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psnet.ahrq.gov/node/37478/psn-pdf
February 22, 2011 - Programmable infusion pumps in ICUs: an analysis of
corresponding adverse drug events.
February 22, 2011
Nuckols TK, Bower AG, Paddock SM, et al. Programmable infusion pumps in ICUs: an analysis of
corresponding adverse drug events. J Gen Intern Med. 2008;23 Suppl 1:41-5. doi:10.1007/s11606-007-
0414-y.
https://p…
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psnet.ahrq.gov/node/37803/psn-pdf
January 06, 2017 - Paying the piper: investing in infrastructure for patient
safety.
January 6, 2017
Pronovost P, Rosenstein BJ, Paine LA, et al. Paying the piper: investing in infrastructure for patient safety.
Jt Comm J Qual Patient Saf. 2008;34(6):342-8.
https://psnet.ahrq.gov/issue/paying-piper-investing-infrastructure-patient-…
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psnet.ahrq.gov/node/867233/psn-pdf
December 04, 2024 - Evaluation of a natural language processing approach to
identify diagnostic errors and analysis of safety learning
system case review data: retrospective cohort study.
December 4, 2024
Tabaie A, Tran A, Calabria T, et al. Evaluation of a natural language processing approach to identify
diagnostic errors and analys…
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psnet.ahrq.gov/node/37386/psn-pdf
January 06, 2017 - Medication reconciliation in ambulatory oncology.
January 6, 2017
Weingart SN, Cleary A, Seger AC, et al. Medication reconciliation in ambulatory oncology. Jt Comm J Qual
Patient Saf. 2007;33(12):750-7.
https://psnet.ahrq.gov/issue/medication-reconciliation-ambulatory-oncology
The Joint Commission mandates systems…
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psnet.ahrq.gov/node/38454/psn-pdf
January 02, 2017 - Comparing process- and outcome-oriented approaches to
voluntary incident reporting in two hospitals.
January 2, 2017
Nuckols TK, Bell D, Paddock SM, et al. Comparing process- and outcome-oriented approaches to
voluntary incident reporting in two hospitals. Jt Comm J Qual Patient Saf. 2009;35(3):139-45.
https://psn…
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psnet.ahrq.gov/node/38489/psn-pdf
November 25, 2009 - Evaluation of the contributions of an electronic web-
based reporting system: enabling action.
November 25, 2009
Levtzion-Korach O, Alcalai H, Orav EJ, et al. Evaluation of the contributions of an electronic web-based
reporting system: enabling action. J Patient Saf. 2009;52(1):9-15. doi:10.1097/PTS.0b013e318198dc8…
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psnet.ahrq.gov/node/38163/psn-pdf
April 11, 2011 - Retrospective evaluation of a computerized physician
order entry adaptation to prevent prescribing errors in a
pediatric emergency department.
April 11, 2011
Sard BE, Walsh KE, Doros G, et al. Retrospective evaluation of a computerized physician order entry
adaptation to prevent prescribing errors in a pediatric e…
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psnet.ahrq.gov/node/47247/psn-pdf
December 19, 2018 - Preventing central line–associated bloodstream
infections in the intensive care unit: application of high-
reliability principles.
December 19, 2018
McCraw B, Crutcher T, Polancich S, et al. Preventing Central Line-Associated Bloodstream Infections in
the Intensive Care Unit: Application of High-Reliability Princi…
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psnet.ahrq.gov/node/47550/psn-pdf
November 21, 2018 - Nurses' and patients' appraisals show patient safety in
hospitals remains a concern.
November 21, 2018
Aiken LH, Sloane DM, Barnes H, et al. Nurses' And Patients' Appraisals Show Patient Safety In Hospitals
Remains A Concern. Health Aff (Millwood). 2018;37(11):1744-1751. doi:10.1377/hlthaff.2018.0711.
https://psne…
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psnet.ahrq.gov/perspective/conversation-susan-mcgrath-phd-and-george-blike-md-about-surveillance-monitoring
April 26, 2023 - Surveillance monitoring systems decreased average vital sign collection time and improved accuracy of
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psnet.ahrq.gov/node/33571/psn-pdf
March 15, 2025 - Reporting Patient Safety Events
March 15, 2025
Reporting Patient Safety Events. PSNet [internet]. 2019.
https://psnet.ahrq.gov/primer/reporting-patient-safety-events
PSNet primers are regularly reviewed and updated by the UC Davis PSNet Editorial Team to ensure that
they reflect current research and practice in th…
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psnet.ahrq.gov/primer/culture-safety
September 15, 2024 - Culture of Safety
Citation Text:
Culture of Safety. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2019.
Copy Citation
Format:
Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged PubMedId RIS
Dow…
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psnet.ahrq.gov/node/33566/psn-pdf
September 15, 2024 - Teamwork Training
September 15, 2024
Teamwork Training. PSNet [internet]. 2019.
https://psnet.ahrq.gov/primer/teamwork-training
PSNet primers are regularly reviewed and updated by the UC Davis PSNet Editorial Team to ensure that
they reflect current research and practice in the patient safety field. Last reviewed …
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psnet.ahrq.gov/perspective/patient-safety-united-kingdom-evolution-and-progress
May 01, 2007 - Patient Safety in the United Kingdom: Evolution and Progress
Susan Burnett and Charles Vincent, PhD | May 1, 2007
Also Read a Conversation
View more articles from the same authors.
Citation Text:
Burnett S, Vincent CA. Patient Safety in the United Kingdom: Evol…
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psnet.ahrq.gov/sites/default/files/2021-09/spotlight_missed_sea_09.17.2021_-_final.pdf
January 01, 2021 - Spotlight
Spotlight
Dangers of Missing an Epidural Abscess:
Multiple Visits and Delayed Diagnosis with
a Severely Negative Outcome
Source and Credits
• This presentation is based on the June 2021 AHRQ WebM&M
Spotlight Case
o See the full article at https://psnet.ahrq.gov/webmm
o CME credit is available
o Comm…
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psnet.ahrq.gov/issue/patient-specific-electronic-decision-support-reduces-prescription-excessive-doses
November 02, 2010 - Study
Patient-specific electronic decision support reduces prescription of excessive doses.
Citation Text:
Seidling HM, Schmitt SPW, Bruckner T, et al. Patient-specific electronic decision support reduces prescription of excessive doses. Qual Saf Health Care. 2010;19(5):e15. doi:10.113…
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psnet.ahrq.gov/issue/patient-safety-incidents-involving-sick-children-primary-care-england-and-wales-mixed-methods
October 12, 2016 - Study
Patient safety incidents involving sick children in primary care in England and Wales: a mixed methods analysis.
Citation Text:
Rees P, Edwards A, Powell C, et al. Patient Safety Incidents Involving Sick Children in Primary Care in England and Wales: A Mixed Methods Analysis. PLoS …
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psnet.ahrq.gov/issue/multi-method-exploratory-evaluation-service-designed-improve-medication-safety-patients
July 22, 2020 - Study
A multi-method exploratory evaluation of a service designed to improve medication safety for patients with monitored dosage systems following hospital discharge.
Citation Text:
Alqenae FA, Steinke DT, Belither H, et al. A multi-method exploratory evaluation of a service designed to…
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psnet.ahrq.gov/issue/association-between-complications-incidents-and-patient-experience-retrospective-linkage
February 20, 2019 - Study
The association between complications, incidents, and patient experience: retrospective linkage of routine patient experience surveys and safety data.
Citation Text:
de Vos MS, Hamming JF, Boosman H, et al. The Association Between Complications, Incidents, and Patient Experience: R…
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psnet.ahrq.gov/issue/why-do-we-still-page-each-other-examining-frequency-types-and-senders-pages-academic-medical
September 11, 2019 - Study
Why do we still page each other? Examining the frequency, types and senders of pages in academic medical services.
Citation Text:
Carlile N, Rhatigan JJ, Bates DW. Why do we still page each other? Examining the frequency, types and senders of pages in academic medical services. BMJ…