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361. John M. Eisenberg Patient Safety Awards. Safety, effectiveness, and efficiency: a Web-based virtual anticoagulation clinic. | PSNet
     psnet.ahrq.gov/issue/john-m-eisenberg-patient-safety-awards-safety-effectiveness-and-efficiency-web-based-virtual
     September 13, 2023 - 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.

362. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/48076/psn-pdf
     July 24, 2019 - Simulation-based event analysis improves error discovery and generates improved strategies for error … Simulation-based event analysis improves error discovery and generates improved strategies for error … https://psnet.ahrq.gov/issue/simulation-based-event-analysis-improves-error-discovery-and-generates- … simulation format and compared to traditional RCA, simulation participants identified novel sources of error … https://psnet.ahrq.gov/issue/simulation-based-event-analysis-improves-error-discovery-and-generates-improved-strategies

363. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/60198/psn-pdf
     April 08, 2020 - Hierarchy and medical error: speaking up when witnessing an error. … Hierarchy and medical error: speaking up when witnessing an error. … https://psnet.ahrq.gov/issue/hierarchy-and-medical-error-speaking-when-witnessing-error A key tenet … https://psnet.ahrq.gov/issue/hierarchy-and-medical-error-speaking-when-witnessing-error https://psnet.ahrq.gov

364. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/60649/psn-pdf
     July 01, 2020 - The differences between human error, at-risk behavior, and reckless behavior are key to a just culture … July 1, 2020 The differences between human error, at-risk behavior, and reckless behavior are key to … https://psnet.ahrq.gov/issue/differences-between-human-error-risk-behavior-and-reckless-behavior-are- … This article compares human error, at-risk behavior, and reckless behavior to suggest systems design … https://psnet.ahrq.gov/issue/human-error-models-and-management

365. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/845636/psn-pdf
     March 08, 2023 - The effects of leadership for self-worth, inclusion, trust, and psychological safety on medical error … The effects of leadership for self-worth, inclusion, trust, and psychological safety on medical error … psnet.ahrq.gov/issue/effects-leadership-self-worth-inclusion-trust-and-psychological-safety-medical- error … This study reports on how trust and psychological safety interact to increase error reporting. … Results indicate that trust in leaders encouraged error reporting and psychological safety encouraged

366. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/60304/psn-pdf
     January 01, 2021 - Patients' perspectives of diagnostic error: a qualitative study. … Patients' perspectives of diagnostic error: a qualitative study. … https://psnet.ahrq.gov/issue/patients-perspectives-diagnostic-error-qualitative-study Using the IOM … Qualitative analysis revealed five main themes underlying the causes of diagnostic error: problems with … Suggested strategies to reduce diagnostic error included improvements to clinical management, increase

367. Proceedings of a summit on preventing patient harm and death from IV medication errors. | PSNet
     psnet.ahrq.gov/issue/proceedings-summit-preventing-patient-harm-and-death-iv-medication-errors
     June 16, 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.

368. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/837800/psn-pdf
     August 10, 2022 - Preferences and perceptions of medical error disclosure among marginalized populations: a narrative … Preferences and perceptions of medical error disclosure among marginalized populations: a narrative … https://psnet.ahrq.gov/issue/preferences-and-perceptions-medical-error-disclosure-among-marginalized- … populations-narrative Patients and families prefer to be told if they experience a medical error. … This systematic review identified 6 studies focused on error disclosure in one of three marginalized

369. Anticoagulation-associated adverse drug events. | PSNet
     psnet.ahrq.gov/issue/anticoagulation-associated-adverse-drug-events
     July 26, 2023 - 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.

370. Physician perspectives on quality and error in the outpatient setting. | PSNet
     psnet.ahrq.gov/issue/physician-perspectives-quality-and-error-outpatient-setting
     July 29, 2009 - Study Physician perspectives on quality and error in the outpatient setting. … Physician perspectives on quality and error in the outpatient setting. WMJ. 2009;108(3):139-44. … Physician perspectives on quality and error in the outpatient setting. WMJ. 2009;108(3):139-44.

371. Communication skills and error in the intensive care unit. | PSNet
     psnet.ahrq.gov/issue/communication-skills-and-error-intensive-care-unit
     May 06, 2009 - Review Communication skills and error in the intensive care unit. … Communication skills and error in the intensive care unit. Curr Opin Crit Care. 2007;13(6):732-6. … Communication skills and error in the intensive care unit. … December 21, 2011 Patient safety: helping medical students understand error in healthcare

372. Parent preferences for medical error disclosure: a qualitative study. | PSNet
     psnet.ahrq.gov/issue/parent-preferences-medical-error-disclosure-qualitative-study
     January 25, 2017 - Study Parent preferences for medical error disclosure: a qualitative study. … Parent Preferences for Medical Error Disclosure: A Qualitative Study. … Parent Preferences for Medical Error Disclosure: A Qualitative Study. … August 10, 2022 Disclosure of medical error to parents and paediatric patients: assessment … July 2, 2014 Simulation-based medical error disclosure training for pediatric healthcare

373. Impact of a statewide reporting system on medication error reduction. | PSNet
     psnet.ahrq.gov/issue/impact-statewide-reporting-system-medication-error-reduction
     December 16, 2011 - Study Impact of a statewide reporting system on medication error reduction. … Citation Text: Impact of a statewide reporting system on medication error reduction. … Citation Citation Text: Impact of a statewide reporting system on medication error … April 12, 2006 Medical Device Use Error: Root Cause Analysis. … About The Topic Hospitals Health Care Executives and Administrators Medication Safety Error

374. A medication error prevention survey: five years of results. | PSNet
     psnet.ahrq.gov/issue/medication-error-prevention-survey-five-years-results
     March 26, 2015 - Study A medication error prevention survey: five years of results. … A medication error prevention survey: five years of results. … A medication error prevention survey: five years of results. … Chemotherapy medication errors in a pediatric cancer treatment center: prospective characterization of error … types and frequency and development of a quality improvement initiative to lower the error rate.

375. Nursing home error and level of staff credentials. | PSNet
     psnet.ahrq.gov/issue/nursing-home-error-and-level-staff-credentials
     September 24, 2010 - Study Nursing home error and level of staff credentials. … Nursing home error and level of staff credentials. Clin Nurs Res. 2007;16(1):72-8. … Nursing home error and level of staff credentials. Clin Nurs Res. 2007;16(1):72-8. … February 17, 2010 WebM&M Cases Cups of Error May … April 6, 2011 WebM&M Cases Workaround Error February

376. Human factors and error prevention in emergency medicine. | PSNet
     psnet.ahrq.gov/issue/human-factors-and-error-prevention-emergency-medicine
     October 03, 2011 - Commentary Human factors and error prevention in emergency medicine. … Human factors and error prevention in emergency medicine. … Human factors and error prevention in emergency medicine. … patient is awake and we need to stay calm": reconsidering indirect communication in the face of medical error … View More Related Resources What interventions could reduce diagnostic error

377. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/838075/psn-pdf
     September 14, 2022 - Crisis recovery in surgery: error management and problem solving in safety-critical situations. … Crisis recovery in surgery: error management and problem solving in safety-critical situations. … https://psnet.ahrq.gov/issue/crisis-recovery-surgery-error-management-and-problem-solving-safety-critical … safety experts, this study adapted interventions from aviation crisis recovery for use in surgical error … https://psnet.ahrq.gov/issue/error-management-lessons-aviation https://psnet.ahrq.gov/issue/its-big-part-being-good-surgeons-surgical-trainees-perceptions-error-recovery-operating-room

378. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/50739/psn-pdf
     December 11, 2019 - Medical error and moral luck. December 11, 2019 Allhoff F. Medical Error and Moral Luck. … https://psnet.ahrq.gov/issue/medical-error-and-moral-luck Medical error is a n important  problem but … between medical errors and adverse events, challenges current ideas about what comprises a medical error … https://psnet.ahrq.gov/issue/medical-error-and-moral-luck https://psnet.ahrq.gov/issue/medical-error

379. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/848358/psn-pdf
     May 03, 2023 - Identifying electronic health record contributions to diagnostic error in ambulatory settings through … Identifying electronic health record contributions to diagnostic error in ambulatory settings through … https://psnet.ahrq.gov/issue/identifying-electronic-health-record-contributions-diagnostic-error-ambulatory … from the CRICO malpractice insurance database to identify whether the EHR contributes to diagnostic error … EHR contributed to diagnostic error in 61% of claims, the majority in outpatient care, and 92% at the

380. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/842762/psn-pdf
     January 18, 2023 - Support for healthcare workers and patients after medical error through mutual healing: another step … Support for healthcare workers and patients after medical error through mutual healing: another step … https://psnet.ahrq.gov/issue/support-healthcare-workers-and-patients-after-medical-error-through-mutual … Healthcare workers (HCW) and patients can experience negative psychological impacts following medical error … the negative impact can be compounded when workers and patients are prevented from processing the error