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  1. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/38994/psn-pdf
    March 04, 2011 - Computerized surveillance for adverse drug events in a pediatric hospital. March 4, 2011 Kilbridge PM, Noirot LA, Reichley RM, et al. Computerized surveillance for adverse drug events in a pediatric hospital. J Am Med Inform Assoc. 2009;16(5):607-12. doi:10.1197/jamia.M3167. https://psnet.ahrq.gov/issue/computeriz…
  2. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/46210/psn-pdf
    July 12, 2017 - Could emotional intelligence make patients safer? July 12, 2017 Codier E, Codier DD. Could Emotional Intelligence Make Patients Safer? Am J Nurs. 2017;117(7):58-62. doi:10.1097/01.NAJ.0000520946.39224.db. https://psnet.ahrq.gov/issue/could-emotional-intelligence-make-patients-safer Nontechnical skill development i…
  3. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/73991/psn-pdf
    October 20, 2021 - Digital Clinical Safety Strategy October 20, 2021 NHSX, NHS Digital, NHS England, et al. London, England: Crown Copyright; September 2021. https://psnet.ahrq.gov/issue/digital-clinical-safety-strategy Digital clinical technologies hold promise for care improvement while contributing to potential failures due to th…
  4. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/60565/psn-pdf
    June 03, 2020 - The public has been forgiving. But hospitals got some things wrong. June 3, 2020 Ofri D. The public has been forgiving. But hospitals got some things wrong. New York Times. 2020; May 21. https://psnet.ahrq.gov/issue/public-has-been-forgiving-hospitals-got-some-things-wrong The complexity of the COVID-19 crisis cr…
  5. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/40713/psn-pdf
    August 24, 2011 - Medication reconciliation: barriers and facilitators from the perspectives of resident physicians and pharmacists. August 24, 2011 Boockvar KS, Santos SL, Kushniruk AW, et al. Medication reconciliation: Barriers and facilitators from the perspectives of resident physicians and pharmacists. J Hosp Med. 2011;6(6). do…
  6. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/50743/psn-pdf
    December 18, 2019 - Design of a safety dashboard for patients. December 18, 2019 Gibson B, Butler J, Schnock KO, et al. Design of a safety dashboard for patients. Patient Educ Couns. 2019;103(4):741-747. doi:10.1016/j.pec.2019.10.021. https://psnet.ahrq.gov/issue/design-safety-dashboard-patients Patients and caregivers should be acti…
  7. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/45450/psn-pdf
    February 13, 2018 - Avoiding Unconscious Bias: a Guide for Surgeons. February 13, 2018 London, UK: Royal College of Surgeons of England; 2016. https://psnet.ahrq.gov/issue/avoiding-unconscious-bias-guide-surgeons Biases can affect decision making and behaviors toward colleagues and patients. This guidance provides information for sur…
  8. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/46634/psn-pdf
    November 22, 2017 - Ambulatory Care Patient Safety 2017–2018. November 22, 2017 National Quality Forum; NQF. https://psnet.ahrq.gov/issue/ambulatory-care-patient-safety-2017-2018 Patient safety in ambulatory care is emerging as a focus of research, regulation, and measurement efforts. This website provides information and resources r…
  9. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/48136/psn-pdf
    August 07, 2019 - Safe Practices for Drug Allergies—Using CDS and Health IT. August 7, 2019 Partnership for Health IT Patient Safety. Plymouth Meeting, PA: ECRI Institute; 2019. https://psnet.ahrq.gov/issue/safe-practices-drug-allergies-using-cds-and-health-it Inconsistent checking for and consideration of drug allergy alerts can d…
  10. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/46452/psn-pdf
    November 15, 2017 - Quality Improvement. November 15, 2017 Gupta M, Kaplan HC, eds. Clin Perinatol. 2017;44(3):469-728. https://psnet.ahrq.gov/issue/quality-improvement Improvement efforts in health care focus on quality and patient safety. Articles in this special issue explore the complexities of providing effective perinatal–neona…
  11. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/836717/psn-pdf
    March 09, 2022 - The problem with…using stories as a source of evidence and learning. March 9, 2022 Iedema R. The problem with … using stories as a source of evidence and learning. BMJ Qual Saf. 2022;31(3):234-237. doi:10.1136/bmjqs-2021-014221. https://psnet.ahrq.gov/issue/problem-withusing-stories-source-evidence-and-learning P…
  12. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/43790/psn-pdf
    October 23, 2023 - Complaints to the Parliamentary and Health Service Ombudsman. October 23, 2023 Manchester, UK: Parliamentary and Health Service Ombudsman. https://psnet.ahrq.gov/issue/complaints-about-acute-trusts-2016-2017 The National Health Service broadly reports the results of system-level analyses and investigations into t…
  13. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/36085/psn-pdf
    September 28, 2010 - VA Health Care: Selected Credentialing Requirements at Seven Medical Facilities Met, but an Aspect of Privileging Process Needs Improvement. September 28, 2010 Washington, DC: Government Accountability Office; May 2006. Report no GAO-06-648. https://psnet.ahrq.gov/issue/va-health-care-selected-credentialing-requir…
  14. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/39098/psn-pdf
    November 11, 2009 - Building team and technical competency for obstetric emergencies: the mobile obstetric emergencies simulator (MOES) system. November 11, 2009 Deering S, Rosen MA, Salas E, et al. Building team and technical competency for obstetric emergencies: the mobile obstetric emergencies simulator (MOES) system. Simul Health…
  15. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/37857/psn-pdf
    May 26, 2011 - The impact of computerized physician medication order entry in hospitalized patients—a systematic review. May 26, 2011 Eslami S, de Keizer NF, Abu-Hanna A. The impact of computerized physician medication order entry in hospitalized patients--a systematic review. Int J Med Inform. 2008;77(6):365-76. https://psnet.a…
  16. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/865588/psn-pdf
    April 17, 2024 - Inattentional blindness in medicine. April 17, 2024 Hults CM, Ding Y, Xie GG, et al. Inattentional blindness in medicine. Cogn Res Princ Implic. 2024;9(1):18. doi:10.1186/s41235-024-00537-x. https://psnet.ahrq.gov/issue/inattentional-blindness-medicine Inattentional blindness occurs when a person is focused so int…
  17. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/43477/psn-pdf
    May 19, 2015 - Adverse events in healthcare: learning from mistakes. May 19, 2015 Rafter N, Hickey A, Condell S, et al. Adverse events in healthcare: learning from mistakes. QJM. 2015;108(4):273-7. doi:10.1093/qjmed/hcu145. https://psnet.ahrq.gov/issue/adverse-events-healthcare-learning-mistakes This review discusses chart revie…
  18. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/854266/psn-pdf
    October 04, 2023 - Smart Healthcare Safety. October 4, 2023 Plymouth Meeting PA, ECRI. 2019-2023. https://psnet.ahrq.gov/issue/smart-healthcare-safety A wide variety of considerations must converge to inform an understanding of system vulnerabilities and the application of strategies to address them. This series of webinars covers a…
  19. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/866359/psn-pdf
    June 01, 2022 - Diagnostic Safety Toolkit. June 1, 2022 Diagnostic Safety Toolkit. https://psnet.ahrq.gov/issue/diagnostic-safety-toolkit-0 Effective communication is critical as patients shift from one level of care to another as their diagnosis evolves. This toolkit is designed to help academic medical centers initiate conversa…
  20. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/42902/psn-pdf
    January 29, 2014 - Improving Patient Safety Through Teamwork and Team Training. January 29, 2014 Salas E, Frush K, eds. Oxford, UK: Oxford University Press; 2013. ISBN: 9780195399097. https://psnet.ahrq.gov/issue/improving-patient-safety-through-teamwork-and-team-training Health care has been recently been directed toward focusing o…

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