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psnet.ahrq.gov/node/43265/psn-pdf
February 15, 2024 - Five Medication Safety Tips for Older Adults.
February 15, 2024
FDA Consumer Health Information. Silver Spring, MD: US Food and Drug Administration; February 15,
2024.
https://psnet.ahrq.gov/issue/five-medication-safety-tips-older-adults
Highlighting how aging affects medication absorption that may lead to complic…
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psnet.ahrq.gov/issue/reporting-incidents-involving-use-advanced-medical-technologies-nurses-home-care-cross
March 24, 2021 - Study
Reporting incidents involving the use of advanced medical technologies by nurses in home care: a cross-sectional survey and an analysis of registration data.
Citation Text:
ten Haken I, Ben Allouch S, van Harten WH. Reporting incidents involving the use of advanced medical technolo…
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psnet.ahrq.gov/issue/use-recalled-devices-new-device-authorizations-under-us-food-and-drug-administrations-510k
April 13, 2022 - Study
Use of recalled devices in new device authorizations under the US Food and Drug Administration's 510(k) pathway and risk of subsequent recalls.
Citation Text:
Kramer DB, Yeh RW. Use of recalled devices in new device authorizations under the US Food and Drug Administration's 510(k) …
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psnet.ahrq.gov/issue/indication-alerts-intercept-drug-name-confusion-errors-during-computerized-entry-medication
August 28, 2019 - Study
Indication alerts intercept drug name confusion errors during computerized entry of medication orders.
Citation Text:
Galanter W, Bryson M, Falck S, et al. Indication alerts intercept drug name confusion errors during computerized entry of medication orders. PLoS One. 2014;9(7):e10…
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psnet.ahrq.gov/issue/experience-trigger-tool-identifying-adverse-drug-events-among-older-adults-ambulatory-primary
June 07, 2023 - Study
Experience with a trigger tool for identifying adverse drug events among older adults in ambulatory primary care.
Citation Text:
Singh R, McLean-Plunckett EA, Kee R, et al. Experience with a trigger tool for identifying adverse drug events among older adults in ambulatory primary …
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psnet.ahrq.gov/node/33646/psn-pdf
February 01, 2007 - In Conversation with...Joseph Britto, MD
February 1, 2007
In Conversation with..Joseph Britto, MD. PSNet [internet]. 2007.
https://psnet.ahrq.gov/perspective/conversation-withjoseph-britto-md
Editor's Note: Joseph Britto, MD, is CEO and Co-founder of Isabel Healthcare Inc. Isabel, a clinical
decision support syste…
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psnet.ahrq.gov/node/49694/psn-pdf
October 01, 2013 - Are You Mrs. A? An Issue of Identification Over
Telephone
October 1, 2013
Adelman JS. Are You Mrs. A? An Issue of Identification Over Telephone. PSNet [internet]. 2013.
https://psnet.ahrq.gov/web-mm/are-you-mrs-issue-identification-over-telephone
The Case
Mr. A was a 78-year-old man admitted with non-ST elevation…
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psnet.ahrq.gov/node/49707/psn-pdf
April 01, 2014 - CYP450 Drugs: Expect the Unexpected
April 1, 2014
Gonzalez CJ. CYP450 Drugs: Expect the Unexpected. PSNet [internet]. 2014.
https://psnet.ahrq.gov/web-mm/cyp450-drugs-expect-unexpected
The Case
A 42-year-old man with acquired immunodeficiency syndrome (AIDS) (CD4 count 198), hip dystocia, and
generalized anxiety …
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psnet.ahrq.gov/node/49781/psn-pdf
January 01, 2017 - Phenytoin was listed as the
fourth leading drug associated with loading dose incidents, behind only
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psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.230_slideshow.ppt
December 01, 2010 - 19486198
*
Regulatory Bodies & Payers
In 2007, Centers for Medicare & Medicaid
Services (CMS) listed
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psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.362_slideshow.ppt
December 01, 2015 - have been issued about deaths due to silencing alarms on patient monitoring devices
Alarm fatigue was listed
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psnet.ahrq.gov/issue/medication-reconciliation-ambulatory-care-attempts-improvement
March 28, 2011 - Study
Medication reconciliation in ambulatory care: attempts at improvement.
Citation Text:
Nassaralla CL, Naessens JM, Hunt VL, et al. Medication reconciliation in ambulatory care: attempts at improvement. Qual Saf Health Care. 2009;18(5):402-7. doi:10.1136/qshc.2007.024513.
Copy Ci…
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psnet.ahrq.gov/issue/standardizing-concentrations-adult-drug-infusions-indiana
August 01, 2018 - Commentary
Standardizing concentrations of adult drug infusions in Indiana.
Citation Text:
Walroth TA, Dossett HA, Doolin M, et al. Standardizing concentrations of adult drug infusions in Indiana. Am J Health Syst Pharm. 2017;74(7):491-497. doi:10.2146/ajhp151018.
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For…
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psnet.ahrq.gov/issue/developing-agreement-never-events-primary-care-dentistry-international-edelphi-study
October 05, 2016 - Study
Developing agreement on never events in primary care dentistry: an international eDelphi study.
Citation Text:
Ensaldo-Carrasco E, Carson-Stevens A, Cresswell K, et al. Developing agreement on never events in primary care dentistry: an international eDelphi study. Br Dent J. 2018;2…
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psnet.ahrq.gov/issue/necessity-pathway-high-alert-patients
July 14, 2010 - Commentary
Necessity for a pathway for "high-alert" patients.
Citation Text:
Shane R, Amer K, Noh L, et al. Necessity for a pathway for "high-alert" patients. Am J Health Syst Pharm. 2018;75(13):993-997. doi:10.2146/ajhp170397.
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Format:
DOI Google Scholar PubMe…
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psnet.ahrq.gov/issue/medication-reconciliation-qualitative-analysis-clinicians-perceptions
October 10, 2015 - Study
Medication reconciliation: a qualitative analysis of clinicians' perceptions.
Citation Text:
Vogelsmeier A, Pepper GA, Oderda L, et al. Medication reconciliation: A qualitative analysis of clinicians' perceptions. Res Social Adm Pharm. 2013;9(4):419-30. doi:10.1016/j.sapharm.201…
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psnet.ahrq.gov/curated-library/medicationdrug-errors
March 12, 2021 - Breadcrumb
Home
The PSNet Collection
Curated Libraries
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Medication/Drug Errors
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Created By: Dr. Yan Xiao, AHRQ TEP Member
Date…
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psnet.ahrq.gov/issue/using-pediatric-trigger-tool-estimate-total-harm-burden-hospital-acquired-conditions
July 03, 2016 - Study
Using a pediatric trigger tool to estimate total harm burden hospital-acquired conditions represent.
Citation Text:
Stockwell DC, Landrigan CP, Schuster MA, et al. Using a Pediatric Trigger Tool to Estimate Total Harm Burden Hospital-acquired Conditions Represent. Pediatr Qual Saf.…
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psnet.ahrq.gov/issue/secondary-analysis-hand-offs-internal-medicine-using-i-pass-mnemonic
April 22, 2013 - Study
Secondary analysis of hand-offs in internal medicine using the I-PASS mnemonic.
Citation Text:
Huber A, Moyano B, Blondon K. Secondary analysis of hand-offs in internal medicine using the I-PASS mnemonic. BMC Med Educ. 2024;24(1):1046. doi:10.1186/s12909-024-05880-7.
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psnet.ahrq.gov/node/40395/psn-pdf
May 13, 2021 - Hospital Compare.
May 13, 2021
Centers for Medicare & Medicaid Services.
https://psnet.ahrq.gov/issue/hospital-compare
The Centers for Medicare and Medicaid Services (CMS) provides consumers with publicly available
information on the quality of Medicare-certified hospital care through this Web site. The site inclu…