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Evolving quality improvement support strategies to improve Plan–Do–Study–Act cycle fidelity: a retrospective mixed-methods study. | PSNet

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March 17, 2014 - Study Emerging Classic Evolving quality improvement support strategies to improve Plan–Do–Study–Act cycle fidelity: a retrospective mixed-methods study. Citation Text: McNicholas C, Lennox L, Woodcock T, et al. Evolving quality improvement support strategies to …

Pediatric obesity and safety in inpatient settings: a systematic literature review. | PSNet

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November 12, 2014 - Review Pediatric obesity and safety in inpatient settings: a systematic literature review. Citation Text: Halvorson EE, Irby MB, Skelton JA. Pediatric obesity and safety in inpatient settings: a systematic literature review. Clin Pediatr (Phila). 2014;53(10):975-87. doi:10.1177/000992281…

Use of a prospective risk analysis method to improve the safety of the cancer chemotherapy process. | PSNet

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May 29, 2019 - Study Use of a prospective risk analysis method to improve the safety of the cancer chemotherapy process. Citation Text: Bonnabry P, Cingria L, Ackermann M, et al. Use of a prospective risk analysis method to improve the safety of the cancer chemotherapy process. Int J Qual Health Care…

Error in intensive care: psychological repercussions and defense mechanisms among health professionals. | PSNet

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November 29, 2023 - Study Error in intensive care: psychological repercussions and defense mechanisms among health professionals. Citation Text: Laurent A, Aubert L, Chahraoui K, et al. Error in intensive care: psychological repercussions and defense mechanisms among health professionals. Crit Care Med. 201…

Can medical students identify a potentially serious acetaminophen dosing error in a simulated encounter? A case control study. | PSNet

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March 30, 2011 - Study Can medical students identify a potentially serious acetaminophen dosing error in a simulated encounter? A case control study. Citation Text: Dudas RA, Barone MA. Can medical students identify a potentially serious acetaminophen dosing error in a simulated encounter? a case control…

Internal reporting system to improve a pharmacy's medication distribution process. | PSNet

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October 31, 2017 - Study Internal reporting system to improve a pharmacy's medication distribution process. Citation Text: Rickrode GA, Williams-Lowe ME, Rippe JL, et al. Internal reporting system to improve a pharmacy's medication distribution process. Am J Health Syst Pharm. 2007;64(11):1197-202. Cop…

The impact of a standardized incident reporting system in the perioperative setting: a single center experience on 2,563 'near-misses' and adverse events. | PSNet

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February 09, 2022 - Study The impact of a standardized incident reporting system in the perioperative setting: a single center experience on 2,563 'near-misses' and adverse events. Citation Text: Heideveld-Chevalking AJ, Calsbeek H, Damen J, et al. The impact of a standardized incident reporting system in t…

Reducing near miss medication events using an evidence-based approach. | PSNet

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July 07, 2021 - Study Reducing near miss medication events using an evidence-based approach. Citation Text: Smith-Love J. Reducing near miss medication events using an evidence-based approach. J Nurs Care Qual. 2022;37(4):327-333. doi:10.1097/ncq.0000000000000630. Copy Citation Format: DOI…

COVID-19 and patient safety: time to tap into our investment in high reliability. | PSNet

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July 21, 2021 - Commentary COVID-19 and patient safety: time to tap into our investment in high reliability. Citation Text: Adelman JS, Gandhi TK. COVID-19 and patient safety: time to tap into our investment in high reliability. J Patient Saf. 2021;17(4):331-333. doi:10.1097/pts.0000000000000843. Copy…

Patient safety issues from information overload in electronic medical records. | PSNet

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May 04, 2022 - Review Patient safety issues from information overload in electronic medical records. Citation Text: Nijor S, Rallis G, Lad N, et al. Patient safety issues from information overload in electronic medical records. J Patient Saf. 2022;18(6):e999-e1003. doi:10.1097/pts.0000000000001002. C…

"I wish I had seen this test result earlier!": dissatisfaction with test result management systems in primary care. | PSNet

psnet.ahrq.gov/issue/i-wish-i-had-seen-test-result-earlier-dissatisfaction-test-result-management-systems-primary

February 15, 2011 - Study "I wish I had seen this test result earlier!": dissatisfaction with test result management systems in primary care. Citation Text: Poon EG, Gandhi TK, Sequist TD, et al. "I wish I had seen this test result earlier!": Dissatisfaction with test result management systems in primary ca…

Efficacy and unintended consequences of hard-stop alerts in electronic health record systems: a systematic review. | PSNet

psnet.ahrq.gov/issue/efficacy-and-unintended-consequences-hard-stop-alerts-electronic-health-record-systems

March 14, 2022 - Review Emerging Classic Efficacy and unintended consequences of hard-stop alerts in electronic health record systems: a systematic review. Citation Text: Powers EM, Shiffman RN, Melnick ER, et al. Efficacy and unintended consequences of hard-stop alerts in elect…

Patterns of communication breakdowns resulting in injury to surgical patients. | PSNet

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March 03, 2011 - Study Classic Patterns of communication breakdowns resulting in injury to surgical patients. Citation Text: Greenberg CC, Regenbogen SE, Studdert DM, et al. Patterns of communication breakdowns resulting in injury to surgical patients. J Am Coll Surg. 2007;204…

Summary and frequency of barriers to adoption of CPOE in the US. | PSNet

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March 17, 2021 - Review Summary and frequency of barriers to adoption of CPOE in the US. Citation Text: Kruse CS, Goetz K. Summary and frequency of barriers to adoption of CPOE in the U.S. J Med Syst. 2015;39(2):15. doi:10.1007/s10916-015-0198-2. Copy Citation Format: DOI Google Scholar Pub…

Identifying electronic health record contributions to diagnostic error in ambulatory settings through legal claims analysis. | PSNet

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January 25, 2023 - Study Identifying electronic health record contributions to diagnostic error in ambulatory settings through legal claims analysis. Citation Text: Krevat S, Samuel S, Boxley C, et al. Identifying electronic health record contributions to diagnostic error in ambulatory settings through leg…

Making communication and resolution programmes mission critical in healthcare organisations. | PSNet

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September 09, 2020 - Commentary Making communication and resolution programmes mission critical in healthcare organisations. Citation Text: Gallagher TH, Boothman RC, Schweitzer L, et al. Making communication and resolution programmes mission critical in healthcare organisations. BMJ Qual Saf. 2020;29(11):87…

Centers for Disease Control and Prevention Guideline for the Prevention of Surgical Site Infection, 2017. | PSNet

psnet.ahrq.gov/issue/centers-disease-control-and-prevention-guideline-prevention-surgical-site-infection-2017

June 27, 2018 - Review Centers for Disease Control and Prevention Guideline for the Prevention of Surgical Site Infection, 2017. Citation Text: Berríos-Torres SI, Umscheid CA, Bratzler DW, et al. Centers for Disease Control and Prevention Guideline for the Prevention of Surgical Site Infection, 2017. JA…

Trends in maternal mortality and severe maternal morbidity during delivery-related hospitalizations in the United States, 2008 to 2021. | PSNet

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September 29, 2017 - Study Trends in maternal mortality and severe maternal morbidity during delivery-related hospitalizations in the United States, 2008 to 2021. Citation Text: Fink DA, Kilday D, Cao Z, et al. Trends in maternal mortality and severe maternal morbidity during delivery-related hospitalization…

Effect of an Electronic Medication Reconciliation Intervention on Adverse Drug Events: A Cluster Randomized Trial | PSNet

psnet.ahrq.gov/issue/effect-electronic-medication-reconciliation-intervention-adverse-drug-events-cluster

April 29, 2018 - Study Effect of an Electronic Medication Reconciliation Intervention on Adverse Drug Events: A Cluster Randomized Trial Citation Text: Tamblyn R, Abrahamowicz M, Buckeridge DL, et al. Effect of an Electronic Medication Reconciliation Intervention on Adverse Drug Events: A Cluster Randomi…

Immersive high fidelity simulation of critically ill patients to study cognitive errors: a pilot study. | PSNet

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August 15, 2018 - Study Immersive high fidelity simulation of critically ill patients to study cognitive errors: a pilot study. Citation Text: Prakash S, Bihari S, Need P, et al. Immersive high fidelity simulation of critically ill patients to study cognitive errors: a pilot study. BMC Med Educ. 2017;17(1…

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