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psnet.ahrq.gov/issue/va-health-care-improvements-needed-processes-used-address-providers-actions-contribute
October 12, 2022 - Book/Report
VA Health Care: Improvements Needed in Processes Used to Address Providers' Actions That Contribute to Adverse Events.
Citation Text:
VA Health Care: Improvements Needed in Processes Used to Address Providers' Actions That Contribute to Adverse Events. Draper D. Washington,…
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psnet.ahrq.gov/issue/improving-communication-icu-using-daily-goals
December 19, 2018 - Study
Improving communication in the ICU using daily goals.
Citation Text:
Pronovost P, Berenholtz SM, Dorman T, et al. Improving communication in the ICU using daily goals. J Crit Care. 2003;18(2):71-5.
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psnet.ahrq.gov/issue/essential-activities-electronic-health-record-safety-qualitative-study
April 29, 2018 - Study
Essential activities for electronic health record safety: a qualitative study.
Citation Text:
Ash JS, Singh H, Wright A, et al. Essential activities for electronic health record safety: A qualitative study. Health Informatics J. 2019:1460458219833109. doi:10.1177/1460458219833109. …
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psnet.ahrq.gov/issue/surgical-never-events-and-contributing-human-factors
August 20, 2018 - Study
Classic
Surgical never events and contributing human factors.
Citation Text:
Thiels CA, Lal TM, Nienow JM, et al. Surgical never events and contributing human factors. Surgery. 2015;158(2):515-21. doi:10.1016/j.surg.2015.03.053.
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psnet.ahrq.gov/issue/patient-safety-systems-primary-health-care-diabetes-story-missed-opportunities
March 28, 2011 - Review
Patient safety systems in the primary health care of diabetes—a story of missed opportunities?
Citation Text:
Taub N, Baker R, Khunti K, et al. Patient safety systems in the primary health care of diabetes—a story of missed opportunities? Diabet Med. 2010;27(11):1322-6.
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psnet.ahrq.gov/issue/safety-stand-down-technique-improving-and-sustaining-hand-hygiene-compliance-among-health
August 01, 2018 - Study
The safety stand-down: a technique for improving and sustaining hand hygiene compliance among health care personnel.
Citation Text:
Cunningham D, Brilli RJ, McClead RE, et al. The Safety Stand-down: A Technique for Improving and Sustaining Hand Hygiene Compliance Among Health Care …
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psnet.ahrq.gov/issue/pharmacovigilance-using-clinical-notes
April 24, 2018 - Study
Pharmacovigilance using clinical notes.
Citation Text:
LePendu P, Iyer S, Bauer-Mehren A, et al. Pharmacovigilance using clinical notes. Clin Pharmacol Ther. 2013;93(6):547-55. doi:10.1038/clpt.2013.47.
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psnet.ahrq.gov/issue/clinical-pathway-adherence-and-missed-diagnostic-opportunities-among-children-musculoskeletal
November 08, 2023 - Study
Clinical pathway adherence and missed diagnostic opportunities among children with musculoskeletal infections.
Citation Text:
Grubenhoff JA, Bakel LA, Dominguez F, et al. Clinical pathway adherence and missed diagnostic opportunities among children with musculoskeletal infections. …
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psnet.ahrq.gov/issue/preferred-language-and-diagnostic-errors-pediatric-emergency-department
April 06, 2022 - Study
Preferred language and diagnostic errors in the pediatric emergency department.
Citation Text:
Lowe JT, Leonard J, Dominguez F, et al. Preferred language and diagnostic errors in the pediatric emergency department. Diagnosis (Berl). 2024;11(1):49-53. doi:10.1515/dx-2023-0079.
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psnet.ahrq.gov/issue/overview-intravenous-related-medication-administration-errors-reported-medmarxr-national
April 14, 2021 - Study
An overview of intravenous-related medication administration errors as reported to MEDMARX(R), a national medication error-reporting program.
Citation Text:
Hicks RW, Becker SC. An overview of intravenous-related medication administration errors as reported to MEDMARX, a national…
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psnet.ahrq.gov/issue/measuring-and-improving-patient-safety-through-health-information-technology-health-it-safety
December 06, 2023 - Commentary
Measuring and improving patient safety through health information technology: the Health IT Safety Framework.
Citation Text:
Singh H, Sittig DF. Measuring and improving patient safety through health information technology: The Health IT Safety Framework. BMJ Qual Saf. 2016;25(…
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psnet.ahrq.gov/issue/safe-care-pediatric-patients-scoping-review-across-multiple-health-care-settings
August 03, 2022 - Review
Safe care for pediatric patients: a scoping review across multiple health care settings.
Citation Text:
Stang A, Thomson D, Hartling L, et al. Safe Care for Pediatric Patients: A Scoping Review Across Multiple Health Care Settings. Clin Pediatr (Phila). 2018;57(1):62-75. doi:10.11…
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psnet.ahrq.gov/issue/increasing-reporting-adverse-events-improve-educational-value-morbidity-and-mortality
February 04, 2016 - Study
Increasing reporting of adverse events to improve the educational value of the morbidity and mortality conference.
Citation Text:
McVeigh TP, Waters PS, Murphy R, et al. Increasing reporting of adverse events to improve the educational value of the morbidity and mortality confere…
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psnet.ahrq.gov/issue/guideline-opioid-therapy-and-chronic-noncancer-pain
June 17, 2014 - Review
Guideline for opioid therapy and chronic noncancer pain.
Citation Text:
Busse JW, Craigie S, Juurlink DN, et al. Guideline for opioid therapy and chronic noncancer pain. CMAJ. 2017;189(18):E659-E666. doi:10.1503/cmaj.170363.
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psnet.ahrq.gov/issue/essential-elements-nurses-have-address-promote-safe-discharge-paediatrics-systematic-review
September 28, 2022 - Review
Essential elements nurses have to address to promote a safe discharge in paediatrics: a systematic review and narrative synthesis.
Citation Text:
Rossi S, Hayter M, Zuco A, et al. Essential elements nurses have to address to promote a safe discharge in paediatrics: a systematic re…
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psnet.ahrq.gov/issue/barriers-and-facilitators-associated-implementation-surgical-safety-checklists-qualitative
August 17, 2022 - Review
Barriers and facilitators associated with the implementation of surgical safety checklists: a qualitative systematic review.
Citation Text:
Paterson C, Mckie A, Turner M, et al. Barriers and facilitators associated with the implementation of surgical safety checklists: a qualitati…
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psnet.ahrq.gov/issue/preventing-wrong-site-procedure-and-patient-events-using-common-cause-analysis
October 03, 2017 - Study
Preventing wrong site, procedure, and patient events using a common cause analysis.
Citation Text:
Mallett R, Conroy M, Saslaw LZ, et al. Preventing wrong site, procedure, and patient events using a common cause analysis. Am J Med Qual. 2012;27(1):21-9. doi:10.1177/10628606114120…
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psnet.ahrq.gov/issue/virtual-patients-designed-training-against-medical-error-exploring-impact-decision-making
May 15, 2024 - Study
Virtual patients designed for training against medical error: exploring the impact of decision-making on learner motivation.
Citation Text:
Woodham LA, Round J, Stenfors T, et al. Virtual patients designed for training against medical error: Exploring the impact of decision-making …
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psnet.ahrq.gov/issue/patient-misidentification-laboratory-medicine-qualitative-analysis-227-root-cause-analysis
August 28, 2024 - Study
Patient misidentification in laboratory medicine: a qualitative analysis of 227 root cause analysis reports in the Veterans Health Administration.
Citation Text:
Dunn EJ, Moga PJ. Patient misidentification in laboratory medicine: a qualitative analysis of 227 root cause analysis …
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psnet.ahrq.gov/issue/positive-predictive-value-ahrq-accidental-puncture-or-laceration-patient-safety-indicator
April 03, 2017 - Slideset
Positive predictive value of the AHRQ accidental puncture or laceration patient safety indicator.
Citation Text:
Utter GH, Zrelak PA, Baron R, et al. Positive predictive value of the AHRQ accidental puncture or laceration patient safety indicator. Ann Surg. 2009;250(6):1041-5.…