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Always Check the Muscle Twitch: Residual Neuromuscular Block After Removal of a Gastric Balloon | PSNet

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January 29, 2021 - Always Check the Muscle Twitch: Residual Neuromuscular Block After Removal of a Gastric Balloon Citation Text: Bohringer C, Ashley S. Always Check the Muscle Twitch: Residual Neuromuscular Block After Removal of a Gastric Balloon. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality,…

Respiratory Distress after Neck Surgery: Two Cases of Postoperative Cervical Hematoma. | PSNet

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August 14, 2024 - SPOTLIGHT CASE Respiratory Distress after Neck Surgery: Two Cases of Postoperative Cervical Hematoma. Citation Text: Graves CE, Kuhn MA. Respiratory Distress after Neck Surgery: Two Cases of Postoperative Cervical Hematoma.. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Qua…

Dangers of Missing an Epidural Abscess: Multiple Visits and Delayed Diagnosis with a Severely Negative Outcome | PSNet

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April 27, 2022 - SPOTLIGHT CASE Dangers of Missing an Epidural Abscess: Multiple Visits and Delayed Diagnosis with a Severely Negative Outcome Citation Text: Lantz L, Yoon J, Barnes DK. Dangers of Missing an Epidural Abscess: Multiple Visits and Delayed Diagnosis with a Severely Negative Outcome. PSNet [internet…

Missed acute myocardial infarction in the emergency department-standardizing measurement of misdiagnosis-related harms using the SPADE method. | PSNet

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May 12, 2021 - Study Missed acute myocardial infarction in the emergency department-standardizing measurement of misdiagnosis-related harms using the SPADE method. Citation Text: Sharp AL, Baecker A, Nassery N, et al. Missed acute myocardial infarction in the emergency department–standardizing measurem…

Ethical considerations and patient safety concerns for cancelling non-urgent surgeries during the COVID-19 pandemic: a review. | PSNet

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June 23, 2021 - Commentary Ethical considerations and patient safety concerns for cancelling non-urgent surgeries during the COVID-19 pandemic: a review. Citation Text: Brown NJ, Wilson B, Szabadi S, et al. Ethical considerations and patient safety concerns for cancelling non-urgent surgeries during the…

The perception of patient safety in an alternate site of care for elective surgery during the first wave of the novel coronavirus pandemic in the United Kingdom: a survey of 158 patients. | PSNet

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May 12, 2021 - Study The perception of patient safety in an alternate site of care for elective surgery during the first wave of the novel coronavirus pandemic in the United Kingdom: a survey of 158 patients. Citation Text: Lee G, Clough OT, Walker JA, et al. The perception of patient safety in an alte…

Investigating the impact of a pharmacist intervention on inappropriate prescribing practices at hospital admission and discharge in older patients: a secondary outcome analysis from a randomized controlled trial. | PSNet

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November 30, 2022 - Study Investigating the impact of a pharmacist intervention on inappropriate prescribing practices at hospital admission and discharge in older patients: a secondary outcome analysis from a randomized controlled trial. Citation Text: Garcia BH, Omma KK, Småbrekke L, et al. Investigating …

Intended and unintended consequences: changes in opioid prescribing practices for postsurgical, acute, and chronic pain indications following two policies in North Carolina, 2012-2018 - controlled and single-series interrupted time series analyses. | PSNet

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August 10, 2022 - Study Intended and unintended consequences: changes in opioid prescribing practices for postsurgical, acute, and chronic pain indications following two policies in North Carolina, 2012-2018 - controlled and single-series interrupted time series analyses. Citation Text: Maierhofer CN, Ran…

A pharmacist-led information technology intervention for medication errors (PINCER): a multicentre, cluster randomised, controlled trial and cost-effectiveness analysis. | PSNet

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January 11, 2023 - Study Classic A pharmacist-led information technology intervention for medication errors (PINCER): a multicentre, cluster randomised, controlled trial and cost-effectiveness analysis. Citation Text: Avery A, Rodgers S, Cantrill JA, et al. A pharmacist-led info…

Clinical decision support systems could be modified to reduce 'alert fatigue' while still minimizing the risk of litigation. | PSNet

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December 21, 2022 - Commentary Clinical decision support systems could be modified to reduce 'alert fatigue' while still minimizing the risk of litigation. Citation Text: Kesselheim AS, Cresswell K, Phansalkar S, et al. Clinical decision support systems could be modified to reduce 'alert fatigue' while stil…

Concordance with urgent referral guidelines in patients presenting with any of six ‘alarm’ features of possible cancer: a retrospective cohort study using linked primary care records. | PSNet

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February 17, 2021 - Study Concordance with urgent referral guidelines in patients presenting with any of six ‘alarm’ features of possible cancer: a retrospective cohort study using linked primary care records. Citation Text: Wiering B, Lyratzopoulos G, Hamilton W, et al. Concordance with urgent referral gui…

Serious misdiagnosis-related harms in malpractice claims: the "Big Three": vascular events, infections, and cancers. | PSNet

psnet.ahrq.gov/issue/serious-misdiagnosis-related-harms-malpractice-claims-big-three-vascular-events-infections

July 28, 2023 - Study Emerging Classic Serious misdiagnosis-related harms in malpractice claims: the "Big Three": vascular events, infections, and cancers. Citation Text: Newman-Toker DE, Schaffer AC, Yu-Moe CW, et al. Serious misdiagnosis-related harms in malpractice claims: T…

Exploring the roots of unintended safety threats associated with the introduction of hospital ePrescribing systems and candidate avoidance and/or mitigation strategies: a qualitative study. | PSNet

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December 21, 2022 - Study Exploring the roots of unintended safety threats associated with the introduction of hospital ePrescribing systems and candidate avoidance and/or mitigation strategies: a qualitative study. Citation Text: Mozaffar H, Cresswell K, Williams R, et al. Exploring the roots of unintended…

Efficiency and thoroughness trade-offs in high-volume organisational routines: an ethnographic study of prescribing safety in primary care. | PSNet

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June 14, 2017 - Study Efficiency and thoroughness trade-offs in high-volume organisational routines: an ethnographic study of prescribing safety in primary care. Citation Text: Grant S, Guthrie B. Efficiency and thoroughness trade-offs in high-volume organisational routines: an ethnographic study of pre…

The relationship between patients' perception of care and measures of hospital quality and safety. | PSNet

psnet.ahrq.gov/issue/relationship-between-patients-perception-care-and-measures-hospital-quality-and-safety

February 13, 2019 - Study Classic The relationship between patients' perception of care and measures of hospital quality and safety. Citation Text: Isaac T, Zaslavsky AM, Cleary PD, et al. The relationship between patients' perception of care and measures of hospital quality and …

A systematic review of the types and causes of prescribing errors generated from using computerized provider order entry systems in primary and secondary care. | PSNet

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July 02, 2019 - Review A systematic review of the types and causes of prescribing errors generated from using computerized provider order entry systems in primary and secondary care. Citation Text: Brown CL, Mulcaster HL, Triffitt KL, et al. A systematic review of the types and causes of prescribing err…

Postoperative adverse events inconsistently improved by the World Health Organization surgical safety checklist: a systematic literature review of 25 studies. | PSNet

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March 29, 2023 - Review Classic Postoperative adverse events inconsistently improved by the World Health Organization surgical safety checklist: a systematic literature review of 25 studies. Citation Text: de Jager E, McKenna C, Bartlett L, et al. Postoperative adverse events in…

Influence of opioid prescription policy on overdoses and related adverse effects in a primary care population. | PSNet

psnet.ahrq.gov/issue/influence-opioid-prescription-policy-overdoses-and-related-adverse-effects-primary-care

March 24, 2021 - Study Influence of opioid prescription policy on overdoses and related adverse effects in a primary care population. Citation Text: Harder VS, Plante TB, Koh I, et al. Influence of opioid prescription policy on overdoses and related adverse effects in a primary care population. J Gen Int…

The national cost of adverse drug events resulting from inappropriate medication-related alert overrides in the United States. | PSNet

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July 02, 2019 - Study The national cost of adverse drug events resulting from inappropriate medication-related alert overrides in the United States. Citation Text: Slight SP, Seger DL, Franz C, et al. The national cost of adverse drug events resulting from inappropriate medication-related alert override…

Safety risks associated with the lack of integration and interfacing of hospital health information technologies: a qualitative study of hospital electronic prescribing systems in England. | PSNet

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December 21, 2022 - Study Safety risks associated with the lack of integration and interfacing of hospital health information technologies: a qualitative study of hospital electronic prescribing systems in England. Citation Text: Cresswell K, Mozaffar H, Lee L, et al. Safety risks associated with the lack o…

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