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Benefits of direct observation in medication administration to detect errors. | PSNet

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March 09, 2022 - Study Benefits of direct observation in medication administration to detect errors. Citation Text: Diaz-Navarlaz T, Pronovost P, Beortegui E, et al. Benefits of Direct Observation in Medication Administration to Detect Errors. J Patient Saf. 2009;3(4). doi:10.1097/pts.0b013e31815b4cc3.…

The morbidity and mortality meeting: time for a different approach? | PSNet

psnet.ahrq.gov/issue/morbidity-and-mortality-meeting-time-different-approach

August 30, 2023 - Commentary The morbidity and mortality meeting: time for a different approach? Citation Text: Fraser J. The morbidity and mortality meeting: time for a different approach? Arch Dis Child. 2016;101(1):4-8. doi:10.1136/archdischild-2015-309536. Copy Citation Format: DOI Googl…

Automated dispensing cabinets and their impact on the rate of omitted and delayed doses: a systematic review. | PSNet

psnet.ahrq.gov/issue/automated-dispensing-cabinets-and-their-impact-rate-omitted-and-delayed-doses-systematic

October 12, 2022 - Review Automated dispensing cabinets and their impact on the rate of omitted and delayed doses: a systematic review. Citation Text: Jeffrey E, Dalby M, Walsh Á, et al. Automated dispensing cabinets and their impact on the rate of omitted and delayed doses: a systematic review. Explor Res…

Morbidity and mortality conference, grand rounds, and the ACGME's core competencies. | PSNet

psnet.ahrq.gov/issue/morbidity-and-mortality-conference-grand-rounds-and-acgmes-core-competencies

November 16, 2022 - Commentary Morbidity and mortality conference, grand rounds, and the ACGME's core competencies. Citation Text: Kravet SJ, Howell E, Wright SM. Morbidity and mortality conference, grand rounds, and the ACGME's core competencies. J Gen Intern Med. 2006;21(11):1192-4. Copy Citation …

Preventing medication errors at small and rural hospitals. | PSNet

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May 19, 2021 - Newspaper/Magazine Article Preventing medication errors at small and rural hospitals. Citation Text: Preventing medication errors at small and rural hospitals. McCook A. Preventing medication errors at small and rural hospitals. Pharmacy Practice News. May 6, 2020. Copy Citatio…

Nursing and Patient Safety | PSNet

psnet.ahrq.gov/primer/nursing-and-patient-safety

September 15, 2024 - While physicians make diagnostic and treatment decisions, they may only spend 30 to 45 minutes a day … example, in 2020 the national average was 0.75 hprd, which is the equivalent of ¾ of an hour, or 45 minutes

Teamwork in obstetric critical care. | PSNet

psnet.ahrq.gov/issue/teamwork-obstetric-critical-care

January 31, 2024 - Review Teamwork in obstetric critical care. Citation Text: Guise J-M, Segel S. Teamwork in obstetric critical care. Best Pract Res Clin Obstet Gynaecol. 2008;22(5):937-51. doi:10.1016/j.bpobgyn.2008.06.010. Copy Citation Format: DOI Google Scholar PubMed BibTeX EndNote X3…

Another round of the blame game: a paralyzing criminal indictment that recklessly "overrides" just culture. | PSNet

psnet.ahrq.gov/issue/another-round-blame-game-paralyzing-criminal-indictment-recklessly-overrides-just-culture

May 02, 2018 - Newspaper/Magazine Article Another round of the blame game: a paralyzing criminal indictment that recklessly "overrides" just culture. Citation Text: Another round of the blame game: a paralyzing criminal indictment that recklessly "overrides" just culture. ISMP Medication Safety Alert! …

The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity. | PSNet

psnet.ahrq.gov/issue/future-nursing-2020-2030-charting-path-achieve-health-equity

September 12, 2018 - Book/Report The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity. Citation Text: The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity. National Academies of Sciences, Engineering, and Medicine. Washington DC: National Academies Press; …

HealthGrades Quality Study: Third Annual Patient Safety in American Hospitals Study. | PSNet

psnet.ahrq.gov/issue/healthgrades-quality-study-third-annual-patient-safety-american-hospitals-study

September 12, 2012 - Book/Report HealthGrades Quality Study: Third Annual Patient Safety in American Hospitals Study. Citation Text: HealthGrades Quality Study: Third Annual Patient Safety in American Hospitals Study. Denver, CO: HealthGrades; 2006. Copy Citation Save Save to your l…

Nurses' clinical reasoning: processes and practices of medication safety. | PSNet

psnet.ahrq.gov/issue/nurses-clinical-reasoning-processes-and-practices-medication-safety

June 15, 2012 - Study Nurses' clinical reasoning: processes and practices of medication safety. Citation Text: Dickson GL, Flynn L. Nurses' clinical reasoning: processes and practices of medication safety. Qual Health Res. 2012;22(1):3-16. doi:10.1177/1049732311420448. Copy Citation Format: …

Maximize benefits of IV workflow management systems by addressing workarounds and errors. | PSNet

psnet.ahrq.gov/issue/maximize-benefits-iv-workflow-management-systems-addressing-workarounds-and-errors

May 31, 2017 - Newspaper/Magazine Article Maximize benefits of IV workflow management systems by addressing workarounds and errors. Citation Text: Maximize benefits of IV workflow management systems by addressing workarounds and errors. ISMP Medication Safety Alert! Acute care edition. September 7, 20…

Metric units and the preferred dosing of orally administered liquid medications. | PSNet

psnet.ahrq.gov/issue/metric-units-and-preferred-dosing-orally-administered-liquid-medications

April 11, 2011 - Organizational Policy/Guidelines Metric units and the preferred dosing of orally administered liquid medications. Citation Text: Metric Units and the Preferred Dosing of Orally Administered Liquid Medications. doi:10.1542/peds.2015-0072. Copy Citation Format: DOI Google Sch…

South Carolina medication error bill is dangerously off target. | PSNet

psnet.ahrq.gov/issue/south-carolina-medication-error-bill-dangerously-target

October 14, 2015 - Newspaper/Magazine Article South Carolina medication error bill is dangerously off target. Citation Text: South Carolina medication error bill is dangerously off target. ISMP Medication Safety Alert! Acute Care Edition. April 9, 2015;20:1,4. Copy Citation Save Sav…

The Economics of Patient Safety: Strengthening a Value-based Approach to Reducing Patient Harm at National Level. | PSNet

psnet.ahrq.gov/issue/economics-patient-safety-strengthening-value-based-approach-reducing-patient-harm-national

May 02, 2018 - Book/Report The Economics of Patient Safety: Strengthening a Value-based Approach to Reducing Patient Harm at National Level. Citation Text: The Economics of Patient Safety: Strengthening a Value-based Approach to Reducing Patient Harm at National Level. Slawomirski L, Auraaen A, Klazing…

HealthGrades Quality Study: Fifth Annual Patient Safety in American Hospitals Study. | PSNet

psnet.ahrq.gov/issue/healthgrades-quality-study-fifth-annual-patient-safety-american-hospitals-study

August 27, 2013 - Book/Report HealthGrades Quality Study: Fifth Annual Patient Safety in American Hospitals Study. Citation Text: HealthGrades Quality Study: Fifth Annual Patient Safety in American Hospitals Study. Golden, CO: HealthGrades, Inc.; April 2008. Copy Citation Save …

Some IV medications are diluted unnecessarily in patient care areas, creating undue risk. | PSNet

psnet.ahrq.gov/issue/some-iv-medications-are-diluted-unnecessarily-patient-care-areas-creating-undue-risk

June 18, 2014 - Newspaper/Magazine Article Some IV medications are diluted unnecessarily in patient care areas, creating undue risk. Citation Text: Some IV medications are diluted unnecessarily in patient care areas, creating undue risk. ISMP Medication Safety Alert! Acute Care Edition. June 19, 2014;19…

Conversations on diagnostic uncertainty and its management among pediatric acute care physicians. | PSNet

psnet.ahrq.gov/issue/conversations-diagnostic-uncertainty-and-its-management-among-pediatric-acute-care-physicians

March 17, 2021 - Study Conversations on diagnostic uncertainty and its management among pediatric acute care physicians. Citation Text: Patel SJ, Ipsaro A, Brady PW. Conversations on diagnostic uncertainty and its management among pediatric acute care physicians. Hosp Pediatr. 2022;12(3):317-324. doi:10.…

Learning collaboratives: insights and a new taxonomy from AHRQ's two decades of experience. | PSNet

psnet.ahrq.gov/issue/learning-collaboratives-insights-and-new-taxonomy-ahrqs-two-decades-experience

April 27, 2019 - Commentary Emerging Classic Learning collaboratives: insights and a new taxonomy from AHRQ's two decades of experience. Citation Text: Nix M, McNamara P, Genevro J, et al. Learning Collaboratives: Insights And A New Taxonomy From AHRQ's Two Decades Of Experience…

A qualitative exploration of the impact of a distressed family member on pediatric resuscitation teams. | PSNet

psnet.ahrq.gov/issue/qualitative-exploration-impact-distressed-family-member-pediatric-resuscitation-teams

March 25, 2020 - Study A qualitative exploration of the impact of a distressed family member on pediatric resuscitation teams. Citation Text: Deacon A, O’Neill T, Delaloye N, et al. A qualitative exploration of the impact of a distressed family member on pediatric resuscitation teams. Hosp Pediatr. 2020;…

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