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psnet.ahrq.gov/issue/frequency-comprehension-and-attitudes-physicians-towards-abbreviations-medical-record
October 14, 2011 - Study
Frequency, comprehension and attitudes of physicians towards abbreviations in the medical record.
Citation Text:
Hamiel U, Hecht I, Nemet A, et al. Frequency, comprehension and attitudes of physicians towards abbreviations in the medical record. Postgrad Med J. 2018;94(1111):254-25…
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psnet.ahrq.gov/issue/large-language-models-preventing-medication-direction-errors-online-pharmacies
February 27, 2019 - Study
Large language models for preventing medication direction errors in online pharmacies.
Citation Text:
Pais C, Liu J, Voigt R, et al. Large language models for preventing medication direction errors in online pharmacies. Nat Med. 2024;30(6):1574-1582. doi:10.1038/s41591-024-02933-8.…
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psnet.ahrq.gov/issue/silent-treatment-why-safety-tools-and-checklists-arent-enough-save-lives
April 03, 2009 - Book/Report
Classic
The Silent Treatment: Why Safety Tools and Checklists Aren't Enough to Save Lives.
Citation Text:
The Silent Treatment: Why Safety Tools and Checklists Aren't Enough to Save Lives. Maxfield D, Grenny J, Lavandero R, et al. Provo, UT: VitalS…
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psnet.ahrq.gov/issue/risk-misdiagnosis-and-delayed-diagnosis-covid-19-syndemic-approach
November 04, 2020 - Commentary
Risk of misdiagnosis and delayed diagnosis with COVID-19: a syndemic approach.
Citation Text:
Muhrer JC. Risk of misdiagnosis and delayed diagnosis with COVID-19. Nurs Pract. 2021;46(2):44-49. doi:10.1097/01.npr.0000731572.91985.98.
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DOI Goo…
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psnet.ahrq.gov/issue/improving-documentation-beta-blocker-quality-measure-through-anesthesia-information
June 23, 2009 - Study
Improving documentation of a beta-blocker quality measure through an anesthesia information management system and real-time notification of documentation errors.
Citation Text:
Nair BG, Peterson GN, Newman S-F, et al. Improving documentation of a beta-blocker quality measure throug…
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psnet.ahrq.gov/issue/lessons-learned-use-event-reporting-nurses-improve-patient-safety-and-quality
May 19, 2013 - Study
Lessons learned: use of event reporting by nurses to improve patient safety and quality.
Citation Text:
Hession-Laband E, Mantell P. Lessons learned: use of event reporting by nurses to improve patient safety and quality. J Pediatr Nurs. 2011;26(2):149-55. doi:10.1016/j.pedn.2010…
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psnet.ahrq.gov/issue/reducing-falls-and-fall-related-injuries-mental-health-1-year-multihospital-falls
January 25, 2023 - Commentary
Reducing falls and fall-related injuries in mental health: a 1-year multihospital falls collaborative.
Citation Text:
Quigley PA, Barnett SD, Bulat T, et al. Reducing falls and fall-related injuries in mental health: a 1-year multihospital falls collaborative. J Nurs Care Qual…
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psnet.ahrq.gov/issue/realist-synthesis-interprofessional-patient-safety-activities-and-healthcare-student
July 01, 2019 - Review
A realist synthesis of interprofessional patient safety activities and healthcare student attitudes towards patient safety.
Citation Text:
Cleary E, Bloomfield J, Frotjold A, et al. A realist synthesis of interprofessional patient safety activities and healthcare student attitudes…
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psnet.ahrq.gov/issue/rate-occult-specimen-provenance-complications-routine-clinical-practice
January 05, 2012 - Study
Rate of occult specimen provenance complications in routine clinical practice.
Citation Text:
Pfeifer JD, Liu J. Rate of occult specimen provenance complications in routine clinical practice. Am J Clin Pathol. 2013;139(1):93-100. doi:10.1309/AJCP50WEZHWIFCIV.
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psnet.ahrq.gov/issue/increased-mortality-associated-weekend-hospital-admission-case-expanded-seven-day-services
March 02, 2012 - Study
Increased mortality associated with weekend hospital admission: a case for expanded seven day services?
Citation Text:
Freemantle N, Ray D, McNulty D, et al. Increased mortality associated with weekend hospital admission: a case for expanded seven day services? BMJ. 2015;351:h4596.…
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psnet.ahrq.gov/issue/patient-risk-factors-medical-injury-case-control-study
April 12, 2011 - Study
Patient risk factors for medical injury: a case–control study.
Citation Text:
Marbella AM, Laud PW, Brasel KJ, et al. Patient risk factors for medical injury: a case-control study. BMJ Qual Saf. 2011;20(2):187-93. doi:10.1136/bmjqs.2009.032664.
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psnet.ahrq.gov/issue/high-cost-low-frequency-events-anatomy-and-economics-surgical-mishaps
October 19, 2022 - Study
Classic
The high cost of low-frequency events: the anatomy and economics of surgical mishaps.
Citation Text:
Couch NP, Tilney NL, Rayner AA, et al. The high cost of low-frequency events: the anatomy and economics of surgical mishaps. N Engl J Med. 1981;3…
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psnet.ahrq.gov/issue/scoping-review-hidden-curriculum-pharmacy-education
November 16, 2022 - Review
A scoping review of the hidden curriculum in pharmacy education.
Citation Text:
Park SK, Chen AMH, Daugherty KK, et al. A scoping review of the hidden curriculum in pharmacy education. Am J Pharm Educ. 2023;87(3):ajpe8999. doi:10.5688/ajpe8999.
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…
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psnet.ahrq.gov/issue/relevance-agency-healthcare-research-and-quality-patient-safety-indicators-childrens
July 14, 2010 - Study
Relevance of the Agency for Healthcare Research and Quality Patient Safety Indicators for children's hospitals.
Citation Text:
Sedman A, Harris M, Schulz K, et al. Relevance of the Agency for Healthcare Research and Quality Patient Safety Indicators for children's hospitals. Pedi…
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psnet.ahrq.gov/issue/patient-identification-error-among-prostate-needle-core-biopsy-specimens-are-we-ready-dna
March 12, 2025 - Study
Patient identification error among prostate needle core biopsy specimens—are we ready for a DNA time-out?
Citation Text:
Suba EJ, Pfeifer JD, Raab SS. Patient identification error among prostate needle core biopsy specimens--are we ready for a DNA time-out? J Urol. 2007;178(4 Pt …
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psnet.ahrq.gov/issue/point-care-testing-error-sources-and-amplifiers-taxonomy-prevention-strategies-and-detection
January 08, 2016 - Study
Point-of-care testing error: sources and amplifiers, taxonomy, prevention strategies, and detection monitors.
Citation Text:
Meier FA, Jones BA. Point-of-care testing error: sources and amplifiers, taxonomy, prevention strategies, and detection monitors. Arch Pathol Lab Med. 2005…
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psnet.ahrq.gov/node/39678/psn-pdf
July 14, 2010 - Medication errors recovered by emergency department
pharmacists.
July 14, 2010
Rothschild JM, Churchill WW, Erickson A, et al. Medication errors recovered by emergency department
pharmacists. Ann Emerg Med. 2010;55(6):513-21. doi:10.1016/j.annemergmed.2009.10.012.
https://psnet.ahrq.gov/issue/medication-errors-rec…
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psnet.ahrq.gov/node/40046/psn-pdf
June 15, 2012 - Applying HFMEA to prevent chemotherapy errors.
June 15, 2012
Cheng C-H, Chou C-J, Wang P-C, et al. Applying HFMEA to prevent chemotherapy errors. J Med Syst.
2012;36(3):1543-51. doi:10.1007/s10916-010-9616-7.
https://psnet.ahrq.gov/issue/applying-hfmea-prevent-chemotherapy-errors
This study provides a practical ex…
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psnet.ahrq.gov/node/35530/psn-pdf
March 02, 2010 - Health care provider use of private sector internal error-
reporting systems.
March 2, 2010
Roumm AR, Sciamanna CN, Nash DB. Health care provider use of private sector internal error-reporting
systems. Am J Med Qual. 2005;20(6):304-12.
https://psnet.ahrq.gov/issue/health-care-provider-use-private-sector-internal-e…
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psnet.ahrq.gov/node/38809/psn-pdf
November 14, 2011 - Safety First: Top of Your Board's Agenda: 100 Day
Challenge Survey Report.
November 14, 2011
The Patients Association. Harrow, Middlesex, UK: The Patients Association; June 2009.
https://psnet.ahrq.gov/issue/safety-first-top-your-boards-agenda-100-day-challenge-survey-report
This publication summarizes the results…