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psnet.ahrq.gov/issue/doctors-thinking-about-system-threat-patient-safety
December 09, 2020 - Study
Doctors' thinking about 'the system' as a threat to patient safety.
Citation Text:
Waring J. Doctors' thinking about 'the system' as a threat to patient safety. Health (London). 2007;11(1):29-46.
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psnet.ahrq.gov/issue/university-michigan-quality-and-safety-academic-medical-center
November 13, 2024 - Commentary
University of Michigan: quality and safety in an academic medical center.
Citation Text:
Strong DL, Kin JM, Kratochwill EW, et al. University of Michigan: quality and safety in an academic medical center. Jt Comm J Qual Patient Saf. 2008;34(11):671-7.
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psnet.ahrq.gov/issue/living-will-misinterpreted-dnr-order-confusion-compromises-patient-care
September 11, 2019 - Commentary
A living will misinterpreted as a DNR order: confusion compromises patient care.
Citation Text:
Katsetos AD, Mirarchi FL. A living will misinterpreted as a DNR order: confusion compromises patient care. J Emerg Med. 2011;40(6):629-32. doi:10.1016/j.jemermed.2008.11.014.
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psnet.ahrq.gov/issue/targeted-communication-intervention-using-nursing-crew-resource-management-principles
August 12, 2015 - Study
Targeted communication intervention using nursing crew resource management principles.
Citation Text:
Tschannen D, McClish D, Aebersold M, et al. Targeted communication intervention using nursing crew resource management principles. J Nurs Care Qual. 2015;30(1):7-11. doi:10.1097/NC…
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psnet.ahrq.gov/issue/medication-reconciliation-emergency-department-opportunities-workflow-redesign
August 04, 2021 - Commentary
Medication reconciliation in the emergency department: opportunities for workflow redesign.
Citation Text:
Hummel J, Evans PC, Lee H. Medication reconciliation in the emergency department: opportunities for workflow redesign. Qual Saf Health Care. 2010;19(6):531-5. doi:10.11…
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psnet.ahrq.gov/issue/series-anesthesia-related-maternal-deaths-michigan-1985-2003
February 26, 2009 - Study
A series of anesthesia-related maternal deaths in Michigan, 1985-2003.
Citation Text:
Mhyre JM, Riesner MN, Polley LS, et al. A series of anesthesia-related maternal deaths in Michigan, 1985-2003. Anesthesiology. 2007;106(6):1096-1104.
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psnet.ahrq.gov/issue/medication-error-alerts-warfarin-orders-detected-bar-code-assisted-medication-administration
July 03, 2014 - Study
Medication-error alerts for warfarin orders detected by a bar-code-assisted medication administration system.
Citation Text:
FitzHenry F, Doran J, Lobo B, et al. Medication-error alerts for warfarin orders detected by a bar-code-assisted medication administration system. Am J Hea…
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psnet.ahrq.gov/issue/patients-and-families-perspectives-patient-safety-end-life-video-reflexive-ethnography-study
December 18, 2013 - Study
Patients' and families' perspectives of patient safety at the end of life: a video-reflexive ethnography study.
Citation Text:
Collier A, Sorensen R, Iedema R. Patients' and families' perspectives of patient safety at the end of life: a video-reflexive ethnography study. Int J Qual…
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psnet.ahrq.gov/issue/daily-dose-communication-improve-quality-and-safety-outcomes
September 15, 2009 - Review
A daily dose of communication to improve quality and safety outcomes.
Citation Text:
Halm MA. A daily dose of communication to improve quality and safety outcomes. Am J Crit Care. 2024;33(4):305-310. doi:10.4037/ajcc2024318.
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psnet.ahrq.gov/issue/case-based-learning-patient-safety-lessons-learnt-program-uk-junior-doctors
July 15, 2015 - Commentary
Case-based learning for patient safety: the Lessons Learnt program for UK junior doctors.
Citation Text:
Ahmed M, Arora S, Baker P, et al. Case-based learning for patient safety: the Lessons Learnt program for UK junior doctors. World J Surg. 2012;36(5):956-8. doi:10.1007/s0…
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psnet.ahrq.gov/issue/review-bringing-patient-safety-forefront-through-structured-computerisation-during-clinical
January 13, 2021 - Review
Review: bringing patient safety to the forefront through structured computerisation during clinical handover.
Citation Text:
Matic J, Davidson PM, Salamonson Y. Review: bringing patient safety to the forefront through structured computerisation during clinical handover. J Clin N…
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psnet.ahrq.gov/issue/patterns-medical-and-nursing-staff-communication-nursing-homes-implications-and-insights
December 22, 2018 - Study
Patterns of medical and nursing staff communication in nursing homes: implications and insights from complexity science.
Citation Text:
Colón-Emeric CS, Ammarell N, Bailey D, et al. Patterns of medical and nursing staff communication in nursing homes: implications and insights fr…
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psnet.ahrq.gov/issue/potential-utility-data-mining-algorithms-early-detection-potentially-fataldisabling-adverse
July 19, 2023 - Study
Potential utility of data-mining algorithms for early detection of potentially fatal/disabling adverse drug reactions: a retrospective evaluation.
Citation Text:
Hauben M, Reich L. Potential utility of data-mining algorithms for early detection of potentially fatal/disabling adve…
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psnet.ahrq.gov/issue/my-brothers-keeper-must-physician-disclose-anothers-medical-error-and-potential-negligence
February 01, 2023 - Commentary
My brother's keeper: must a physician disclose another's medical error and potential negligence?
Citation Text:
Liang BA, Smith C by DS. My brother's keeper: must a physician disclose another's medical error and potential negligence? J Clin Anesth. 2007;19(7):558-562. doi:10…
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psnet.ahrq.gov/issue/current-and-ideal-state-anatomic-pathology-patient-safety
February 15, 2010 - Commentary
The current and ideal state of anatomic pathology patient safety.
Citation Text:
Raab SS. The current and ideal state of anatomic pathology patient safety. MLO Med Lab Obs. 2014;46(6):8-10.
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psnet.ahrq.gov/issue/depth-analysis-medication-errors-hospitalized-patients-hiv
July 15, 2010 - Study
An in-depth analysis of medication errors in hospitalized patients with HIV.
Citation Text:
Snyder AM, Klinker K, Orrick JJ, et al. An in-depth analysis of medication errors in hospitalized patients with HIV. Ann Pharmacother. 2011;45(4):459-68. doi:10.1345/aph.1P599.
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psnet.ahrq.gov/issue/exploring-performance-obstacles-intensive-care-nurses
March 11, 2020 - Study
Exploring performance obstacles of intensive care nurses.
Citation Text:
Gurses AP, Carayon P. Exploring performance obstacles of intensive care nurses. Appl Ergon. 2009;40(3):509-18. doi:10.1016/j.apergo.2008.09.003.
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psnet.ahrq.gov/issue/novice-nurse-and-clinical-decision-making-how-avoid-errors
May 04, 2022 - Review
The novice nurse and clinical decision-making: how to avoid errors.
Citation Text:
Saintsing D, Gibson LM, Pennington AW. The novice nurse and clinical decision-making: how to avoid errors. J Nurs Manag. 2011;19(3):354-9. doi:10.1111/j.1365-2834.2011.01248.x.
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psnet.ahrq.gov/issue/computerized-provider-order-entry-strategies-successful-implementation
February 15, 2017 - Commentary
Computerized provider order entry: strategies for successful implementation.
Citation Text:
Jones S, Moss J. Computerized Provider Order Entry. J Nurs Admin. 2006;36(3):136-139. doi:10.1097/00005110-200603000-00007.
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psnet.ahrq.gov/issue/assessing-organisational-culture-quality-and-safety-improvement-national-survey-tools-and
March 08, 2017 - Study
Assessing organisational culture for quality and safety improvement: a national survey of tools and tool use.
Citation Text:
Mannion R, Konteh FH, Davies HTO. Assessing organisational culture for quality and safety improvement: a national survey of tools and tool use. Qual Saf He…