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psnet.ahrq.gov/node/48028/psn-pdf
August 28, 2019 - Error Reduction and Prevention in Surgical Pathology,
Second Edition.
August 28, 2019
Nakhleh RE, Volmar KE, eds. Cham, Switzerland: Springer Nature; 2019. ISBN: 9783030184636.
https://psnet.ahrq.gov/issue/error-reduction-and-prevention-surgical-pathology-2nd-edition
Surgical specimen and laboratory process proble…
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psnet.ahrq.gov/node/44988/psn-pdf
September 20, 2016 - The promise of big data: improving patient safety and
nursing practice.
September 20, 2016
Linnen D. The promise of big data: Improving patient safety and nursing practice. Nursing (Brux).
2016;46(5):28-34; quiz 34-5. doi:10.1097/01.NURSE.0000482256.71143.09.
https://psnet.ahrq.gov/issue/promise-big-data-improving…
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psnet.ahrq.gov/node/866406/psn-pdf
July 31, 2024 - Impact of a daily huddle on safety in perioperative
services.
July 31, 2024
Tuyishime H, Claure RE, Balakrishnan K, et al. Impact of a daily huddle on safety in perioperative services.
Jt Comm J Qual Patient Saf. 2024;50(9):678-683. doi:10.1016/j.jcjq.2024.04.012.
https://psnet.ahrq.gov/issue/impact-daily-huddle-s…
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psnet.ahrq.gov/node/60819/psn-pdf
August 19, 2020 - Register-based research of adverse events revealing
incomplete records threatening patient safety.
August 19, 2020
Kinnunen U-M, Kivekäs E, Palojoki S, et al. Register-based research of adverse events revealing
incomplete records threatening patient safety. Stud Health Technol Inform. 2020;270:771-775.
doi:10.3233…
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psnet.ahrq.gov/node/45281/psn-pdf
September 01, 2016 - Screen flashes and pop-up reminders: 'alert fatigue'
spreads through medicine.
September 1, 2016
Luthra S. Kaiser Health News. June 15, 2016.
https://psnet.ahrq.gov/issue/screen-flashes-and-pop-reminders-alert-fatigue-spreads-through-medicine
Alert fatigue is known to contribute to medical error. This news article…
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psnet.ahrq.gov/node/37769/psn-pdf
March 10, 2011 - Turning off frequently overridden drug alerts: limited
opportunities for doing it safely.
March 10, 2011
van der Sijs H, Aarts J, van Gelder T, et al. Turning off frequently overridden drug alerts: limited
opportunities for doing it safely. J Am Med Inform Assoc. 2008;15(4):439-48. doi:10.1197/jamia.M2311.
https:/…
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psnet.ahrq.gov/node/60878/psn-pdf
January 01, 2021 - Intervention study for the reduction of medication errors
in elderly trauma patients.
September 2, 2020
Parro Martín M de los Á, Muñoz García M, Delgado Silveira E, et al. Intervention study for the reduction of
medication errors in elderly trauma patients. J Eval Clin Pract. 2021;27(1):160-166. doi:10.1111/jep.134…
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psnet.ahrq.gov/node/46666/psn-pdf
March 28, 2018 - Effectiveness of a clinical knowledge support system for
reducing diagnostic errors in outpatient care in Japan: a
retrospective study.
March 28, 2018
Shimizu T, Nemoto T, Tokuda Y. Effectiveness of a clinical knowledge support system for reducing
diagnostic errors in outpatient care in Japan: A retrospective stud…
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psnet.ahrq.gov/node/47319/psn-pdf
October 10, 2018 - Differences in strength expression on product labels of
compounders and conventional manufacturers may lead
to dosing errors.
October 10, 2018
US Food and Drug Administration; FDA.
https://psnet.ahrq.gov/issue/differences-strength-expression-product-labels-compounders-and-
conventional-manufacturers-may
Confusin…
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psnet.ahrq.gov/node/42741/psn-pdf
March 04, 2015 - Impact of an automated email notification system for
results of tests pending at discharge: a cluster-
randomized controlled trial.
March 4, 2015
Dalal A, Roy CL, Poon EG, et al. Impact of an automated email notification system for results of tests
pending at discharge: a cluster-randomized controlled trial. J Am …
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psnet.ahrq.gov/node/46716/psn-pdf
January 10, 2018 - Toolkit to Engage High-Risk Patients in Safe Transitions
Across Ambulatory Settings.
January 10, 2018
Davis K, Collier S, Situ J, et al. Rockville, MD: Agency for Healthcare Research and Quality; December
2017. AHRQ Publication No. 1800051EF.
https://psnet.ahrq.gov/issue/toolkit-engage-high-risk-patients-safe-tran…
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psnet.ahrq.gov/node/44309/psn-pdf
June 14, 2019 - Provider and patient perceptions of an external
medication history function.
June 14, 2019
Wolver SE, Stultz JS, Aggarwal A, et al. Provider and Patient Perceptions of an External Medication History
Function. J Patient Saf. 2018;14(4):234-240. doi:10.1097/PTS.0000000000000197.
https://psnet.ahrq.gov/issue/provider…
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psnet.ahrq.gov/node/46254/psn-pdf
October 09, 2017 - Using risk stratification to reduce medical errors in
cervical cancer prevention.
October 9, 2017
Perkins RB, Cain JM, Feldman S. Using Risk Stratification to Reduce Medical Errors in Cervical Cancer
Prevention. JAMA Intern Med. 2017;177(10):1411-1412. doi:10.1001/jamainternmed.2017.3999.
https://psnet.ahrq.gov/is…
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psnet.ahrq.gov/node/46973/psn-pdf
June 25, 2018 - Balancing innovation and safety when integrating digital
tools into health care.
June 25, 2018
Auerbach AD, Neinstein A, Khanna R. Balancing Innovation and Safety When Integrating Digital Tools Into
Health Care. Ann Intern Med. 2018;168(10):733-734. doi:10.7326/M17-3108.
https://psnet.ahrq.gov/issue/balancing-inno…
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psnet.ahrq.gov/node/44890/psn-pdf
July 11, 2017 - The frequency of inappropriate nonformulary medication
alert overrides in the inpatient setting.
July 11, 2017
Her QL, Amato MG, Seger DL, et al. The frequency of inappropriate nonformulary medication alert
overrides in the inpatient setting. J Am Med Inform Assoc. 2016;23(5):924-33. doi:10.1093/jamia/ocv181.
http…
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psnet.ahrq.gov/node/38777/psn-pdf
March 04, 2011 - Perceptions of standards-based electronic prescribing
systems as implemented in outpatient primary care: a
physician survey.
March 4, 2011
Wang J, Patel MH, Schueth AJ, et al. Perceptions of standards-based electronic prescribing systems as
implemented in outpatient primary care: a physician survey. J Am Med Infor…
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psnet.ahrq.gov/node/46053/psn-pdf
August 16, 2017 - Pharmacist-led admission medication reconciliation
before and after the implementation of an electronic
medication management system.
August 16, 2017
Sardaneh AA, Burke R, Ritchie A, et al. Pharmacist-led admission medication reconciliation before and
after the implementation of an electronic medication management…
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psnet.ahrq.gov/node/50925/psn-pdf
February 19, 2020 - Report of the Independent Inquiry into the Issues Raised
by Paterson.
February 19, 2020
James G. House Commons Report 31. Department of Health and Social Care. London,
England: Crown Copyright; 2020. ISBN 9781528617284.
https://psnet.ahrq.gov/issue/report-independent-inquiry-issues-raised-paterson
Shari…
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psnet.ahrq.gov/node/41191/psn-pdf
March 21, 2012 - Reviewing the impact of computerized provider order
entry on clinical outcomes: the quality of systematic
reviews.
March 21, 2012
Weir C, Staggers N, Laukert T. Reviewing the impact of computerized provider order entry on clinical
outcomes: The quality of systematic reviews. Int J Med Inform. 2012;81(4):219-31.
d…
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psnet.ahrq.gov/node/74693/psn-pdf
January 26, 2022 - Including the reason for use on prescriptions sent to
pharmacists: scoping review.
January 26, 2022
Mercer K, Carter C, Burns C, et al. Including the reason for use on prescriptions sent to pharmacists:
scoping review. JMIR Hum Factors. 2021;8(4):e22325. doi:10.2196/22325.
https://psnet.ahrq.gov/issue/including-re…