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2901. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49667/psn-pdf
      October 01, 2012 - Looking for Meds in All the Wrong Places October 1, 2012 Manias E. Looking for Meds in All the Wrong Places. PSNet [internet]. 2012. https://psnet.ahrq.gov/web-mm/looking-meds-all-wrong-places The Case A 40-year-old uninsured woman with anxiety ran out of her prescribed clonazepam and had a seizure. She went to t…

2902. Is single room hospital accommodation associated with differences in healthcare-associated infection, falls, pressure ulcers or medication errors? A natural experiment with non-equivalent controls. | PSNet
      psnet.ahrq.gov/issue/single-room-hospital-accommodation-associated-differences-healthcare-associated-infection
      June 21, 2016 - Study Is single room hospital accommodation associated with differences in healthcare-associated infection, falls, pressure ulcers or medication errors? A natural experiment with non-equivalent controls. Citation Text: Simon M, Maben J, Murrells T, et al. Is single room hospital accommod…

2903. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/43599/psn-pdf
      August 04, 2015 - Support from hospital to home for elders: a randomized trial. August 4, 2015 Goldman E, Sarkar U, Kessell E, et al. Support from hospital to home for elders: a randomized trial. Ann Intern Med. 2014;161(7):472-81. doi:10.7326/M14-0094. https://psnet.ahrq.gov/issue/support-hospital-home-elders-randomized-trial Rea…

2904. Honesty and transparency, indispensable to the clinical mission--Parts I-III. | PSNet
      psnet.ahrq.gov/issue/honesty-and-transparency-indispensable-clinical-mission-parts-i-iii
      November 11, 2020 - Commentary Honesty and transparency, indispensable to the clinical mission--Parts I-III. Citation Text: Brenner MJ, Boothman RC, Rushton CH, et al. Honesty and Transparency, Indispensable to the Clinical Mission—Parts I - III. Otolaryngol Clin North Am. 2021;55(1):43-103. doi:10.1016/j.o…

2905. Education initiatives in cognitive debiasing to improve diagnostic accuracy in student providers: a scoping review. | PSNet
      psnet.ahrq.gov/issue/education-initiatives-cognitive-debiasing-improve-diagnostic-accuracy-student-providers
      October 21, 2020 - Review Education initiatives in cognitive debiasing to improve diagnostic accuracy in student providers: a scoping review. Citation Text: Griffith PB, Doherty C, Smeltzer SC, et al. Education initiatives in cognitive debiasing to improve diagnostic accuracy in student providers: a scopin…

2906. Patient safety informatics: criteria development for assessing the maturity of digital patient safety in hospitals. | PSNet
      psnet.ahrq.gov/issue/patient-safety-informatics-criteria-development-assessing-maturity-digital-patient-safety
      July 20, 2022 - Review Patient safety informatics: criteria development for assessing the maturity of digital patient safety in hospitals. Citation Text: Kutza J-O, Hübner U, Holmgren AJ, et al. Patient safety informatics: criteria development for assessing the maturity of digital patient safety in hosp…

2907. Supporting clinicians after adverse events: development of a clinician peer support program. | PSNet
      psnet.ahrq.gov/issue/supporting-clinicians-after-adverse-events-development-clinician-peer-support-program
      April 24, 2018 - Study Emerging Classic Supporting clinicians after adverse events: development of a clinician peer support program. Citation Text: Lane MA, Newman BM, Taylor MZ, et al. Supporting Clinicians After Adverse Events: Development of a Clinician Peer Support Program. …

2908. The admission conference call: a novel approach to optimizing pediatric emergency department to admitting floor communication. | PSNet
      psnet.ahrq.gov/issue/admission-conference-call-novel-approach-optimizing-pediatric-emergency-department-admitting
      December 21, 2022 - Study The admission conference call: a novel approach to optimizing pediatric emergency department to admitting floor communication. Citation Text: Hendrickson MA, Schempf EN, Furnival RA, et al. The Admission Conference Call: A Novel Approach to Optimizing Pediatric Emergency Department…

2909. Clinical evaluation of the ADE scorecards as a decision support tool for adverse drug event analysis and medication safety management. | PSNet
      psnet.ahrq.gov/issue/clinical-evaluation-ade-scorecards-decision-support-tool-adverse-drug-event-analysis-and
      December 31, 2014 - Study Clinical evaluation of the ADE scorecards as a decision support tool for adverse drug event analysis and medication safety management. Citation Text: Hackl WO, Ammenwerth E, Marcilly R, et al. Clinical evaluation of the ADE scorecards as a decision support tool for adverse drug e…

2910. Implementation of the Josie King Care Journal in a pediatric intensive care unit: a quality improvement project. | PSNet
      psnet.ahrq.gov/issue/implementation-josie-king-care-journal-pediatric-intensive-care-unit-quality-improvement
      November 21, 2016 - Study Implementation of the Josie King Care Journal in a pediatric intensive care unit: a quality improvement project. Citation Text: Turner K, Frush K, Hueckel RM, et al. Implementation of the Josie King Care Journal in a pediatric intensive care unit: a quality improvement project. J…

2911. Prosocial voice in the hierarchy of healthcare professionals: the role of emotions after harmful patient safety incidents. | PSNet
      psnet.ahrq.gov/issue/prosocial-voice-hierarchy-healthcare-professionals-role-emotions-after-harmful-patient-safety
      February 23, 2022 - Review Prosocial voice in the hierarchy of healthcare professionals: the role of emotions after harmful patient safety incidents. Citation Text: Richmond JG, Burgess N. Prosocial voice in the hierarchy of healthcare professionals: the role of emotions after harmful patient safety inciden…

2912. Developing, implementing, evaluating electronic apparent cause analysis across a health care system. | PSNet
      psnet.ahrq.gov/issue/developing-implementing-evaluating-electronic-apparent-cause-analysis-across-health-care
      February 07, 2018 - Study Developing, implementing, evaluating electronic apparent cause analysis across a health care system. Citation Text: Oster CA, Woods E, Mumma J, et al. Developing, implementing, evaluating electronic apparent cause analysis across a health care system. Jt Comm J Qual Patient Saf. 2…

2913. Medication errors in intensive care units: an umbrella review of control measures. | PSNet
      psnet.ahrq.gov/issue/medication-errors-intensive-care-units-umbrella-review-control-measures
      February 09, 2022 - Review Medication errors in intensive care units: an umbrella review of control measures. Citation Text: Dionisi S, Giannetta N, Liquori G, et al. Medication errors in intensive care units: an umbrella review of control measures. Healthcare (Basel). 2022;10(7):1221. doi:10.3390/healthcar…

2914. The hazards of hospitalization. | PSNet
      psnet.ahrq.gov/issue/hazards-hospitalization
      December 29, 2014 - Study Classic The hazards of hospitalization. Citation Text: Schimmel E. THE HAZARDS OF HOSPITALIZATION. Ann Intern Med. 1964;60:100-110. Copy Citation Format: Google Scholar PubMed BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged PubMedId RIS …

2915. Innovative approach to reconstruct bedside handoff: using simple rules of complexity science to promote partnership with patients. | PSNet
      psnet.ahrq.gov/issue/innovative-approach-reconstruct-bedside-handoff-using-simple-rules-complexity-science-promote
      November 16, 2022 - Commentary Innovative approach to reconstruct bedside handoff: using simple rules of complexity science to promote partnership with patients. Citation Text: Anthony MK, Kloos J, Beam P, et al. Innovative Approach to Reconstruct Bedside Handoff: Using Simple Rules of Complexity Science to…

2916. The problems of detecting medication errors in hospitals. | PSNet
      psnet.ahrq.gov/issue/problems-detecting-medication-errors-hospitals
      February 01, 2012 - Study Classic The problems of detecting medication errors in hospitals. Citation Text: Barker KN, McConnell WE. The Problems of Detecting Medication Errors in Hospitals. Am J Health Syst Pharm. 1962;19(8):360-369. doi:10.1093/ajhp/19.8.360. Copy Citation …

2917. 6-PACK programme to decrease fall injuries in acute hospitals: cluster randomised controlled trial. | PSNet
      psnet.ahrq.gov/issue/6-pack-programme-decrease-fall-injuries-acute-hospitals-cluster-randomised-controlled-trial
      December 21, 2014 - Study Classic 6-PACK programme to decrease fall injuries in acute hospitals: cluster randomised controlled trial. Citation Text: Barker AL, Morello RT, Wolfe R, et al. 6-PACK programme to decrease fall injuries in acute hospitals: cluster randomised controlled t…

2918. Doctors' thinking about 'the system' as a threat to patient safety. | PSNet
      psnet.ahrq.gov/issue/doctors-thinking-about-system-threat-patient-safety
      December 09, 2020 - Study Doctors' thinking about 'the system' as a threat to patient safety. Citation Text: Waring J. Doctors' thinking about 'the system' as a threat to patient safety. Health (London). 2007;11(1):29-46. Copy Citation Format: Google Scholar PubMed BibTeX EndNote X3 XML EndN…

2919. Multiple Levels Involved in Prescribing the Wrong Medication | PSNet
      psnet.ahrq.gov/web-mm/multiple-levels-involved-prescribing-wrong-medication
      December 23, 2020 - Multiple Levels Involved in Prescribing the Wrong Medication Citation Text: Chin K, Chau V, Spero H, et al. Multiple Levels Involved in Prescribing the Wrong Medication. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2020. Copy Cit…

2920. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49592/psn-pdf
      October 01, 2009 - Danger in Disruption October 1, 2009 Fontaine DK. Danger in Disruption. PSNet [internet]. 2009. https://psnet.ahrq.gov/web-mm/danger-disruption The Case A 23-month-old toddler was severely dehydrated after vomiting due to gastric outlet obstruction. She had metabolic alkalosis (pH = 7.58), and her last peripheral…