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psnet.ahrq.gov/web-mm/medication-overdose
September 01, 2011 - Medication Overdose
Citation Text:
Kaushal R. Medication Overdose. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2003.
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psnet.ahrq.gov/node/866846/psn-pdf
September 24, 2024 - Zero Harm: Striving to Reduce Preventable Harms – Point,
Counterpoint, and Areas of Agreement
September 24, 2024
Stockmeier CA, Thomas E, Mossburg S, et al. Zero Harm: Striving to Reduce Preventable Harms – Point,
Counterpoint, and Areas of Agreement. PSNet [internet]. 2023.
https://psnet.ahrq.gov/perspective/zero…
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psnet.ahrq.gov/web-mm/comanagement-whos-charge
July 01, 2011 - Comanagement: Who's in Charge?
Citation Text:
Cheng HQ. Comanagement: Who's in Charge?. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2012.
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psnet.ahrq.gov/node/42946/psn-pdf
January 07, 2015 - Evaluation of medium-term consequences of
implementing commercial computerized physician order
entry and clinical decision support prescribing systems in
two 'early adopter' hospitals.
January 7, 2015
Cresswell K, Bates DW, Williams R, et al. Evaluation of medium-term consequences of implementing
commercial compu…
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psnet.ahrq.gov/node/43643/psn-pdf
November 04, 2014 - Out-of-hospital medication errors among young children
in the United States, 2002–2012.
November 4, 2014
Smith MD, Spiller HA, Casavant MJ, et al. Out-of-hospital medication errors among young children in the
United States, 2002-2012. Pediatrics. 2014;134(5):867-76. doi:10.1542/peds.2014-0309.
https://psnet.ahrq.g…
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psnet.ahrq.gov/node/43589/psn-pdf
November 17, 2014 - Exploring new avenues to assess the sharp end of patient
safety: an analysis of nationally aggregated peer review
data.
November 17, 2014
Meeks DW, Meyer AND, Rose B, et al. Exploring new avenues to assess the sharp end of patient safety:
an analysis of nationally aggregated peer review data. BMJ Qual Saf. 2014;23…
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psnet.ahrq.gov/node/39438/psn-pdf
March 23, 2011 - Time to listen: a review of methods to solicit patient
reports of adverse events.
March 23, 2011
King A, Daniels J, Lim J, et al. Time to listen: a review of methods to solicit patient reports of adverse
events. Qual Saf Health Care. 2010;19(2):148-57. doi:10.1136/qshc.2008.030114.
https://psnet.ahrq.gov/issue/tim…
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psnet.ahrq.gov/node/45414/psn-pdf
August 17, 2016 - The next wave of hospital innovation to make patients
safer.
August 17, 2016
Ghaferi AA; Myers C; Sutcliffe KM; Pronovost PJ.
https://psnet.ahrq.gov/issue/next-wave-hospital-innovation-make-patients-safer
Achieving high reliability is a recognized goal for health care organizations. Reviewing current technical and…
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psnet.ahrq.gov/node/72512/psn-pdf
November 25, 2020 - The untold story of a cyberattack, a hospital and a dying
woman.
November 25, 2020
Ralston W. Wired Magazine. November 11, 2020.
https://psnet.ahrq.gov/issue/untold-story-cyberattack-hospital-and-dying-woman
Health information system downtime can affect patient safety. This story discusses a ransomware incide…
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psnet.ahrq.gov/node/48183/psn-pdf
August 07, 2019 - Get the Medications Right Institute.
August 7, 2019
8230 Old Courthouse Road, Suite 420, Tysons Corner, VA.
https://psnet.ahrq.gov/issue/get-medications-right-institute
A comprehensive systems-focused approach must be employed in the hospital and at home to ensure
reliable medication use. This institute supports m…
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psnet.ahrq.gov/node/44613/psn-pdf
October 28, 2015 - Getting rid of "never events" in hospitals.
October 28, 2015
Morgenthaler T; Harper CM.
https://psnet.ahrq.gov/issue/getting-rid-never-events-hospitals
Never events are devastating and preventable, and health care organizations are under increasing
pressure to eliminate them. This commentary discusses how the Mayo…
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psnet.ahrq.gov/issue/measure-dx-resource-identify-analyze-and-learn-diagnostic-safety-events
August 01, 2012 - October 23, 2019
Preventable Hospitalizations: A Window Into Primary and Preventive Care
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psnet.ahrq.gov/issue/teamstepps-diagnosis-improvement
July 17, 2024 - July 17, 2024
Preventable Hospitalizations: A Window Into Primary and Preventive Care
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psnet.ahrq.gov/perspective/accreditation-and-regulation-can-they-help-improve-patient-safety
April 01, 2009 - Accreditation and Regulation: Can They Help Improve Patient Safety?
Rebecca N. Warburton, PhD | April 1, 2009
Also Read a Conversation
View more articles from the same authors.
Citation Text:
Warburton RN. Accreditation and Regulation: Can They Help Improve Pat…
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psnet.ahrq.gov/node/72586/psn-pdf
December 23, 2020 - Code Status vs. Care Status
December 23, 2020
Krisman RK, Spero H. Code Status vs. Care Status. PSNet [internet]. 2020.
https://psnet.ahrq.gov/web-mm/code-status-vs-care-status
Disclosure of Relevant Financial Relationships: As a provider accredited by the Accreditation Council for
Continuing Medical Education (AC…
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psnet.ahrq.gov/perspective/establishing-safety-culture-thinking-small
December 01, 2006 - Establishing a Safety Culture: Thinking Small
Timothy J. Hoff, PhD | December 1, 2006
Also Read a Conversation
View more articles from the same authors.
Citation Text:
Hoff TJ. Establishing a Safety Culture: Thinking Small. PSNet [internet]. Rockville (MD): Age…
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psnet.ahrq.gov/node/49642/psn-pdf
December 01, 2011 - Order Interrupted by Text: Multitasking Mishap
December 1, 2011
Halamka J. Order Interrupted by Text: Multitasking Mishap. PSNet [internet]. 2011.
https://psnet.ahrq.gov/web-mm/order-interrupted-text-multitasking-mishap
Case Objectives
State the prevalence of mobile devices among clinicians and their common health…
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psnet.ahrq.gov/innovation/patient-and-family-centered-i-pass-family-centered-communication-program-reduce-medical
February 26, 2025 - Patient and Family Centered I-PASS (Family-Centered Communication Program to Reduce Medical Errors and Improve Family Experience and Communication Processes)
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psnet.ahrq.gov/node/837808/psn-pdf
August 05, 2024 - Recognizing Excellence in Diagnosis: Recommended
Practices for Hospitals.
August 5, 2024
Washington, DC: Leapfrog Group; July 2024.
https://psnet.ahrq.gov/issue/recognizing-excellence-diagnosis-recommended-practices-hospitals
Diagnostic safety is beginning to be established as a systemic, rather than solely an ind…
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psnet.ahrq.gov/node/72655/psn-pdf
January 20, 2021 - A night in the hospital, from both ends of the
stethoscope.
January 20, 2021
Ofri D. New York Times. January 5, 2021.
https://psnet.ahrq.gov/issue/night-hospital-both-ends-stethoscope
Physicians have unique perspectives when exposed to health care delivery problems as patients
themselves or as caregivers. T…