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psnet.ahrq.gov/node/35130/psn-pdf
March 11, 2011 - A trial of automated decision support alerts for
contraindicated medications using computerized
physician order entry.
March 11, 2011
Galanter W, Didomenico RJ, Polikaitis A. A trial of automated decision support alerts for contraindicated
medications using computerized physician order entry. J Am Med Inform Assoc…
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psnet.ahrq.gov/node/42838/psn-pdf
January 08, 2014 - Management of arterial lines and blood sampling in
intensive care: a threat to patient safety.
January 8, 2014
Leslie RA, Gouldson S, Habib N, et al. Management of arterial lines and blood sampling in intensive care: a
threat to patient safety. Anaesthesia. 2013;68(11). doi:10.1111/anae.12389.
https://psnet.ahrq.g…
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psnet.ahrq.gov/node/45693/psn-pdf
February 22, 2017 - Meta-analyses of the effects of standardized handoff
protocols on patient, provider, and organizational
outcomes.
February 22, 2017
Keebler JR, Lazzara EH, Patzer BS, et al. Meta-Analyses of the Effects of Standardized Handoff Protocols
on Patient, Provider, and Organizational Outcomes. Hum Factors. 2016;58(8):118…
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psnet.ahrq.gov/node/39860/psn-pdf
September 01, 2017 - Interventions to improve hand hygiene compliance in
patient care.
September 1, 2017
Gould DJ, Moralejo D, Drey N, et al. Interventions to improve hand hygiene compliance in patient care.
Cochrane Database Syst Rev. 2017;9(9):CD005186. doi:10.1002/14651858.cd005186.pub4.
https://psnet.ahrq.gov/issue/interventions-i…
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psnet.ahrq.gov/node/45444/psn-pdf
December 04, 2016 - Alarm fatigue: use of an evidence-based alarm
management strategy.
December 4, 2016
Turmell JW, Coke L, Catinella R, et al. Alarm Fatigue. J Nurs Care Qual. 2016;32(1):47-54.
doi:10.1097/ncq.0000000000000223.
https://psnet.ahrq.gov/issue/alarm-fatigue-use-evidence-based-alarm-management-strategy
Reducing nuisance…
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psnet.ahrq.gov/node/45854/psn-pdf
July 12, 2017 - The second victim phenomenon after a clinical error: the
design and evaluation of a website to reduce caregivers'
emotional responses after a clinical error.
July 12, 2017
Mira JJ, Carrillo I, Guilabert M, et al. The Second Victim Phenomenon After a Clinical Error: The Design
and Evaluation of a Website to Reduce …
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psnet.ahrq.gov/node/47786/psn-pdf
June 26, 2019 - Creating a Safe Space: Psychological Health and Safety
of Healthcare Workers.
June 26, 2019
Canadian Patient Safety Institute: 2019.
https://psnet.ahrq.gov/issue/creating-safe-space-psychological-health-and-safety-healthcare-workers
Structured approaches to managing negative psychological consequences of medical e…
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psnet.ahrq.gov/node/843094/psn-pdf
January 25, 2023 - Getting Started with a Communication and Resolution
Program (CRP) Policy or Commitment Statement to CR.
January 25, 2023
Collaborative for Accountability and Improvement Policy Committee. Seattle, WA: University of
Washington; 2022
https://psnet.ahrq.gov/issue/getting-started-communication-and-resolution-program-c…
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psnet.ahrq.gov/node/46292/psn-pdf
August 02, 2017 - Clinical alerts to decrease high-risk medication use in
older adults.
August 2, 2017
Lord-Adem W, Brandt NJ. Clinical Alerts to Decrease High-Risk Medication Use in Older Adults. J Gerontol
Nurs. 2017;43(7):7-12. doi:10.3928/00989134-20170614-04.
https://psnet.ahrq.gov/issue/clinical-alerts-decrease-high-risk-medi…
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psnet.ahrq.gov/node/866809/psn-pdf
September 25, 2024 - Stop the line: interventions to prevent retained surgical
items.
September 25, 2024
Angelilli S. Stop the line: interventions to prevent retained surgical items. AORN J. 2024;120(2):71-81.
doi:10.1002/aorn.14190.
https://psnet.ahrq.gov/issue/stop-line-interventions-prevent-retained-surgical-items
Retained surgica…
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psnet.ahrq.gov/node/43986/psn-pdf
September 26, 2016 - The effect of a safe zone on nurse interruptions,
distractions, and medication administration errors.
September 26, 2016
Yoder M, Schadewald D, Dietrich K. The effect of a safe zone on nurse interruptions, distractions, and
medication administration errors. J Infus Nurs. 2015;38(2):140-51. doi:10.1097/NAN.000000000…
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psnet.ahrq.gov/node/866192/psn-pdf
June 26, 2024 - A systemwide strategy to embed equity into patient safety
event analysis.
June 26, 2024
Chandra K, Garcia M, Bajaj K, et al. A systemwide strategy to embed equity into patient safety event
analysis. Jt Comm J Qual Patient Saf. 2024;50(8):606-611 . doi:10.1016/j.jcjq.2024.04.004.
https://psnet.ahrq.gov/issue/system…
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psnet.ahrq.gov/node/43053/psn-pdf
May 26, 2014 - Evidence-based organization and patient safety strategies
in European hospitals.
May 26, 2014
Suñol R, Wagner C, Arah OA, et al. Evidence-based organization and patient safety strategies in European
hospitals. Int J Qual Health Care. 2014;26 Suppl 1:47-55. doi:10.1093/intqhc/mzu016.
https://psnet.ahrq.gov/issue/ev…
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psnet.ahrq.gov/node/73469/psn-pdf
July 07, 2021 - Barriers to and facilitators of bedside nursing handover: a
systematic review and meta-synthesis.
July 7, 2021
Clari M, Conti A, Chiarini D, et al. Barriers to and facilitators of bedside nursing handover: a systematic
review and meta-synthesis. J Nurs Care Qual. 2021;36(4):e51-e58. doi:10.1097/ncq.0000000000000564…
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psnet.ahrq.gov/node/849615/psn-pdf
May 31, 2023 - Clinical Investigation Booking Systems Failures: Written
Communications in Community Languages.
May 31, 2023
Farnborough, UK: Healthcare Safety Investigation Branch; April 2023.
https://psnet.ahrq.gov/issue/clinical-investigation-booking-systems-failures-written-communications-
community-languages
Gaps in patient…
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psnet.ahrq.gov/node/42905/psn-pdf
July 30, 2014 - The surgical safety checklist and teamwork coaching
tools: a study of inter-rater reliability.
July 30, 2014
Huang LC, Conley D, Lipsitz S, et al. The Surgical Safety Checklist and Teamwork Coaching Tools: a study
of inter-rater reliability. BMJ Qual Saf. 2014;23(8):639-50. doi:10.1136/bmjqs-2013-002446.
https://p…
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psnet.ahrq.gov/node/47119/psn-pdf
September 19, 2018 - A usability and safety analysis of electronic health
records: a multi-center study.
September 19, 2018
Ratwani RM, Savage E, Will A, et al. A usability and safety analysis of electronic health records: a multi-
center study. J Am Med Inform Assoc. 2018;25(9):1197-1201. doi:10.1093/jamia/ocy088.
https://psnet.ahrq.…
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psnet.ahrq.gov/node/39102/psn-pdf
January 04, 2010 - Quality and safety on an acute surgical ward: an
exploratory cohort study of process and outcome.
January 4, 2010
Kreckler S, Catchpole K, New SJ, et al. Quality and safety on an acute surgical ward: an exploratory cohort
study of process and outcome. Ann Surg. 2009;250(6):1035-40. doi:10.1097/SLA.0b013e3181bd54c2.…
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psnet.ahrq.gov/node/44735/psn-pdf
January 06, 2016 - Quality and patient safety teams in the perioperative
setting.
January 6, 2016
Serino MF. Quality and Patient Safety Teams in the Perioperative Setting. AORN J. 2015;102(6):617-28.
doi:10.1016/j.aorn.2015.10.006.
https://psnet.ahrq.gov/issue/quality-and-patient-safety-teams-perioperative-setting
Team effectivenes…
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psnet.ahrq.gov/node/39270/psn-pdf
February 03, 2010 - Organization-wide adoption of computerized provider
order entry systems: a study based on diffusion of
innovations theory.
February 3, 2010
Rahimi B, Timpka T, Vimarlund V, et al. Organization-wide adoption of computerized provider order entry
systems: a study based on diffusion of innovations theory. BMC Med Info…