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psnet.ahrq.gov/issue/epidural-iv-route-mix-ups-reducing-risk-deadly-errors
May 02, 2018 - Newspaper/Magazine Article
Epidural-IV route mix-ups: reducing the risk of deadly errors.
Citation Text:
Epidural-IV route mix-ups: reducing the risk of deadly errors. ISMP Medication Safety Alert! Acute Care Edition. July 3, 2008;13:1-3.
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psnet.ahrq.gov/issue/pharmacist-staffing-and-use-technology-small-rural-hospitals-implications-medication-safety
August 01, 2012 - Book/Report
Pharmacist Staffing and the Use of Technology in Small Rural Hospitals: Implications for Medication Safety.
Citation Text:
Pharmacist Staffing and the Use of Technology in Small Rural Hospitals: Implications for Medication Safety. Casey MM, Moscovice I, Davidson G. Minn…
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psnet.ahrq.gov/issue/ismp-survey-shows-provider-text-messaging-often-runs-afoul-patient-safety
May 07, 2018 - Newspaper/Magazine Article
ISMP survey shows provider text messaging often runs afoul of patient safety.
Citation Text:
ISMP survey shows provider text messaging often runs afoul of patient safety. ISMP Medication Safety Alert! Acute Care Edition. November 16, 2017;22:1-5.
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psnet.ahrq.gov/issue/first-annual-review-data-submitted-ismp-national-vaccine-errors-reporting-program-verp
June 10, 2018 - Newspaper/Magazine Article
First annual review of data submitted to the ISMP National Vaccine Errors Reporting Program (VERP).
Citation Text:
First annual review of data submitted to the ISMP National Vaccine Errors Reporting Program (VERP). ISMP Medication Safety Alert! Acute Care Editi…
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psnet.ahrq.gov/issue/ockenden-report-emerging-fndings-and-recommendations-independent-review-maternity-services
April 27, 2022 - Book/Report
Ockenden Report. Emerging Fndings and Recommendations from the Independent Review of Maternity Services at the Shrewsbury and Telford Hospital NHS Trust.
Citation Text:
Ockenden Report. Emerging Fndings and Recommendations from the Independent Review of Maternity Services at …
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psnet.ahrq.gov/issue/ismp-survey-provides-insights-preparation-and-admixture-practices-outside-pharmacy
December 02, 2020 - Newspaper/Magazine Article
ISMP Survey provides insights into preparation and admixture practices OUTSIDE the pharmacy.
Citation Text:
ISMP Survey provides insights into preparation and admixture practices OUTSIDE the pharmacy. ISMP Medication Safety Alert! Acute care edition. November 5…
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psnet.ahrq.gov/issue/follow-markedly-elevated-serum-potassium-results-ambulatory-setting-implications-patient
September 29, 2021 - Study
Follow-up of markedly elevated serum potassium results in the ambulatory setting: implications for patient safety.
Citation Text:
Follow-up of markedly elevated serum potassium results in the ambulatory setting: implications for patient safety. Moore CR; Lin JJ; O'Connor N; Hal…
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psnet.ahrq.gov/issue/medication-errors-attributed-health-information-technology
March 27, 2018 - Newspaper/Magazine Article
Medication errors attributed to health information technology.
Citation Text:
Medication errors attributed to health information technology. Lawes S, Grissinger M. PA-PSRS Patient Saf Advis. March 2017;14:1-8.
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psnet.ahrq.gov/issue/community-pharmacy-survey-patient-safety-culture
October 23, 2019 - Measurement Tool/Indicator
Community Pharmacy Survey on Patient Safety Culture.
Citation Text:
Community Pharmacy Survey on Patient Safety Culture. Rockville, MD: Agency for Healthcare Research and Quality; July 2018.
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psnet.ahrq.gov/issue/freedom-speak-review-whistleblowing-nhs
April 24, 2013 - Book/Report
Freedom to Speak Up: A Review of Whistleblowing in the NHS.
Citation Text:
Freedom to Speak Up: A Review of Whistleblowing in the NHS. Francis R. London, UK: Department of Health; February 2015.
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www.ahrq.gov/sites/default/files/wysiwyg/evidencenow/results/research/blood-pressure-narrative.pdf
December 31, 2018 - Controlling High Blood Pressure
Measure Narrative
Description
Percentage of patients 18-85 years of age who had a diagnosis of hypertension and whose blood
pressure was adequately controlled (<140/90mmHg) during the measurement period.
Methodology
Population identification is accomplished via a query of a pra…
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psnet.ahrq.gov/issue/lot-happens-when-you-report-hazard-or-error-ismp-theres-no-black-hole-here
December 27, 2018 - Newspaper/Magazine Article
A lot happens when you report a hazard or error to ISMP—there’s no “black hole” here!
Citation Text:
A lot happens when you report a hazard or error to ISMP—there’s no “black hole” here! ISMP Medication Safety Alert! Acute Care Edition. November 7, 2019
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psnet.ahrq.gov/issue/ecri-out-10-deadly-healthcare-technology-hazards-2017
February 21, 2024 - Newspaper/Magazine Article
ECRI out with 10 deadly healthcare technology hazards for 2017.
Citation Text:
ECRI out with 10 deadly healthcare technology hazards for 2017. Monegain B. Healthcare IT News. November 7, 2016.
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psnet.ahrq.gov/issue/comparing-perspectives-organisational-silence-analysis-gosport-inquiry
September 29, 2021 - Commentary
Comparing perspectives on organisational silence: an analysis of the Gosport inquiry.
Citation Text:
Comparing perspectives on organisational silence: an analysis of the Gosport inquiry. Powell M. J Health Org Manag. 2023;37(1):67-83.
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psnet.ahrq.gov/issue/cancer-diagnoses-delayed-among-prisoners-washington-state
March 24, 2021 - Newspaper/Magazine Article
Cancer diagnoses delayed among prisoners in Washington state.
Citation Text:
Cancer diagnoses delayed among prisoners in Washington state. Medscape Medical News. May 12, 2021.
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psnet.ahrq.gov/issue/unintended-consequences-new-problems-and-new-solutions
June 27, 2018 - Book/Report
Unintended Consequences: New Problems and New Solutions.
Citation Text:
Unintended Consequences: New Problems and New Solutions. Lehmann CU, Sroussi B, Jaulent MC, eds. Yearb Med Inform. 2016;1:1-271.
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psnet.ahrq.gov/issue/hazards-tied-medical-records-rush
July 26, 2011 - Newspaper/Magazine Article
Hazards tied to medical records rush.
Citation Text:
Hazards tied to medical records rush. Rowland C.
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psnet.ahrq.gov/issue/naval-aviation-safety-and-its-application-medicine
June 01, 2016 - Newspaper/Magazine Article
Naval aviation safety and its application to medicine.
Citation Text:
Naval aviation safety and its application to medicine. Harmon KT. Patient Saf Qual Healthc. March/April 2006.
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psnet.ahrq.gov/issue/improving-rapid-response-systems-progress-issues-and-future-directions
January 26, 2022 - Meeting/Conference Proceedings
Improving rapid response systems: progress, issues, and future directions.
Citation Text:
Ovretveit J, Suffoletto J-A. Improving rapid response systems: progress, issues, and future directions.
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psnet.ahrq.gov/issue/safety-still-compromised-computer-weaknesses
September 14, 2016 - Newspaper/Magazine Article
Safety still compromised by computer weaknesses.
Citation Text:
Safety still compromised by computer weaknesses. ISMP Medication Safety Alert! Acute Care Edition. August 25, 2005;10:1-3.
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