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psnet.ahrq.gov/node/36359/psn-pdf
October 26, 2010 - How might acknowledging a medical error promote
patient safety? … How might acknowledging a medical error promote patient safety? J Fam Pract.
2006;55(9):775-80. … https://psnet.ahrq.gov/issue/how-might-acknowledging-medical-error-promote-patient-safety
The authors … present a case of diagnostic error and use a question-and-answer format to review how to
disclose and … //#error
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psnet.ahrq.gov/node/36704/psn-pdf
March 28, 2011 - Stopping the error cascade: a report on ameliorators from
the ASIPS collaborative. … Stopping the error cascade: a report on ameliorators from the ASIPS
collaborative. … https://psnet.ahrq.gov/issue/stopping-error-cascade-report-ameliorators-asips-collaborative
The investigators … qualitatively analyzed error reports from the primary care setting in which an error had
been caught … https://psnet.ahrq.gov/issue/stopping-error-cascade-report-ameliorators-asips-collaborative
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psnet.ahrq.gov/node/36127/psn-pdf
September 29, 2010 - Fatality involving vinblastine overdose as a result of a
complex medical error. … Fatality involving vinblastine overdose as a result of a complex
medical error. … https://psnet.ahrq.gov/issue/fatality-involving-vinblastine-overdose-result-complex-medical-error
The … authors investigated a fatal chemotherapy-related error and identified contributing factors that led … ://psnet.ahrq.gov//#error
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psnet.ahrq.gov/node/35401/psn-pdf
April 06, 2011 - What constitutes a prescribing error in paediatrics? … What constitutes a prescribing error in paediatrics? Qual Saf
Health Care. 2005;14(5):352-7. … https://psnet.ahrq.gov/issue/what-constitutes-prescribing-error-paediatrics
The authors used a Delphi … technique to gather expert opinion on what constitutes a prescribing error in
pediatrics. … https://psnet.ahrq.gov/issue/what-constitutes-prescribing-error-paediatrics
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psnet.ahrq.gov/issue/improving-insulin-distribution-and-administration-safety-using-lean-six-sigma-methodologies
March 19, 2019 - June 16, 2019
ISMP medication error report analysis. … June 16, 2019
ISMP medication error report analysis. … June 16, 2019
ISMP medication error report analysis. … June 16, 2019
ISMP medication error report analysis. … June 16, 2019
ISMP medication error report analysis.
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psnet.ahrq.gov/node/43272/psn-pdf
June 18, 2014 - Physician assistants and the disclosure of medical error. … Physician assistants and the disclosure of medical error. … https://psnet.ahrq.gov/issue/physician-assistants-and-disclosure-medical-error
Most existing evidence … and guidelines for error disclosure are modeled around physicians, nurses, and risk
managers. … https://psnet.ahrq.gov/issue/physician-assistants-and-disclosure-medical-error
https://psnet.ahrq.gov
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psnet.ahrq.gov/issue/crack-our-best-armor-wrong-patient-injections-insulin-pens-alarmingly-frequent-even-barcode
October 22, 2014 - June 16, 2019
ISMP medication error report analysis. … June 16, 2019
ISMP medication error report analysis. … June 16, 2019
ISMP medication error report analysis. … June 16, 2019
ISMP medication error report analysis. … May 29, 2019
ISMP medication error report analysis.
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psnet.ahrq.gov/node/42228/psn-pdf
October 08, 2013 - Cognitive diagnostic error in internal medicine.
October 8, 2013
Van den Berge K, Mamede S. … Cognitive diagnostic error in internal medicine. … https://psnet.ahrq.gov/issue/cognitive-diagnostic-error-internal-medicine
This review discusses how … confirmation bias and availability bias can contribute to diagnostic error and
highlights the need for … https://psnet.ahrq.gov/issue/cognitive-diagnostic-error-internal-medicine
https://psnet.ahrq.gov/issue
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psnet.ahrq.gov/node/39723/psn-pdf
February 01, 2011 - Barriers and facilitators to chemotherapy patients'
engagement in medical error prevention. … Barriers and facilitators to chemotherapy patients' engagement in medical
error prevention. … https://psnet.ahrq.gov/issue/barriers-and-facilitators-chemotherapy-patients-engagement-medical-error … -
prevention
This study found that patients are engaged in error prevention but perceive considerable … https://psnet.ahrq.gov/issue/barriers-and-facilitators-chemotherapy-patients-engagement-medical-error-prevention
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psnet.ahrq.gov/node/37292/psn-pdf
May 24, 2015 - Guilty, afraid, and alone — struggling with medical error.
May 24, 2015
Delbanco T, Bell SK. … Guilty, afraid, and alone--struggling with medical error. N Engl J Med.
2007;357(17):1682-3. … https://psnet.ahrq.gov/issue/guilty-afraid-and-alone-struggling-medical-error
Disclosure of medical … An AHRQ WebM&M commentary,
perspective, and interview also discuss multiple facets of error disclosure … https://psnet.ahrq.gov/issue/guilty-afraid-and-alone-struggling-medical-error
https://psnet.ahrq.gov/
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psnet.ahrq.gov/node/37095/psn-pdf
September 04, 2010 - Prospective error recording in surgery: an analysis of
1108 elective neurosurgical cases. … Prospective error recording in surgery: an analysis of 1108 elective neurosurgical
cases. … https://psnet.ahrq.gov/issue/prospective-error-recording-surgery-analysis-1108-elective-neurosurgical … frequently, most
were preventable, and 2.7% of patients experienced an adverse clinical outcome due to error … https://psnet.ahrq.gov/issue/prospective-error-recording-surgery-analysis-1108-elective-neurosurgical-cases
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psnet.ahrq.gov/node/36011/psn-pdf
September 24, 2010 - Geometric probability distribution for modeling of error
risk during prescription dispensing. … Geometric probability distribution for modeling of error risk
during prescription dispensing. … https://psnet.ahrq.gov/issue/geometric-probability-distribution-modeling-error-risk-during-prescription … dispensing
Investigators observed pharmacy staff to determine the probability of at least one dispensing error … https://psnet.ahrq.gov/issue/geometric-probability-distribution-modeling-error-risk-during-prescription-dispensing
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psnet.ahrq.gov/node/42491/psn-pdf
September 18, 2013 - The incidence of diagnostic error in medicine.
September 18, 2013
Graber ML. … The incidence of diagnostic error in medicine. BMJ Qual Saf. 2013;22 Suppl 2:ii21-ii27. … https://psnet.ahrq.gov/issue/incidence-diagnostic-error-medicine
This review examines eight research … methods used to estimate the incidence of diagnostic error and
recommends tactics to improve its measurement … https://psnet.ahrq.gov/issue/incidence-diagnostic-error-medicine
https://psnet.ahrq.gov/issue/overconfidence-cause-diagnostic-error-medicine
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psnet.ahrq.gov/issue/dealing-honestly-honest-mistake
March 24, 2019 - June 16, 2019
ISMP medication error report analysis. … June 16, 2019
ISMP medication error report analysis. … June 16, 2019
ISMP medication error report analysis. … June 16, 2019
ISMP medication error report analysis. … June 16, 2019
ISMP medication error report analysis.
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psnet.ahrq.gov/node/38814/psn-pdf
July 29, 2009 - Pediatric vaccination errors: application of the "5 rights"
framework to a national error reporting … Pediatric vaccination errors: application of the "5 rights" framework
to a national error reporting … https://psnet.ahrq.gov/issue/pediatric-vaccination-errors-application-5-rights-framework-national-error … -
reporting-database
This study analyzed more than 600 pediatric vaccination error reports from MEDMARX … https://psnet.ahrq.gov/issue/pediatric-vaccination-errors-application-5-rights-framework-national-error-reporting-database
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psnet.ahrq.gov/node/49552/psn-pdf
January 01, 2008 - Understand coping strategies, including error disclosure. … is difficult, although 2 factors related to the error itself have been
proposed. … felt for the error. … The resident was devastated by the
error. … Medical error: the second victim. The doctor who makes the mistake needs help too.
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psnet.ahrq.gov/node/45834/psn-pdf
February 22, 2017 - Implementing an error disclosure coaching model: a
multicenter case study. … Implementing an error disclosure coaching model: A multicenter
case study. … https://psnet.ahrq.gov/issue/implementing-error-disclosure-coaching-model-multicenter-case-study
This … study described a demonstration project to enhance error disclosure. … ://psnet.ahrq.gov/primer/disclosure-errors
https://psnet.ahrq.gov/issue/medical-error-second-victim
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psnet.ahrq.gov/node/40527/psn-pdf
June 15, 2011 - Online medication error graphic reports: a pilot in North
Carolina nursing homes. … Online medication error graphic reports: a pilot in North Carolina
nursing homes. … https://psnet.ahrq.gov/issue/online-medication-error-graphic-reports-pilot-north-carolina-nursing-homes … All North Carolina nursing homes are required to report medication error data. … This study reports on a pilot
effort to feed back data on error rates to individual nursing homes.
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psnet.ahrq.gov/issue/common-cause-analysis
June 27, 2018 - June 16, 2019
ISMP medication error report analysis. … June 16, 2019
ISMP medication error report analysis. … June 16, 2019
ISMP medication error report analysis. … June 16, 2019
ISMP medication error report analysis. … May 7, 2018
ISMP medication error report analysis.
-
psnet.ahrq.gov/node/35700/psn-pdf
February 15, 2010 - Point-of-care testing error: sources and amplifiers,
taxonomy, prevention strategies, and detection … Point-of-care testing error: sources and amplifiers, taxonomy, prevention strategies,
and detection … https://psnet.ahrq.gov/issue/point-care-testing-error-sources-and-amplifiers-taxonomy-prevention-
strategies-and-detection … They provide several strategies for error
reduction. … https://psnet.ahrq.gov/issue/point-care-testing-error-sources-and-amplifiers-taxonomy-prevention-strategies-and-detection