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psnet.ahrq.gov/node/837429/psn-pdf
January 01, 2022 - Improving allergy documentation: a retrospective
electronic health record system-wide patient safety
initiative.
January 1, 2022
Li L, Foer D, Hallisey RK, et al. Improving allergy documentation: a retrospective electronic health record
system-wide patient safety initiative. J Patient Saf. 2022;18(1):e108-e114.
d…
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psnet.ahrq.gov/node/35462/psn-pdf
February 18, 2011 - Effect of the transformation of the Veterans Affairs Health
Care System on the quality of care.
February 18, 2011
Jha AK, Perlin JB, Kizer KW, et al. Effect of the transformation of the Veterans Affairs Health Care System
on the quality of care. N Engl J Med. 2003;348(22):2218-27.
https://psnet.ahrq.gov/issue/effe…
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psnet.ahrq.gov/node/846440/psn-pdf
March 22, 2023 - "Are we there yet?" Ten persistent hazards and
inefficiencies with the use of medication administration
technology from the perspective of practicing nurses.
March 22, 2023
Taft T, Rudd EA, Thraen I, et al. “Are we there yet?” Ten persistent hazards and inefficiencies with the use
of medication administration tech…
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psnet.ahrq.gov/node/46532/psn-pdf
July 30, 2018 - Efficiency and safety of speech recognition for
documentation in the electronic health record.
July 30, 2018
Hodgson T, Magrabi F, Coiera E. Efficiency and safety of speech recognition for documentation in the
electronic health record. J Am Med Inform Assoc. 2017;24(6):1127-1133. doi:10.1093/jamia/ocx073.
https://…
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psnet.ahrq.gov/node/40807/psn-pdf
September 01, 2016 - Prevalence of medication administration errors in two
medical units with automated prescription and
dispensing.
September 1, 2016
Rodriguez-Gonzalez CG, Herranz-Alonso A, Martin-Barbero ML, et al. Prevalence of medication
administration errors in two medical units with automated prescription and dispensing. J Am M…
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psnet.ahrq.gov/node/72792/psn-pdf
March 03, 2021 - Avoiding a Med-Wreck: a structured medication
reconciliation framework and standardized auditing tool
utilized to optimize patient safety and reallocate hospital
resources.
March 3, 2021
Elbeddini A, Almasalkhi S, Prabaharan T, et al. Avoiding a Med-Wreck: a structured medication
reconciliation framework and stan…
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psnet.ahrq.gov/node/42542/psn-pdf
March 17, 2014 - Surgical checklists: a systematic review of impacts and
implementation.
March 17, 2014
Treadwell JR, Lucas S, Tsou AY. Surgical checklists: a systematic review of impacts and implementation.
BMJ Qual Saf. 2014;23(4):299-318. doi:10.1136/bmjqs-2012-001797.
https://psnet.ahrq.gov/issue/surgical-checklists-systematic…
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psnet.ahrq.gov/node/865483/psn-pdf
April 03, 2024 - Risks in the analogue and digitally-supported medication
process and potential solutions to increase patient safety
in the hospital: a mixed methods study.
April 3, 2024
Kopanz J, Lichtenegger K, Schwarz CM, et al. Risks in the analogue and digitally-supported medication
process and potential solutions to increase…
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psnet.ahrq.gov/node/853965/psn-pdf
September 27, 2023 - Patients' negative experiences with health care settings
brought to light by formal complaints: a qualitative
metasynthesis.
September 27, 2023
Eriksen AA, Fegran L, Fredwall TE, et al. Patients' negative experiences with health care settings brought
to light by formal complaints: a qualitative metasynthesis. J Cl…
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psnet.ahrq.gov/node/50406/psn-pdf
October 02, 2019 - The co-design, implementation and evaluation of a
serious board game 'PlayDecide patient safety' to educate
junior doctors about patient safety and the importance of
reporting safety concerns
October 2, 2019
Ward M, Shé ÉN, De Brún A, et al. The co-design, implementation and evaluation of a serious board game
'Pl…
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psnet.ahrq.gov/node/60326/psn-pdf
May 13, 2020 - Preventing diagnostic errors in ambulatory care: an
electronic notification tool for incomplete radiology tests.
May 13, 2020
Weingart SN, Yaghi O, Barnhart L, et al. Preventing diagnostic errors in ambulatory care: an electronic
notification tool for incomplete radiology tests. Appl Clin Inform. 2020;11(02). doi:1…
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psnet.ahrq.gov/node/45942/psn-pdf
January 01, 2021 - Medication safety in two intensive care units of a
community teaching hospital after electronic health
record implementation: sociotechnical and human factors
engineering considerations.
March 15, 2017
Carayon P, Wetterneck TB, Cartmill R, et al. Medication Safety in Two Intensive Care Units of a
Community Teachi…
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psnet.ahrq.gov/node/35050/psn-pdf
May 27, 2011 - High rates of adverse drug events in a highly
computerized hospital.
May 27, 2011
Nebeker JR, Hoffman JM, Weir C, et al. High rates of adverse drug events in a highly computerized
hospital. Arch Intern Med. 2005;165(10):1111-6.
https://psnet.ahrq.gov/issue/high-rates-adverse-drug-events-highly-computerized-hospita…
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psnet.ahrq.gov/node/36222/psn-pdf
March 10, 2011 - Impact of a computerized clinical decision support
system on reducing inappropriate antimicrobial use: a
randomized controlled trial.
March 10, 2011
McGregor JC, Weekes E, Forrest GN, et al. Impact of a computerized clinical decision support system on
reducing inappropriate antimicrobial use: a randomized controll…
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psnet.ahrq.gov/node/35907/psn-pdf
October 03, 2017 - Transparent and open discussion of errors does not
increase malpractice risk in trauma patients.
October 3, 2017
Stewart RM, Corneille MG, Johnston J, et al. Transparent and open discussion of errors does not increase
malpractice risk in trauma patients. Ann Surg. 2006;243(5):645-9; discussion 649-51.
https://psne…
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psnet.ahrq.gov/node/867384/psn-pdf
December 18, 2024 - Involving patients and/or their next of kin in serious
adverse event investigations: a qualitative study on
hospital perspectives.
December 18, 2024
Knap LJ, Dijkstra-Eijkemans RI, Friele RD, et al. Involving patients and/or their next of kin in serious
adverse event investigations: a qualitative study on hospital…
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psnet.ahrq.gov/node/865711/psn-pdf
May 01, 2024 - Paediatric medication incident reporting: a multicentre
comparison study of medication errors identified at audit,
detected by staff and reported to an incident system.
May 1, 2024
Li L, Badgery-Parker T, Merchant A, et al. Paediatric medication incident reporting: a multicentre
comparison study of medication erro…
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psnet.ahrq.gov/node/841151/psn-pdf
December 07, 2022 - Discontinuation of outpatient medications: implications
for electronic messaging to pharmacies using CancelRx.
December 7, 2022
Pitts S, Yang Y, Thomas BA, et al. Discontinuation of outpatient medications: implications for electronic
messaging to pharmacies using CancelRx. J Am Med Inform Assoc. 2022;29(12):2101-21…
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psnet.ahrq.gov/node/42832/psn-pdf
September 01, 2016 - Overrides of medication-related clinical decision support
alerts in outpatients.
September 1, 2016
Nanji KC, Slight SP, Seger DL, et al. Overrides of medication-related clinical decision support alerts in
outpatients. J Am Med Inform Assoc. 2014;21(3):487-91. doi:10.1136/amiajnl-2013-001813.
https://psnet.ahrq.gov…
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psnet.ahrq.gov/node/42149/psn-pdf
December 23, 2016 - Medical device alarm safety in hospitals.
December 23, 2016
Medical device alarm safety in hospitals. Sentinel event alert. 2013;(50):1-3.
https://psnet.ahrq.gov/issue/medical-device-alarm-safety-hospitals
The cacophony of alarms in hospitals has led many health care providers to become desensitized to them,
a con…