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  1. Topics | PSNet

    psnet.ahrq.gov/topics-0
    March 03, 2025 - Thromboembolism Go to this topic Medication Safety Go to this topic Medication … Errors/Preventable Adverse Drug Events Go to this topic Administration Errors Go to this

  2. Improving Laboratory Monitoring in Community Practices: A Randomized Trial - Final Report (pdf file)

    digital.ahrq.gov/sites/default/files/docs/citation/r18hs017201-simon-final-report-2012.pdf
    January 01, 2012 - Purpose Objectives of Study Medication errors and preventable adverse drug events occur commonly … Scope Background Medication … errors and preventable adverse drug events are an important target for patient safety and quality improvement … The Institute of Medicine report “Prevention of Medication Errors,” highlights the problem of medication … errors and adverse drug events in the outpatient setting and estimates that at least 1.5 million preventable

  3. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/37165/psn-pdf
    May 02, 2018 - Lack of standard dosing methods contributes to IV errors. May 2, 2018 ISMP Medication Safety Alert! Acute care edition. August 23, 2007, https://psnet.ahrq.gov/issue/lack-standard-dosing-methods-contributes-iv-errors This article discusses the myriad dosing methods that can lead to errors in administering intraveno…

  4. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/35683/psn-pdf
    April 25, 2018 - Double key bounce and double keying errors. April 25, 2018 ISMP Medication Safety Alert! Acute care edition. January 12, 2006. https://psnet.ahrq.gov/issue/double-key-bounce-and-double-keying-errors This article describes problems involving the keys on infusion pumps and includes recommendations to help prevent er…

  5. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/867047/psn-pdf
    October 30, 2024 - Therapeutic errors involving diabetes medications reported to United States poison centers. October 30, 2024 Thurgood Giarman A, Hays HL, Badeti J, et al. Therapeutic errors involving diabetes medications reported to United States poison centers. Inj Epidemiol. 2024;11(1):51. doi:10.1186/s40621-024-00536-y. https:…

  6. The Role of Health Literacy in Patient Safety | PSNet

    psnet.ahrq.gov/perspective/role-health-literacy-patient-safety
    March 22, 2009 - errors that result from improper dosing administration.( 6 ) Numerous studies have found low health … December 19, 2017 Pictograms, units and dosing tools, and parent medication errors: a … November 26, 2014 Liquid medication errors and dosing tools: a randomized controlled … November 2, 2010 Medication errors in chemotherapy: incidence, types and involvement … June 2, 2010 Out-of-hospital medication errors: a 6-year analysis of the national poison

  7. Drug shortages continue to compromise patient care. | PSNet

    psnet.ahrq.gov/issue/drug-shortages-continue-compromise-patient-care
    February 24, 2016 - Newspaper/Magazine Article Drug shortages continue to compromise patient care. Citation Text: Drug shortages continue to compromise patient care. ISMP Medication Safety Alert! Acute Care Edition. January 11, 2018;23:1-4. Copy Citation Save Save to your library …

  8. Are you well positioned to resolve conflicts with the safety of an order? Learning from a physician’s homicide trial and the firing of multiple healthcare workers. | PSNet

    psnet.ahrq.gov/issue/are-you-well-positioned-resolve-conflicts-safety-order-learning-physicians-homicide-trial-and
    May 18, 2022 - Newspaper/Magazine Article Are you well positioned to resolve conflicts with the safety of an order? Learning from a physician’s homicide trial and the firing of multiple healthcare workers. Citation Text: Are you well positioned to resolve conflicts with the safety of an order? Learning…

  9. Drug shortages and clinicians: no time for complacency. | PSNet

    psnet.ahrq.gov/issue/drug-shortages-and-clinicians-no-time-complacency
    February 26, 2009 - Commentary Drug shortages and clinicians: no time for complacency. Citation Text: Rochon P, Gurwitz JH. Drug shortages and clinicians: no time for complacency. Arch Intern Med. 2012;172(19):1499-500. Copy Citation Format: Google Scholar PubMed BibTeX EndNote X3 XML EndNote …

  10. Check Your Medicines: Tips for Taking Medicines Safely. | PSNet

    psnet.ahrq.gov/issue/check-your-medicines-tips-taking-medicines-safely
    September 04, 2018 - Government Resource Check Your Medicines: Tips for Taking Medicines Safely. Save Save to your library Print Download PDF Share Facebook Twitter Linkedin Copy URL April 23, 2012 This 5-point checklist provides consu…

  11. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/852275/psn-pdf
    January 01, 2024 - Improving emergency medicine clinician awareness of prehospital-administered medications. August 9, 2023 Kamta J, Fregoso B, Lee A, et al. Improving emergency medicine clinician awareness of prehospital- administered medications. Prehosp Emerg Care. 2024;28(3):506-512. doi:10.1080/10903127.2023.2238815. https://p…

  12. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/73595/psn-pdf
    August 11, 2021 - Safety committees need to proactively address the risk of accidental cerebral injection of intravenous (IV) drugs. August 11, 2021 ISMP Medication Safety Alert! Acute care edition. July 29, 2021;26(15);1-5. https://psnet.ahrq.gov/issue/safety-committees-need-proactively-address-risk-accidental-cerebral-injection- …

  13. Medication Safety in Nursing Homes: What's Wrong and How to Fix It | PSNet

    psnet.ahrq.gov/perspective/medication-safety-nursing-homes-whats-wrong-and-how-fix-it
    August 01, 2012 - and the hospital are very common in this patient population and add further to increasing the risk of medication … errors and preventable adverse drug events. … 28, 2021 Multicomponent pharmacist intervention did not reduce clinically important medication … errors for ambulatory patients initiating direct oral anticoagulants. … September 2, 2015 Patterns in nursing home medication errors: disproportionality analysis

  14. Physician liability in the age of data reliance and errors. | PSNet

    psnet.ahrq.gov/issue/physician-liability-age-data-reliance-and-errors
    March 18, 2020 - Commentary Physician liability in the age of data reliance and errors. Citation Text: Physician liability in the age of data reliance and errors. Montesantos L. Ann Health Law Life Sci. 2022;31(Spring):179-215. Copy Citation Save Save to your library Print…

  15. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/42810/psn-pdf
    June 10, 2018 - First annual review of data submitted to the ISMP National Vaccine Errors Reporting Program (VERP). June 10, 2018 ISMP Medication Safety Alert! Acute Care Edition. November 28, 2013;18:1-5. https://psnet.ahrq.gov/issue/first-annual-review-data-submitted-ismp-national-vaccine-errors-reporting- program-verp This re…

  16. Medication Error and Near Miss Classification Form | Digital Healthcare Research

    digital.ahrq.gov/health-it-tools-and-resources/ahrq-funded-project-resources-archives/medication-error-and-near-miss
    January 01, 2023 - Medication Error and Near Miss Classification Form Description This is a near … Document Source Statewide Implementation of Electronic Health Records PDF Medication … Error and Near Miss Classification Form

  17. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/73995/psn-pdf
    October 20, 2021 - Potential for medication overdose with ENFit low dose tip syringe: FDA Safety Communication. October 20, 2021 MedWatch Safety Alert. Silver Spring, MD: US Food and Drug Administration; October 12, 2021. https://psnet.ahrq.gov/issue/potential-medication-overdose-enfit-low-dose-tip-syringe-fda-safety- communication …

  18. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/46751/psn-pdf
    July 23, 2018 - A call for a systems-thinking approach to medication adherence: stop blaming the patient. July 23, 2018 Lauffenburger JC, Choudhry NK. A Call for a Systems-Thinking Approach to Medication Adherence: Stop Blaming the Patient. JAMA Intern Med. 2018;178(7):950-951. doi:10.1001/jamainternmed.2018.0790. https://psnet.a…

  19. Healthcare failure mode and effect analysis (HFMEA) as an effective mechanism in preventing infection caused by accompanying caregivers during COVID-19-experience of a city medical center in Taiwan. | PSNet

    psnet.ahrq.gov/issue/healthcare-failure-mode-and-effect-analysis-hfmea-effective-mechanism-preventing-infection
    April 05, 2023 - April 5, 2023 How effective are electronic medication systems in reducing medication … error rates and associated harm among hospital inpatients?

  20. Escape Room. | PSNet

    psnet.ahrq.gov/issue/escape-room
    April 30, 2024 - Tools/Toolkit Escape Room. Citation Text: Escape Room. Harrisburg, PA: Pennsylvania Safety Authority; 2020. Copy Citation Save Save to your library Print Download PDF Share Facebook Twitter Linkedin Copy URL …
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