong-site surgery by focusing on the
documentation transition
-
psnet.ahrq.gov/node/43630/psn-pdf
April 15, 2016 - This gap between patient reports and hospital documentation emphasizes the ongoing challenge of
safe
-
psnet.ahrq.gov/node/43653/psn-pdf
January 01, 2015 - safety data beyond what chart review can provide and underscores the need to improve
existing clinical documentation