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psnet.ahrq.gov/node/855436/psn-pdf
November 15, 2023 - Medication Safety for Look-alike, Sound-alike Medicines.
November 15, 2023
Galappatthy P, Mair A, Dhingra-Kumar N et al. Geneva, Switzerland: World Health Organization; 2023.
ISBN 9789240058897.
https://psnet.ahrq.gov/issue/medication-safety-look-alike-sound-alike-medicines
Look-alike, sound-alike (LASA) medicines…
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psnet.ahrq.gov/node/40118/psn-pdf
January 05, 2011 - Hospital computerized provider order entry adoption and
quality: an examination of the United States.
January 5, 2011
Kazley AS, Diana ML. Hospital computerized provider order entry adoption and quality: an examination of
the United States. Health Care Manage Rev. 2011;36(1):86-94. doi:10.1097/HMR.0b013e3181c8b1e5.…
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psnet.ahrq.gov/node/41546/psn-pdf
December 29, 2014 - Using a logic model to design and evaluate quality and
patient safety improvement programs.
December 29, 2014
Goeschel CA, Weiss WM, Pronovost P. Using a logic model to design and evaluate quality and patient
safety improvement programs. Int J Qual Health Care. 2012;24(4):330-7. doi:10.1093/intqhc/mzs029.
https://…
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psnet.ahrq.gov/node/44547/psn-pdf
November 25, 2015 - Monitoring patient safety in primary care: an exploratory
study using in-depth semistructured interviews.
November 25, 2015
Samra R, Bottle A, Aylin PP. Monitoring patient safety in primary care: an exploratory study using in-depth
semistructured interviews. BMJ Open. 2015;5(9):e008128. doi:10.1136/bmjopen-2015-008…
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psnet.ahrq.gov/node/45181/psn-pdf
June 22, 2016 - Strengthening leadership as a catalyst for enhanced
patient safety culture: a repeated cross-sectional
experimental study.
June 22, 2016
Kristensen S, Christensen KB, Jaquet A, et al. Strengthening leadership as a catalyst for enhanced patient
safety culture: a repeated cross-sectional experimental study. BMJ Open…
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psnet.ahrq.gov/node/74722/psn-pdf
February 02, 2022 - Preventing and mitigating radiology system failures: a
guide to disaster planning.
February 2, 2022
Gibney BT, Roberts JM, D'Ortenzio RM, et al. Preventing and mitigating radiology system failures: a guide
to disaster planning. RadioGraphics. 2021;41(7):2111-2126. doi:10.1148/rg.2021210083.
https://psnet.ahrq.gov/…
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psnet.ahrq.gov/node/40101/psn-pdf
January 17, 2012 - Lessons learned from implementation of a computerized
application for pending tests at hospital discharge.
January 17, 2012
Dalal A, Poon EG, Karson A, et al. Lessons learned from implementation of a computerized application for
pending tests at hospital discharge. J Hosp Med. 2011;6(1):16-21. doi:10.1002/jhm.794.
…
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psnet.ahrq.gov/node/46369/psn-pdf
September 06, 2017 - Critical Issues in Food Allergy: A National Academies
Consensus Report.
September 6, 2017
Sicherer SH, Allen K, Lack G, et al. Critical Issues in Food Allergy: A National Academies Consensus
Report. Pediatrics. 2017;140(2). doi:10.1542/peds.2017-0194.
https://psnet.ahrq.gov/issue/critical-issues-food-allergy-natio…
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psnet.ahrq.gov/node/845276/psn-pdf
March 01, 2023 - Cognitive biases in surgery: systematic review.
March 1, 2023
Armstrong BA, Dutescu IA, Tung A, et al. Cognitive biases in surgery: systematic review. Br J Surg.
2023;110(6):645-654. doi:10.1093/bjs/znad004.
https://psnet.ahrq.gov/issue/cognitive-biases-surgery-systematic-review
Cognitive biases are a known source…
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psnet.ahrq.gov/node/39614/psn-pdf
June 18, 2021 - Preventing violence in the health care setting.
June 18, 2021
Preventing violence in the health care setting. Sentinel Event Alert. 2010;(45):1-3.
https://psnet.ahrq.gov/issue/preventing-violence-health-care-setting
Revised June 2021. The Joint Commission issues sentinel event alerts to highlight areas of high risk…
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psnet.ahrq.gov/node/41228/psn-pdf
August 02, 2012 - Identifying the latent failures underpinning medication
administration errors: an exploratory study.
August 2, 2012
Lawton R, Carruthers S, Gardner P, et al. Identifying the latent failures underpinning medication
administration errors: an exploratory study. Health Serv Res. 2012;47(4):1437-1459. doi:10.1111/j.1475…
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psnet.ahrq.gov/node/45826/psn-pdf
January 18, 2017 - Ensuring staff safety when treating potentially violent
patients.
January 18, 2017
Roca RP, Charen B, Boronow J. Ensuring Staff Safety When Treating Potentially Violent Patients. JAMA.
2016;316(24):2669-2670. doi:10.1001/jama.2016.18260.
https://psnet.ahrq.gov/issue/ensuring-staff-safety-when-treating-potentially-…
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psnet.ahrq.gov/node/46564/psn-pdf
December 06, 2017 - Can the aviation industry be useful in teaching oncology
about safety?
December 6, 2017
Davies JM, Delaney G. Can the Aviation Industry be Useful in Teaching Oncology about Safety? Clin Oncol
(R Coll Radiol). 2017;29(10):669-675. doi:10.1016/j.clon.2017.06.007.
https://psnet.ahrq.gov/issue/can-aviation-industry-be…
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psnet.ahrq.gov/node/46710/psn-pdf
January 30, 2018 - Bias in radiology: the how and why of misses and
misinterpretations.
January 30, 2018
Busby LP, Courtier JL, Glastonbury CM. Bias in Radiology: The How and Why of Misses and
Misinterpretations. Radiographics. 2018;38(1):236-247. doi:10.1148/rg.2018170107.
https://psnet.ahrq.gov/issue/bias-radiology-how-and-why-mis…
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psnet.ahrq.gov/node/48075/psn-pdf
June 19, 2019 - A mismatch made in America.
June 19, 2019
Butcher L. Managed Care. June 2019;28:37-39.
https://psnet.ahrq.gov/issue/mismatch-made-america
Inconsistent patient name entry practices in electronic health records can contribute to wrong-patient
errors. This magazine article reports on the complex nature of addressing …
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psnet.ahrq.gov/node/37307/psn-pdf
January 04, 2012 - Diagnostic errors and abnormal diagnostic tests lost to
follow-up: a source of needless waste and delay to
treatment.
January 4, 2012
Wahls TL. Diagnostic errors and abnormal diagnostic tests lost to follow-up: a source of needless waste
and delay to treatment. J Ambul Care Manage. 2007;30(4):338-343.
https://psn…
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psnet.ahrq.gov/node/39136/psn-pdf
November 25, 2009 - We may remember but what did we learn? Dealing with
errors, crimes and misdemeanours around adverse
events in healthcare.
November 25, 2009
Fischbacher-Smith D, Fischbacher-Smith M. WE MAY REMEMBER BUT WHAT DID WE LEARN?
DEALING WITH ERRORS, CRIMES AND MISDEMEANOURS AROUND ADVERSE EVENTS IN
HEALTHCARE. Financial …
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psnet.ahrq.gov/node/40278/psn-pdf
March 09, 2011 - Safety issues related to the electronic medical record
(EMR): synthesis of the literature from the last decade,
2000–2009.
March 9, 2011
Harrington L, Kennerly DA, Johnson C. Safety issues related to the electronic medical record (EMR):
synthesis of the literature from the last decade, 2000-2009. J Healthc Manag. …
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psnet.ahrq.gov/node/837516/psn-pdf
June 22, 2022 - Fostering ethical conduct through psychological safety.
June 22, 2022
Ferrere A, Rider C, Renerte B et al. Sloan Manag Rev. Summer 2022;39-43.
https://psnet.ahrq.gov/issue/fostering-ethical-conduct-through-psychological-safety
A baseline expectation in a safe organization is that employees feel comfortable and supp…
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psnet.ahrq.gov/node/43410/psn-pdf
August 20, 2014 - Antibiotic prescribing practice in residential aged care
facilities—health care providers' perspectives.
August 20, 2014
Lim CJ, Kwong MW-L, Stuart RL, et al. Antibiotic prescribing practice in residential aged care facilities--
health care providers' perspectives. Med J Aust. 2014;201(2):98-102.
https://psnet.ahr…