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psnet.ahrq.gov/issue/improving-patient-safety-using-interactive-evidence-based-decision-support-tools
September 14, 2022 - Commentary
Improving patient safety using interactive, evidence-based decision support tools.
Citation Text:
Quinn MM, Mannion J. Improving patient safety using interactive, evidence-based decision support tools. Jt Comm J Qual Patient Saf. 2005;31(12):678-683.
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psnet.ahrq.gov/issue/managing-medication-errors-qualitative-study
December 06, 2023 - Study
Managing medication errors—a qualitative study.
Citation Text:
Stetina P, Groves M, Pafford L. Managing medication errors--a qualitative study. Medsurg Nurs. 2005;14(3):174-8.
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psnet.ahrq.gov/issue/primary-medication-non-adherence-analysis-195930-electronic-prescriptions
July 27, 2016 - Study
Primary medication non-adherence: analysis of 195,930 electronic prescriptions.
Citation Text:
Fischer MA, Stedman MR, Lii J, et al. Primary medication non-adherence: analysis of 195,930 electronic prescriptions. J Gen Intern Med. 2010;25(4):284-90. doi:10.1007/s11606-010-1253-9.…
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psnet.ahrq.gov/issue/monitoring-anaesthetist-operating-theatre-professional-competence-and-patient-safety
November 15, 2023 - Review
Monitoring the anaesthetist in the operating theatre—professional competence and patient safety.
Citation Text:
Larsson J. Monitoring the anaesthetist in the operating theatre - professional competence and patient safety. Anaesthesia. 2017;72 Suppl 1:76-83. doi:10.1111/anae.13743.…
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psnet.ahrq.gov/issue/medication-errors-pediatric-inpatients-prevalence-and-results-prevention-program
May 22, 2019 - Study
Medication errors in pediatric inpatients: prevalence and results of a prevention program.
Citation Text:
Otero P, Leyton A, Mariani G, et al. Medication errors in pediatric inpatients: prevalence and results of a prevention program. Pediatrics. 2008;122(3):e737-43. doi:10.1542/…
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psnet.ahrq.gov/issue/always-having-say-youre-sorry-ethical-response-making-mistakes-professional-practice
September 09, 2011 - Review
Always having to say you're sorry: an ethical response to making mistakes in professional practice.
Citation Text:
Crigger NJ. Always having to say you're sorry: an ethical response to making mistakes in professional practice. Nurs Ethics. 2004;11(6):568-76.
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psnet.ahrq.gov/issue/distracting-communications-operating-theatre
August 18, 2017 - Study
Distracting communications in the operating theatre.
Citation Text:
Sevdalis N, Healey AN, Vincent CA. Distracting communications in the operating theatre. J Eval Clin Pract. 2007;13(3). doi:10.1111/j.1365-2753.2006.00712.x.
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psnet.ahrq.gov/issue/performance-web-based-clinical-diagnosis-support-system-internists
August 02, 2023 - Study
Performance of a web-based clinical diagnosis support system for internists.
Citation Text:
Graber ML, Mathew A. Performance of a web-based clinical diagnosis support system for internists. J Gen Intern Med. 2008;23 Suppl 1:37-40. doi:10.1007/s11606-007-0271-8.
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psnet.ahrq.gov/issue/personalised-performance-feedback-reduces-narcotic-prescription-errors-nicu
July 13, 2010 - Study
Personalised performance feedback reduces narcotic prescription errors in a NICU.
Citation Text:
Sullivan KM, Suh S, Monk H, et al. Personalised performance feedback reduces narcotic prescription errors in a NICU. BMJ Qual Saf. 2013;22(3):256-62. doi:10.1136/bmjqs-2012-001089.
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psnet.ahrq.gov/issue/faces-errors-case-based-approach-educating-providers-policy-makers-and-public-about-patient
March 13, 2013 - Commentary
The faces of errors: a case-based approach to educating providers, policy makers, and the public about patient safety.
Citation Text:
Wachter R, Shojania KG. The faces of errors: a case-based approach to educating providers, policymakers, and the public about patient safety. J…
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psnet.ahrq.gov/issue/disclosing-medical-errors-patients-challenge-health-care-professionals-and-institutions
April 19, 2017 - Commentary
Disclosing medical errors to patients: a challenge for health care professionals and institutions.
Citation Text:
Levinson W. Disclosing medical errors to patients: a challenge for health care professionals and institutions. Patient Educ Couns. 2009;76(3):296-9. doi:10.1016/…
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psnet.ahrq.gov/issue/quality-improvement-healthcare-new-zealand-part-2-are-our-patients-safe-and-what-are-we-doing
April 01, 2015 - Commentary
Quality improvement in healthcare in New Zealand. Part 2: are our patients safe--and what are we doing about it?
Citation Text:
Merry A, Seddon M, Quality EPI and. Quality improvement in healthcare in New Zealand. Part 2: are our patients safe--and what are we doing about it…
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psnet.ahrq.gov/issue/prioritizing-threats-patient-safety-rural-primary-care
April 23, 2014 - Study
Prioritizing threats to patient safety in rural primary care.
Citation Text:
Singh R, Singh A, Servoss TJ, et al. Prioritizing threats to patient safety in rural primary care. J Rural Health. 2007;23(2):173-8.
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psnet.ahrq.gov/issue/inpatient-notes-reducing-diagnostic-error-new-horizon-opportunities-hospital-medicine
February 24, 2021 - Commentary
Inpatient notes: reducing diagnostic error—a new horizon of opportunities for hospital medicine.
Citation Text:
Singh H, Zwaan L. Web Exclusives. Annals for Hospitalists Inpatient Notes - Reducing Diagnostic Error-A New Horizon of Opportunities for Hospital Medicine. Ann Inter…
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psnet.ahrq.gov/issue/use-cascading-a3s-drive-systemwide-improvement
January 29, 2015 - Commentary
Use of cascading A3s to drive systemwide improvement.
Citation Text:
Winner LE, Burroughs TJ, Cady-Reh JA, et al. Use of Cascading A3s to Drive Systemwide Improvement. Jt Comm J Qual Patient Saf. 2017;43(8):422-428. doi:10.1016/j.jcjq.2017.03.011.
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psnet.ahrq.gov/issue/quality-safety-time-coronavirus-design-better-learn-faster
March 29, 2017 - Commentary
Quality & safety in the time of coronavirus--design better, learn faster.
Citation Text:
Fitzsimons J. Quality and safety in the time of Coronavirus: design better, learn faster. Int J Qual Health Care. 2021;33(1):mzaa051. doi:10.1093/intqhc/mzaa051.
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psnet.ahrq.gov/issue/set-phasers-stun-and-other-true-tales-design-technology-and-human-error-second-edition
May 30, 2019 - Book/Report
Classic
Set Phasers on Stun: And Other True Tales of Design, Technology, and Human Error, Second Edition.
Citation Text:
Set Phasers on Stun: And Other True Tales of Design, Technology, and Human Error, Second Edition. Casey SM. Santa Barbara, CA: Ae…
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psnet.ahrq.gov/issue/universal-protocol-preventing-wrong-site-wrong-procedure-wrong-person-surgery
May 30, 2012 - Multi-use Website
Classic
Universal Protocol for Preventing Wrong Site, Wrong Procedure, Wrong Person Surgery.
Citation Text:
Universal Protocol for Preventing Wrong Site, Wrong Procedure, Wrong Person Surgery. The Joint Commission.
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psnet.ahrq.gov/issue/understanding-and-responding-adverse-events
July 19, 2019 - Commentary
Classic
Understanding and responding to adverse events.
Citation Text:
Vincent CA. Understanding and Responding to Adverse Events. New Engl J Med. 2003;348(11):1051-1056. doi:10.1056/nejmhpr020760.
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psnet.ahrq.gov/issue/case-study-identifying-potential-problems-humantechnical-interface-complex-clinical-systems
July 22, 2009 - Commentary
Case study: identifying potential problems at the human/technical interface in complex clinical systems.
Citation Text:
Caudill-Slosberg M, Weeks WB. Case study: identifying potential problems at the human/technical interface in complex clinical systems. Am J Med Qual. 2005;…