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psnet.ahrq.gov/issue/using-human-factors-engineering-improve-patient-safety-second-edition
May 18, 2016 - Book/Report
Using Human Factors Engineering to Improve Patient Safety, Second edition.
Citation Text:
Using Human Factors Engineering to Improve Patient Safety, Second edition. Gosbee JW, Gosbee LL. Oakbrook, IL: Joint Commission; 2010. ISBN: 9781599404110.
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psnet.ahrq.gov/issue/magnet-support-patient-safety
November 01, 2012 - Special or Theme Issue
Magnet in Support of Patient Safety.
Citation Text:
Magnet in Support of Patient Safety. Lewis L, ed. J Nurs Adm. 2014;44(suppl 10):S1-S53.
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psnet.ahrq.gov/issue/hospitals-can-take-key-steps-improve-safe-use-digital-systems
April 01, 2020 - Book/Report
Hospitals Can Take Key Steps to Improve Safe Use of Digital Systems.
Citation Text:
Hospitals Can Take Key Steps to Improve Safe Use of Digital Systems. Philadelphia, PA: Pew Charitable Trusts; July 21, 2020.
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psnet.ahrq.gov/issue/critical-incident-reviews-significant-adverse-event-reports-and-action-plans
June 26, 2019 - Government Resource
Critical Incident Reviews, Significant Adverse Event Reports and Action Plans.
Citation Text:
Critical Incident Reviews, Significant Adverse Event Reports and Action Plans. St Andrews, Scotland: Scottish Information Commissioner; February 21, 2012. Reference No: 2…
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psnet.ahrq.gov/issue/transformation-through-collaboration-2018-2019-mha-keystone-center-annual-report
September 26, 2016 - Book/Report
MHA and MHA Keystone Center Annual Reports.
Citation Text:
MHA and MHA Keystone Center Annual Reports. Okemos, MI: Michigan Health & Hospital Association.
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psnet.ahrq.gov/node/35604/psn-pdf
January 04, 2006 - Hospitals save money, but safety is questioned.
January 4, 2006
Klein A. Washington Post. December 11, 2005.
https://psnet.ahrq.gov/issue/hospitals-save-money-safety-questioned
This article reports on the reuse of single-use medical instruments, discussing both the benefits and risks of
the practice.
https://psne…
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psnet.ahrq.gov/node/36055/psn-pdf
August 09, 2007 - Hospitals move to cut dangerous lab errors.
August 9, 2007
Landro L.
https://psnet.ahrq.gov/issue/hospitals-move-cut-dangerous-lab-errors
This article reports on a laboratory mix-up resulting in misdiagnosis and unneeded surgery and discusses
the problem of laboratory errors.
https://psnet.ahrq.gov/issue/hospital…
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psnet.ahrq.gov/node/865698/psn-pdf
April 24, 2024 - Patient Safety Amid Nursing Workforce Challenges
April 24, 2024
Leary KB, Lee M, Mossburg S. Patient Safety Amid Nursing Workforce Challenges . PSNet [internet]. 2024.
https://psnet.ahrq.gov/perspective/patient-safety-amid-nursing-workforce-challenges
Introduction
Nurses are essential to patient care, and having a…
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psnet.ahrq.gov/node/49844/psn-pdf
October 01, 2018 - Diffusion of Responsibility Leads to Danger
October 1, 2018
Balcezak TJ, Deshpande O. Diffusion of Responsibility Leads to Danger. PSNet [internet]. 2018.
https://psnet.ahrq.gov/web-mm/diffusion-responsibility-leads-danger
The Case
A 70-year-old man was sent to the emergency department (ED) from a nursing facility…
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psnet.ahrq.gov/node/37537/psn-pdf
February 13, 2008 - Hospitals to tear up bills for medical mistakes.
February 13, 2008
Ostrom CM. Seattle Times. January 29, 2008.
https://psnet.ahrq.gov/issue/hospitals-tear-bills-medical-mistakes
This article discusses a voluntary initiative in the state of Washington to cease billing patients for costs
associated with preventable …
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psnet.ahrq.gov/perspective/communication-during-transitions-care
July 10, 2024 - Annual Perspective
Communication During Transitions of Care
Ayse P. Gurses; Sarah Mossburg; Zoe Sousane
| March 27, 2024
View more articles from the same authors.
Citation Text:
Gurses AP, Sousane Z, Mossburg S. Communication During Transitions of Care. PS…
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psnet.ahrq.gov/node/36937/psn-pdf
November 21, 2016 - Patients, families take up the cause of hospital safety.
November 21, 2016
Landro L.
https://psnet.ahrq.gov/issue/patients-families-take-cause-hospital-safety
This article describes several patient safety improvement efforts led by patients and families who have
been affected by medical error.
https://psnet.ahrq.…
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psnet.ahrq.gov/node/36809/psn-pdf
May 04, 2015 - Hospitals target risks of color wristbands.
May 4, 2015
Landro L.
https://psnet.ahrq.gov/issue/hospitals-target-risks-color-wristbands
This article reports on initiatives to standardize the color designations of color-coded wristbands to avoid
confusion and reduce the risk of error.
https://psnet.ahrq.gov/issue/h…
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psnet.ahrq.gov/node/36374/psn-pdf
October 07, 2008 - Fixing America's hospitals.
October 7, 2008
Newsweek. October 15, 2006.
https://psnet.ahrq.gov/issue/fixing-americas-hospitals
This "Health for Life" series features 10 case studies about patient safety and quality improvement efforts
as well as several short articles on safety-related topics such as disclosure an…
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psnet.ahrq.gov/issue/methodological-variability-detecting-prescribing-errors-and-consequences-evaluation
March 05, 2010 - Study
Methodological variability in detecting prescribing errors and consequences for the evaluation of interventions.
Citation Text:
Franklin BD, Birch S, Savage I, et al. Methodological variability in detecting prescribing errors and consequences for the evaluation of interventions. …
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psnet.ahrq.gov/issue/family-participation-during-intensive-care-unit-rounds-goals-and-expectations-parents-and
June 12, 2019 - Study
Family participation during intensive care unit rounds: goals and expectations of parents and health care providers in a tertiary pediatric intensive care unit.
Citation Text:
Stickney CA, Ziniel SI, Brett MS, et al. Family participation during intensive care unit rounds: goals and…
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psnet.ahrq.gov/issue/effects-patient-safety-culture-interventions-incident-reporting-general-practice-cluster
September 07, 2016 - Study
Effects of patient safety culture interventions on incident reporting in general practice: a cluster randomised trial.
Citation Text:
Verbakel NJ, Langelaan M, Verheij TJM, et al. Effects of patient safety culture interventions on incident reporting in general practice: a cluster r…
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psnet.ahrq.gov/issue/development-and-implementation-subcutaneous-insulin-pen-label-bar-code-scanning-protocol
October 19, 2022 - Study
Development and implementation of a subcutaneous insulin pen label bar code scanning protocol to prevent wrong-patient insulin pen errors.
Citation Text:
MacMaster HW, Gonzalez S, Maruoka A, et al. Development and Implementation of a Subcutaneous Insulin Pen Label Bar Code Scanning…
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psnet.ahrq.gov/issue/structuring-patient-and-family-involvement-medical-error-event-disclosure-and-analysis
September 01, 2018 - Study
Structuring patient and family involvement in medical error event disclosure and analysis.
Citation Text:
Etchegaray J, Ottosen M, Burress L, et al. Structuring patient and family involvement in medical error event disclosure and analysis. Health Aff (Millwood). 2014;33(1):46-52. d…
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psnet.ahrq.gov/issue/strategies-prevent-central-line-associated-bloodstream-infections-acute-care-hospitals-2022
February 07, 2022 - Organizational Policy/Guidelines
Strategies to prevent central line-associated bloodstream infections in acute-care hospitals: 2022 Update.
Citation Text:
Buetti N, Marschall J, Drees M, et al. Strategies to prevent central line-associated bloodstream infections in acute-care hospitals: …