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psnet.ahrq.gov/issue/cognitive-bias-during-clinical-decision-making-and-its-influence-patient-outcomes-emergency
September 21, 2022 - Review
Cognitive bias during clinical decision-making and its influence on patient outcomes in the emergency department: a scoping review.
Citation Text:
Jala S, Fry M, Elliott R. Cognitive bias during clinical decision‐making and its influence on patient outcomes in the emergency depart…
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psnet.ahrq.gov/issue/effects-patient-environment-and-medication-related-factors-high-alert-medication-incidents
January 22, 2016 - Study
Effects of patient-, environment- and medication-related factors on high-alert medication incidents.
Citation Text:
Manias E, Williams A, Liew D, et al. Effects of patient-, environment- and medication-related factors on high-alert medication incidents. Int J Qual Health Care. 2014…
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psnet.ahrq.gov/issue/does-perception-severity-medical-error-differ-between-varying-levels-clinical-seniority
August 31, 2022 - Study
Does the perception of severity of medical error differ between varying levels of clinical seniority?
Citation Text:
Khan I, Arsanious M. Does the perception of severity of medical error differ between varying levels of clinical seniority? Adv Med Educ Pract. 2018;9:443-452. doi:10…
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psnet.ahrq.gov/issue/defining-minimum-necessary-anticoagulation-related-communication-discharge-consensus-care
March 04, 2020 - Study
Defining minimum necessary anticoagulation-related communication at discharge: Consensus of the Care Transitions Task Force of the New York State Anticoagulation Coalition.
Citation Text:
Triller D, Myrka A, Gassler J, et al. Defining Minimum Necessary Anticoagulation-Related Commu…
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psnet.ahrq.gov/issue/adverse-events-are-common-intensive-care-unit-results-structured-record-review
January 28, 2010 - Study
Adverse events are common on the intensive care unit: results from a structured record review.
Citation Text:
Nilsson L, Pihl A, Tågsjö M, et al. Adverse events are common on the intensive care unit: results from a structured record review. Acta Anaesthesiol Scand. 2012;56(8):959…
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psnet.ahrq.gov/issue/improving-quality-drug-error-reporting
December 21, 2016 - Study
Improving the quality of drug error reporting.
Citation Text:
Armitage G, Newell R, Wright J. Improving the quality of drug error reporting. J Eval Clin Pract. 2010;16(6):1189-97. doi:10.1111/j.1365-2753.2009.01293.x.
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psnet.ahrq.gov/issue/impact-sleep-deprivation-product-quality-and-procedure-effectiveness-laparoscopic-physical
June 03, 2020 - Study
The impact of sleep deprivation on product quality and procedure effectiveness in a laparoscopic physical simulator: a randomized controlled trial.
Citation Text:
Uchal M, Tjugum J, Martinsen E, et al. The impact of sleep deprivation on product quality and procedure effectivene…
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www.ahrq.gov/sites/default/files/wysiwyg/patient-safety/highlights/ps-project-highlights-hit-hie-2025.pdf
January 01, 2025 - The
investigators concluded that using health information technology in long-term
care pharmacies to
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol4/Pratt.pdf
March 01, 2004 - low-risk but
potentially high-yield information sharing activity that could bring all the hospital
pharmacies … This was another opportunity for all of
the hospital pharmacies to benefit from the work done in each
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psnet.ahrq.gov/perspective/conversation-withmark-chassin-md-mpp-mph
April 01, 2009 - Commission issued its 1998 Sentinel Alert about keeping concentrated potassium chloride only in hospital pharmacies … ( 11 ) found that delays in receiving dilute solutions from the pharmacy turned ICUs into de facto pharmacies
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psnet.ahrq.gov/node/60241/psn-pdf
February 24, 2022 - The federal government, states, and territories partnered with multiple national and independent
pharmacies … The pharmacies facilitated vaccinations for NH residents
and staff at no cost to the NHs.76 The CDC
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www.ahrq.gov/sites/default/files/2024-01/kazi-report.pdf
January 01, 2024 - Final Progress Report: A Memory-Based Approach to Reducing Medication Errors
A Memory-Based Approach to Reducing
Medication Errors
Project Final Report
June 26th, 2023
Principal Investigator:
Sadaf Kazi, PhD
Team Members:
Raj Ratwani, PhD
Ella Franklin, MSN, RN
Deanna-Nicole Busog
Organization:
MedSta…
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www.ahrq.gov/patient-safety/reports/liability/neumiller.html
August 01, 2017 - Advances in Patient Safety and Medical Liability
Medication Discrepancies and Potential Adverse Drug Events During Transfer of Care from Hospital to Home
Previous Page
Table of Contents
Advances in Patient Safety and Medical Liability
Preface
Acknowledgments
Prologue
Silence A Commentary
…
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digital.ahrq.gov/sites/default/files/docs/page/2006Nace_051811comp.pdf
January 01, 2001 - in-hospital changes, and
discharge medications on a single form increases the conformity
rates of community … pharmacy patient profiles after hospitalization3
4
66% of adverse events identified by Forster, et
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www.ahrq.gov/sites/default/files/2024-11/becker-bix-report.pdf
January 01, 2024 - Final Progress Report: Optimizing OTC labels for older adults
AHRQ Grant Final Progress Report
Optimizing OTC labels for older adults: Empirical evaluation of labels designed to provide older users the
information they need to minimize adverse drug events
Principal Investigators:
Mark W. Becker, Ph…
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/perinatal-care/modules/strategies/medication/tool_safe-mgso4.docx
May 30, 2013 - AHRQ Safety Program for Perinatal Care: Safe Medication Administration: Magnesium Sulfate
AHRQ Safety Program for Perinatal Care
Safe Medication Administration
Magnesium Sulfate
Safe Medication Administration—Magnesium Sulfate
Purpose of the tool: This tool describes the key perinatal safety elements with examples for…
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www.ahrq.gov/sites/default/files/2024-01/brown-report.pdf
January 01, 2024 - Final Progress Report: Addressing Preventable Medication Use Variance in Mississippi
FINAL PROGRESS REPORT
Title of Project: Addressing Preventable Medication Use Variance in Mississippi
Principal Investigator: Brown, CA, MD, MPH
Team Members: William Rudman, PhD, Calvin Hewitt, MBA,
Honey Holman, MD, Kent Kirchn…
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psnet.ahrq.gov/innovation/care-managers-use-software-aided-medication-review-protocol-frail-community-dwelling
September 13, 2023 - Care Managers Use Software-Aided Medication Review Protocol for Frail, Community-Dwelling Seniors, Leading to More Appropriate Medication Use
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March 31…
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digital.ahrq.gov/sites/default/files/docs/citation/r21hs021544-zhou-final-report-2014.pdf
January 01, 2014 - medication regimen through the
integration of EHRs with other information sources (e.g., claims, pharmacies … Medication
reconciliation in a community pharmacy setting.
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www.ahrq.gov/patient-safety/settings/long-term-care/resource/facilities/ltc/mod3concl.html
October 01, 2014 - Module 3: Falls Prevention and Management
Conclusion
Previous Page Next Page
Table of Contents
Module 3: Falls Prevention and Management
Learning and Performance Objectives
Session 1
Session 2
Conclusion
Appendix. Additional Tools and Resources
In Summary
Falls prevention…