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3021. From the school of nursing quality and safety officer: nursing students' use of safety reporting tools and their perception of safety issues in clinical settings. | PSNet
      psnet.ahrq.gov/issue/school-nursing-quality-and-safety-officer-nursing-students-use-safety-reporting-tools-and
      October 19, 2022 - safety officer: nursing students' use of safety reporting tools and their perception of safety issues in … November 21, 2017 Overtreatment in the United States. … July 17, 2024 Safety of inpatient care in surgical settings: cohort study. … June 5, 2019 Medication safety initiative in reducing medication errors. … October 19, 2011 View More See More About The Topic Hospitals Nurse

3022. Thinking fast and slow in medicine. | PSNet
      psnet.ahrq.gov/issue/thinking-fast-and-slow-medicine
      June 21, 2017 - Commentary Thinking fast and slow in medicine. … Thinking fast and slow in medicine. … Thinking fast and slow in medicine. … incidents in a Dutch exploratory cohort study? … November 23, 2011 Safety and risk management interventions in hospitals: a systematic

3023. Skin-deep diagnosis: affective bias and zebra retreat complicating the diagnosis of systemic sclerosis. | PSNet
      psnet.ahrq.gov/issue/skin-deep-diagnosis-affective-bias-and-zebra-retreat-complicating-diagnosis-systemic
      July 29, 2020 - Analyzing a case that resulted in delayed diagnosis of an uncommon condition, this commentary discusses … July 29, 2020 Association between long-term opioid use in family members and persistent … January 29, 2020 New persistent opioid use after minor and major surgical procedures in … August 16, 2017 Postoperative opioid prescribing and the pain scores on Hospital Consumer … The effect of opioid prescribing guidelines on prescriptions by emergency physicians in

3024. The quality of pharmacologic care for vulnerable older patients. | PSNet
      psnet.ahrq.gov/issue/quality-pharmacologic-care-vulnerable-older-patients
      August 27, 2012 - Related Resources From the Same Author(s) An exploration of safety climate in … 2011 Implementation of the World Health Organization Trauma Care Checklist Program in … April 12, 2023 Determination of unnecessary blood transfusion by comprehensive 15-hospital … September 17, 2014 Facility-level variation in potentially inappropriate prescribing … March 11, 2011 Appropriateness of use of medicines in elderly inpatients: qualitative

3025. What price must we pay for safety? Excessive cost of EPINEPHrine auto-injectors leads to error-prone use of ampuls or vials and unprepared consumers. | PSNet
      psnet.ahrq.gov/issue/what-price-must-we-pay-safety-excessive-cost-epinephrine-auto-injectors-leads-error-prone-use
      September 14, 2016 - September 14, 2016 Selected medication safety risks to manage in 2016 that might otherwise … June 10, 2018 Accidental IV infusion of heparinized irrigation in the OR. … June 30, 2021 Anticoagulant safety takes center stage in 2007. … Resources Annual Perspective Annual Perspective: Topics in … March 18, 2010 View More See More About The Topic Hospitals Ambulatory

3026. Assessment of the potential impact of a reminder system on the reduction of diagnostic errors: a quasi-experimental study. | PSNet
      psnet.ahrq.gov/issue/assessment-potential-impact-reminder-system-reduction-diagnostic-errors-quasi-experimental
      April 19, 2011 - Related Resources From the Same Author(s) Validation of a diagnostic reminder system in … November 16, 2022 Families as partners in hospital error and adverse event surveillance … August 4, 2021 Optimizing Pediatric Patient Safety in the Emergency Care Setting. … Related Resources Annual Perspective Equity in … February 20, 2019 Diagnostic Error in Medicine.

3027. Time-ordered comorbidity correlations identify patients at risk of mis- and overdiagnosis. | PSNet
      psnet.ahrq.gov/issue/time-ordered-comorbidity-correlations-identify-patients-risk-mis-and-overdiagnosis
      December 07, 2022 - February 22, 2023 Breast cancer screening in Denmark: a cohort study of tumor size and … January 12, 2022 Streamlining care in crisis: rapid creation and implementation of a … 2020 View More Related Resources Racial and ethnic discrepancy in … Clinical decision support improves the appropriateness of laboratory test ordering in … December 19, 2017 View More See More About The Topic Researchers Hospitals

3028. Are apologies a way to reduce malpractice risks?. | PSNet
      psnet.ahrq.gov/issue/are-apologies-way-reduce-malpractice-risks
      October 23, 2018 - They discuss the current presence of apology laws at the state level and the limited role they play in … protecting clinicians who err and apologize in a court of law. … October 16, 2024 Clinical practice guideline: safe medication use in the ICU. … July 5, 2023 The role of apology laws in medical malpractice. … June 5, 2013 View More See More About The Topic Hospitals Ambulatory

3029. What whiteboards in a trauma center operating suite can teach us about emergency department communication. | PSNet
      psnet.ahrq.gov/issue/what-whiteboards-trauma-center-operating-suite-can-teach-us-about-emergency-department
      August 29, 2011 - Study What whiteboards in a trauma center operating suite can teach us about emergency … What whiteboards in a trauma center operating suite can teach us about emergency department communication … The authors observed and photographed ways in which staff used a whiteboard in a surgical trauma unit … August 2, 2012 Safety in EMS. … December 1, 2010 Patient whiteboards as a communication tool in the hospital setting:

3030. Studying the technical work of emergency care. | PSNet
      psnet.ahrq.gov/issue/studying-technical-work-emergency-care
      September 29, 2010 - June 9, 2011 Resilience and resilience engineering in health care. … July 14, 2010 Improving handoffs in the emergency department. … in a high risk emergency department. … December 30, 2014 6-PACK programme to decrease fall injuries in acute hospitals: cluster … January 3, 2017 Patient Safety in Emergency Medicine.

3031. Using information to optimize medical outcomes. | PSNet
      psnet.ahrq.gov/issue/using-information-optimize-medical-outcomes
      August 04, 2021 - November 18, 2016 Medication errors in anesthesiology: is it time to train by example … March 13, 2013 Improving team performance during the preprocedure time-out in pediatric … December 18, 2017 Perceived causes of prescribing errors by junior doctors in hospital … January 30, 2013 Observer-based tools for non-technical skills assessment in simulated … and real clinical environments in healthcare: a systematic review.

3032. Attending work hour restrictions: is it time? | PSNet
      psnet.ahrq.gov/issue/attending-work-hour-restrictions-it-time
      November 28, 2012 - July 29, 2020 Trends and patterns in reporting of patient safety situations in transplantation … studies: identifying what contributes to successful interventions to promote hand hygiene in patient … September 29, 2017 Errors in drug computations during newborn intensive care. … March 27, 2005 Predictive combinations of monitor alarms preceding in-hospital code blue … June 8, 2022 Ethical considerations in the development of the Flexibility in Duty Hour

3033. Risk of mistaken DNR orders. | PSNet
      psnet.ahrq.gov/issue/risk-mistaken-dnr-orders
      October 19, 2022 - Supportive Care in Cancer. 2006;14(8). doi:10.1007/s00520-006-0023-z. … Supportive Care in Cancer . 2006; 14 (8) . View more articles from the same authors. … Supportive Care in Cancer. 2006;14(8). doi:10.1007/s00520-006-0023-z. … March 21, 2017 The use of a checklist in a pediatric oncology clinic. … January 3, 2007 Hospitals save money, but safety is questioned.

3034. Healthcare management strategies: interdisciplinary team factors. | PSNet
      psnet.ahrq.gov/issue/healthcare-management-strategies-interdisciplinary-team-factors
      November 13, 2011 - July 13, 2010 Patient-clinician diagnostic concordance upon hospital admission. … November 6, 2024 Adverse diagnostic events in hospitalised patients: a single-centre, … August 16, 2023 Causes for medical errors in obstetrics and gynaecology. … May 1, 2019 Quality and Safety in Women's Health Care. Second Edition. … May 19, 2010 Teamwork in obstetric critical care.

3035. Verbal medication orders in the OR. | PSNet
      psnet.ahrq.gov/issue/verbal-medication-orders-or
      March 06, 2024 - Commentary Verbal medication orders in the OR. … Verbal medication orders in the OR. AORN J. 2007;86(4):626-9. … This article describes the causes of medication errors in the operating room and discusses prevention … Verbal medication orders in the OR. AORN J. 2007;86(4):626-9. … multistate hospital network--13 academic medical centers, April-June 2020.

3036. Bundaberg and beyond: duty to disclose adverse events to patients. | PSNet
      psnet.ahrq.gov/issue/bundaberg-and-beyond-duty-disclose-adverse-events-patients
      January 12, 2022 - The authors discuss current disclosure policy in Australia and the practical, ethical, and legal issues … January 12, 2022 Changes in medication safety indicators in England throughout the covid … May 4, 2022 Results and lessons from a hospital-wide initiative incentivised by delivery … May 8, 2017 Interventions to improve hand hygiene compliance in the ICU: a systematic … May 8, 2019 Criminalisation of unintentional error in healthcare in the UK: a perspective

3037. Using medical malpractice closed claims data to reduce surgical risk and improve patient safety. | PSNet
      psnet.ahrq.gov/issue/using-medical-malpractice-closed-claims-data-reduce-surgical-risk-and-improve-patient-safety
      December 01, 2010 - Risk Management and Patient Safety December 1, 2010 Teamwork in … March 3, 2021 Omissions of care in nursing home settings: a narrative review. … January 12, 2022 A reengineered hospital discharge program to decrease rehospitalization … 26, 2011 Predictive power of the "trigger tool" for the detection of adverse events in … October 26, 2010 Critical diagnoses (critical values) in anatomic pathology.

3038. Critical incident stress debriefing after adverse patient safety events. | PSNet
      psnet.ahrq.gov/issue/critical-incident-stress-debriefing-after-adverse-patient-safety-events
      April 03, 2019 - Resources From the Same Author(s) The impact of adverse events on clinicians: what's in … 3, 2014 Case studies of patient safety research classics to build research capacity in … July 27, 2022 The impact of adverse events on clinicians: what's in a name? … July 1, 2017 Monitoring for medication errors in outpatient settings. … August 22, 2009 View More See More About The Topic Hospitals Health

3039. Spotlight Case July 2008 (ppt file)
      psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.245_slideshow.ppt
      July 01, 2011 - anticoagulants 3 4 Case: Watch the Warfarin A frail 80-year-old man with a past medical history of dementia, falls … , and atrial fibrillation presented to the hospital with confusion and weakness. … the hospital. 4 5 Case: Watch the Warfarin (2) After 48 hours he was clinically improved and back … atrial fibrillation Dabigatran is as effective as warfarin in preventing stroke in atrial fibrillation … http://www.ncbi.nlm.nih.gov/pubmed/21239798 Take-Home Points Best practices for managing warfarin at hospital

3040. Recurrent Hypoglycemia: A Care Transition Failure? | PSNet
      psnet.ahrq.gov/web-mm/recurrent-hypoglycemia-care-transition-failure
      December 23, 2020 - Errors are likely to be reduced when hospitals use electronic medical record (EMR) systems, because the … Such lack of standardization also impedes efforts to move information in electronic form from hospital … In the hospital, a family member who has access to the patient's medication administration record may … November 20, 2015 Safe use of cellular telephones in hospitals: fundamental principles … Related Resources Patient Safety Innovations Preventing Falls