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psnet.ahrq.gov/issue/development-training-program-bar-code-assisted-medication-administration-inpatient-pharmacy
September 22, 2021 - Commentary
Development of a training program for bar-code–assisted medication administration in inpatient pharmacy.
Citation Text:
Dartt LR, Schneider R. Development of a training program for bar-code-assisted medication administration in inpatient pharmacy. Am J Health Syst Pharm. 2010…
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psnet.ahrq.gov/issue/informatics-confronts-drug-drug-interactions
February 18, 2011 - Review
Informatics confronts drug–drug interactions.
Citation Text:
Percha B, Altman RB. Informatics confronts drug-drug interactions. Trends Pharmacol Sci. 2013;34(3):178-84. doi:10.1016/j.tips.2013.01.006.
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psnet.ahrq.gov/issue/hospital-ethical-climate-and-teamwork-acute-care-moderating-role-leaders
October 15, 2016 - Study
Hospital ethical climate and teamwork in acute care: the moderating role of leaders.
Citation Text:
Rathert C, Fleming DA. Hospital ethical climate and teamwork in acute care: the moderating role of leaders. Health Care Manag Rev. 2008;33(4):323-331. doi:10.1097/01.HCM.0000318769.7…
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psnet.ahrq.gov/issue/advocate-health-care-systemwide-approach-quality-and-safety
July 19, 2023 - Commentary
Advocate Health Care: a systemwide approach to quality and safety.
Citation Text:
Willeumier D. Advocate health care: a systemwide approach to quality and safety. Jt Comm J Qual Patient Saf. 2004;30(10):559-566.
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psnet.ahrq.gov/issue/crossing-safety-transforming-healthcare-organizations-patient-safety
January 05, 2012 - Commentary
Crossing to safety: transforming healthcare organizations for patient safety.
Citation Text:
Ralston JD, Larson EB. Crossing to safety: transforming healthcare organizations for patient safety. J Postgrad Med. 2005;51(1):61-67.
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psnet.ahrq.gov/issue/pediatric-medical-errors-part-1-case-pediatric-drug-overdose-case
April 22, 2020 - Study
Pediatric medical errors part 1: the case. A pediatric drug overdose case.
Citation Text:
Dowdell EB. Pediatric medical errors part 1: the case. A pediatric drug overdose case. Pediatr Nurs. 2004;30(4):328-30.
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psnet.ahrq.gov/issue/functional-health-literacy-and-understanding-medications-discharge
April 24, 2018 - Study
Functional health literacy and understanding of medications at discharge.
Citation Text:
Maniaci MJ, Heckman MG, Dawson NL. Functional health literacy and understanding of medications at discharge. Mayo Clin Proc. 2008;83(5):554-8. doi:10.4065/83.5.554.
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psnet.ahrq.gov/issue/creating-highly-reliable-neonatal-intensive-care-unit-through-safer-systems-care
January 12, 2011 - Review
Creating a highly reliable neonatal intensive care unit through safer systems of care.
Citation Text:
Panagos PG, Pearlman SA. Creating a Highly Reliable Neonatal Intensive Care Unit Through Safer Systems of Care. Clin Perinatol. 2017;44(3):645-662. doi:10.1016/j.clp.2017.05.006. …
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psnet.ahrq.gov/issue/safety-culture-healthcare-review-concepts-dimensions-measures-and-progress
November 21, 2014 - Review
Safety culture in healthcare: a review of concepts, dimensions, measures and progress.
Citation Text:
Halligan M, Zecevic A. Safety culture in healthcare: a review of concepts, dimensions, measures and progress. BMJ Qual Saf. 2011;20(4):338-43. doi:10.1136/bmjqs.2010.040964.
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psnet.ahrq.gov/issue/influence-tall-man-lettering-errors-visual-perception-recognition-written-drug-names
December 19, 2017 - Study
The influence of 'Tall Man' lettering on errors of visual perception in the recognition of written drug names.
Citation Text:
Darker IT, Gerret D, Filik R, et al. The influence of 'Tall Man' lettering on errors of visual perception in the recognition of written drug names. Ergono…
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psnet.ahrq.gov/issue/safety-obstetric-critical-care
August 29, 2011 - Review
Safety in obstetric critical care.
Citation Text:
Scholefield H. Safety in obstetric critical care. Best Pract Res Clin Obstet Gynaecol. 2008;22(5):965-82. doi:10.1016/j.bpobgyn.2008.06.009.
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psnet.ahrq.gov/issue/how-stay-right-side-infection-control-code
November 02, 2016 - Newspaper/Magazine Article
How to stay on the right side of the infection control code.
Citation Text:
Harrison S. How to stay on the right side of the infection control code. Nurs Stand. 2016;19(38):14-16. doi:10.7748/ns.19.38.14.s15.
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psnet.ahrq.gov/issue/ethics-oversight-and-quality-improvement-initiatives
August 04, 2021 - Study
Ethics, oversight and quality improvement initiatives.
Citation Text:
Taylor HA, Pronovost PJ, Sugarman J. Ethics, oversight and quality improvement initiatives. Quality and Safety in Health Care. 2010;19(4). doi:10.1136/qshc.2009.038034.
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psnet.ahrq.gov/issue/implementing-national-strategy-patient-safety-lessons-national-health-service-england
March 02, 2011 - Commentary
Implementing a national strategy for patient safety: lessons from the National Health Service in England.
Citation Text:
Lewis RQ, Fletcher M. Implementing a national strategy for patient safety: lessons from the National Health Service in England. Qual Saf Health Care. 2005…
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psnet.ahrq.gov/issue/presenting-complaint-use-language-disempowers-patients
July 13, 2022 - Commentary
Presenting complaint: use of language that disempowers patients.
Citation Text:
doi:10.1136/bmj-2021-066720.
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psnet.ahrq.gov/issue/using-multidisciplinary-rounds-improve-patient-safety-through-venous-thromboembolism
April 20, 2016 - Study
Using multidisciplinary rounds to improve patient safety through venous thromboembolism prevention awareness.
Citation Text:
Karasin B, Maund C. Using Multidisciplinary Rounds to Improve Patient Safety Through Venous Thromboembolism Prevention Awareness. Jt Comm J Qual Patient Saf.…
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psnet.ahrq.gov/web-mm/turn-other-cheek
October 26, 2010 - Outcome of 6 years of protocol use for preventing wrong site office surgery. … February 10, 2012
Outcome of 6 years of protocol use for preventing wrong site office … August 2, 2015
Outcome of 6 years of protocol use for preventing wrong site office surgery
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psnet.ahrq.gov/node/49466/psn-pdf
October 14, 2004 - studies cite practitioner communication
skills as a factor in malpractice.(1,2) Furthermore, the tragic outcome … /psnet.ahrq.gov/web-mm/hard-swallow
https://psnet.ahrq.gov//#references
were made NPO pending the outcome … clinicians at the time, could have led to follow-up actions to mitigate or avert an
adverse patient outcome
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psnet.ahrq.gov/node/49833/psn-pdf
June 01, 2018 - challenges us to
review potential system and cognitive factors that could have contributed to this outcome … This case represents the treatment of a stroke mimic or misdiagnosis that contributed to an adverse
outcome … Association of outcome with early stroke treatment: pooled
analysis of ATLANTIS, ECASS, and NINDS rt-PA
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psnet.ahrq.gov/web-mm/refused-medication-error
November 01, 2005 - is problematic on many levels, this commentary focuses on the three likely causes of the unfortunate outcome … transfer can be discussed and improved upon.( 11 ) Several best practices might have led to a different outcome … overcome those barriers to effectively communicate.( 7 ) Such practices might have led to a better outcome