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psnet.ahrq.gov/node/36366/psn-pdf
April 11, 2011 - Adverse events in the neonatal intensive care unit:
development, testing, and findings of an NICU-focused
trigger tool to identify harm in North American NICUs.
April 11, 2011
Sharek PJ, Horbar JD, Mason W, et al. Adverse events in the neonatal intensive care unit: development,
testing, and findings of an NICU-foc…
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psnet.ahrq.gov/node/46173/psn-pdf
August 20, 2018 - Advances in Patient Safety and Medical Liability.
August 20, 2018
Battles J, Azam I, Grady M, Reback K, eds. Rockville, MD: Agency for Healthcare Research and Quality;
2017. AHRQ Publication No. 17-0017-EF.
https://psnet.ahrq.gov/issue/advances-patient-safety-and-medical-liability
This publication describes the re…
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psnet.ahrq.gov/primer/diagnostic-errors
June 15, 2024 - Diagnostic Errors
Citation Text:
Diagnostic Errors. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2019.
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psnet.ahrq.gov/primer/ambulatory-care-safety
December 15, 2024 - Ambulatory Care Safety
Citation Text:
Ambulatory Care Safety. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2019.
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psnet.ahrq.gov/node/44958/psn-pdf
March 09, 2016 - The Sepsis Early Recognition and Response Initiative
(SERRI).
March 9, 2016
Jones SL, Ashton CM, Kiehne L, et al. The Sepsis Early Recognition and Response Initiative (SERRI). Jt
Comm J Qual Patient Saf. 2016;42(3):122-138.
https://psnet.ahrq.gov/issue/sepsis-early-recognition-and-response-initiative-serri
Early …
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psnet.ahrq.gov/node/45553/psn-pdf
October 13, 2018 - Computerized prescriber order entry–related patient
safety reports: analysis of 2522 medication errors.
October 13, 2018
Amato MG, Salazar A, Hickman T-TT, et al. Computerized prescriber order entry-related patient safety
reports: analysis of 2522 medication errors. J Am Med Inform Assoc. 2017;24(2):316-322.
doi:1…
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psnet.ahrq.gov/node/40146/psn-pdf
March 02, 2011 - Primary care–relevant interventions to prevent falling in
older adults: a systematic evidence review for the U.S.
Preventive Services Task Force.
March 2, 2011
Michael YL, Whitlock EP, Lin JS, et al. Primary care-relevant interventions to prevent falling in older adults:
a systematic evidence review for the U.S. P…
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psnet.ahrq.gov/node/33804/psn-pdf
March 03, 2016 - In Conversation With… Paul McGann, MD
March 1, 2016
In Conversation With… Paul McGann, MD. PSNet [internet]. 2016.
https://psnet.ahrq.gov/perspective/conversation-paul-mcgann-md
Editor's note: Dr. McGann is the Chief Medical Officer for Quality Improvement at the Centers for
Medicare & Medicaid Services (CMS). He…
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psnet.ahrq.gov/issue/patient-handoffs-0
November 23, 2024 - Review
Patient handoffs.
Citation Text:
Patient handoffs. Arora V, Farnan J. UpToDate. June 24, 2024.
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June 2…
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psnet.ahrq.gov/issue/beyond-error-qualitative-study-human-factors-serious-adverse-events
December 18, 2024 - Study
Beyond error: a qualitative study of human factors in serious adverse events.
Citation Text:
Mujuru C, Peisah C. Beyond error: a qualitative study of human factors in serious adverse events. J Healthc Risk Manag. 2024;44(2):7-13. doi:10.1002/jhrm.21583.
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psnet.ahrq.gov/node/33763/psn-pdf
March 01, 2014 - How Does Infection Prevention Fit Into a Safety Program?
March 1, 2014
Huang SS. How Does Infection Prevention Fit Into a Safety Program? PSNet [internet]. 2014.
https://psnet.ahrq.gov/perspective/how-does-infection-prevention-fit-safety-program
Perspective
In 1999, the Institute of Medicine (IOM) released the To …
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psnet.ahrq.gov/node/43042/psn-pdf
December 18, 2014 - Introduction of surgical safety checklists in Ontario,
Canada.
December 18, 2014
Urbach DR, Govindarajan A, Saskin R, et al. Introduction of Surgical Safety Checklists in Ontario, Canada.
New Engl J Med. 2014;370(11):1029-1038. doi:10.1056/nejmsa1308261.
https://psnet.ahrq.gov/issue/introduction-surgical-safety-ch…
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psnet.ahrq.gov/node/39463/psn-pdf
February 10, 2015 - Mixed results in the safety performance of computerized
physician order entry.
February 10, 2015
Metzger J, Welebob E, Bates DW, et al. Mixed results in the safety performance of computerized physician
order entry. Health Aff (Millwood). 2010;29(4):655-663. doi:10.1377/hlthaff.2010.0160.
https://psnet.ahrq.gov/iss…
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psnet.ahrq.gov/issue/canadian-patient-safety-institute
August 24, 2022 - Multi-use Website
Healthcare Excellence Canada.
Citation Text:
Healthcare Excellence Canada. 150 Kent Street, Suite 200, Ottawa, Ontario, K1P 0E4 Canada.
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psnet.ahrq.gov/issue/national-quality-measures-clearinghouse-nqmc
October 23, 2019 - Database/Directory
National Quality Measures Clearinghouse (NQMC).
Citation Text:
National Quality Measures Clearinghouse (NQMC). Agency for Healthcare Research and Quality. 1998-2018.
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psnet.ahrq.gov/node/42853/psn-pdf
January 15, 2014 - Eliminating central line-associated bloodstream
infections: a national patient safety imperative.
January 15, 2014
Berenholtz SM, Lubomski LH, Weeks K, et al. Eliminating central line-associated bloodstream infections: a
national patient safety imperative. Infect Control Hosp Epidemiol. 2014;35(1):56-62. doi:10.108…
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psnet.ahrq.gov/issue/global-patient-safety-alerts
May 12, 2009 - Database/Directory
Global Patient Safety Alerts.
Citation Text:
Global Patient Safety Alerts. Canadian Patient Safety Institute; CPSI.
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psnet.ahrq.gov/perspective/conversation-withbarbara-blakeney-ms-rn
August 01, 2005 - law, still somewhat controversial, mandating certain nurse-to-patient ratios] , is that in order to fund
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psnet.ahrq.gov/perspective/unfinished-patient-safety-agenda
August 01, 2005 - law, still somewhat controversial, mandating certain nurse-to-patient ratios] , is that in order to fund
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psnet.ahrq.gov/Information/Panel
January 01, 2012 - Browse Author Resources
Technical Expert Panel The AHRQ PSNet Technical Expert Panel (TEP) is a distinguished group of healthcare professionals and subject matter experts dedicated to enhancing patient safety within the healthcare industry. They represent a diverse array of backgrounds, …