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psnet.ahrq.gov/web-mm/unintended-consequences-cpoe
September 01, 2004 - replace it with errors associated with picking the wrong item in a drop-down list, which may result in prescribing … the wrong drug, dose, or route of a medication; prescribing to the wrong patient; or selecting the wrong
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psnet.ahrq.gov/node/49564/psn-pdf
July 01, 2008 - However,
prescribing intravenous morphine would generally not be my initial treatment of choice for
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psnet.ahrq.gov/issue/adverse-drug-events-resulting-patient-errors-older-adults
March 11, 2011 - Study
Adverse drug events resulting from patient errors in older adults.
Citation Text:
Field TS, Mazor KM, Briesacher BA, et al. Adverse Drug Events Resulting from Patient Errors in Older Adults. J Am Geriatr Soc. 2007;55(2):271-276. doi:10.1111/j.1532-5415.2007.01047.x.
Copy Citati…
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psnet.ahrq.gov/issue/dedicated-teams-optimize-quality-and-safety-surgery-systematic-review
October 27, 2021 - Review
Dedicated teams to optimize quality and safety of surgery: a systematic review.
Citation Text:
Lentz CM, De Lind Van Wijngaarden RAF, Willeboordse F, et al. Dedicated teams to optimize quality and safety of surgery: a systematic review. Int J Qual Health Care. 2022;34(4):mzac078.…
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psnet.ahrq.gov/issue/does-patient-centered-design-guarantee-patient-safety-using-human-factors-engineering-find
November 23, 2016 - Study
Does patient-centered design guarantee patient safety?: Using human factors engineering to find a balance between provider and patient needs.
Citation Text:
France DJ, Throop P, Walczyk B, et al. Does Patient-Centered Design Guarantee Patient Safety? J Patient Saf. 2008;1(3):145-15…
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psnet.ahrq.gov/issue/nature-and-timing-incidents-intercepted-surpass-checklist-surgical-patients
September 20, 2011 - Study
Nature and timing of incidents intercepted by the SURPASS checklist in surgical patients.
Citation Text:
de Vries EN, Prins HA, Bennink C, et al. Nature and timing of incidents intercepted by the SURPASS checklist in surgical patients. BMJ Qual Saf. 2012;21(6):503-8. doi:10.1136/…
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psnet.ahrq.gov/issue/eye-storm-role-pharmacist-medication-safety-during-covid-19-pandemic-urban-teaching-hospital
June 02, 2021 - Commentary
In the eye of the storm: the role of the pharmacist in medication safety during the COVID-19 pandemic at an urban teaching hospital.
Citation Text:
Kanaan AO, Sullivan KM, Seed SM, et al. In the eye of the storm: the role of the pharmacist in medication safety during the COVID…
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psnet.ahrq.gov/issue/handling-polypharmacy-qualitative-study-using-focus-group-interviews-older-patients-their
August 03, 2022 - Study
Handling polypharmacy--a qualitative study using focus group interviews with older patients, their relatives, and healthcare professionals.
Citation Text:
Mikkelsen TH, Søndergaard J, Kjaer NK, et al. Handling polypharmacy –a qualitative study using focus group interviews with olde…
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psnet.ahrq.gov/issue/medication-errors-anesthesiology-it-time-train-example-vignettes-can-assess-error-awareness
May 26, 2021 - Study
Medication errors in anesthesiology: is it time to train by example? Vignettes can assess error awareness, assessment of harm, disclosure, and reporting practices.
Citation Text:
Duffy CC, Bass GA, Duncan JR, et al. Medication errors in anesthesiology: is it time to train by exampl…
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psnet.ahrq.gov/issue/combined-impact-medicares-hospital-pay-performance-programs-quality-and-safety-outcomes-mixed
December 08, 2021 - Study
Combined impact of Medicare's hospital pay for performance programs on quality and safety outcomes is mixed.
Citation Text:
Waters TM, Burns N, Kaplan CM, et al. Combined impact of Medicare’s hospital pay for performance programs on quality and safety outcomes is mixed. BMC Health …
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psnet.ahrq.gov/issue/health-care-workers-experiences-workplace-incidents-posed-risk-patient-and-worker-injury
June 23, 2021 - Study
Health care workers' experiences of workplace incidents that posed a risk of patient and worker injury: a critical incident technique analysis.
Citation Text:
Strid EN, Wåhlin C, Ros A, et al. Health care workers’ experiences of workplace incidents that posed a risk of patient and …
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psnet.ahrq.gov/issue/failure-engage-hospitalized-elderly-patients-and-their-families-advance-care-planning
November 21, 2016 - Study
Classic
Failure to engage hospitalized elderly patients and their families in advance care planning.
Citation Text:
Heyland DK, Barwich D, Pichora D, et al. Failure to engage hospitalized elderly patients and their families in advance care planning. JAMA I…
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psnet.ahrq.gov/issue/emergency-diagnosis-cancer-and-previous-general-practice-consultations-insights-linked
February 17, 2021 - Study
Emergency diagnosis of cancer and previous general practice consultations: insights from linked patient survey data.
Citation Text:
Abel GA, Mendonca SC, McPhail S, et al. Emergency diagnosis of cancer and previous general practice consultations: insights from linked patient survey…
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psnet.ahrq.gov/issue/evaluation-natural-language-processing-approach-identify-diagnostic-errors-and-analysis
October 30, 2024 - Study
Evaluation of a natural language processing approach to identify diagnostic errors and analysis of safety learning system case review data: retrospective cohort study.
Citation Text:
Tabaie A, Tran A, Calabria T, et al. Evaluation of a natural language processing approach to identi…
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psnet.ahrq.gov/issue/one-needle-one-syringe-only-one-time-survey-physician-and-nurse-knowledge-attitudes-and
June 28, 2013 - Study
One needle, one syringe, only one time? A survey of physician and nurse knowledge, attitudes, and practices around injection safety.
Citation Text:
Kossover-Smith RA, Coutts K, Hatfield KM, et al. One needle, one syringe, only one time? A survey of physician and nurse knowledge, at…
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psnet.ahrq.gov/issue/impact-incorporating-pharmacy-claims-data-electronic-medication-reconciliation
September 01, 2016 - Study
Impact of incorporating pharmacy claims data into electronic medication reconciliation.
Citation Text:
Phansalkar S, Her QL, Tucker AD, et al. Impact of incorporating pharmacy claims data into electronic medication reconciliation. Am J Health Syst Pharm. 2015;72(3):212-7. doi:10.21…
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psnet.ahrq.gov/issue/development-just-culture-assessment-tool-measuring-perceptions-health-care-professionals
January 12, 2022 - Study
Development of the just culture assessment tool: measuring the perceptions of health-care professionals in hospitals.
Citation Text:
Petschonek S, Burlison JD, Cross C, et al. Development of the just culture assessment tool: measuring the perceptions of health-care professionals i…
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psnet.ahrq.gov/issue/linking-transformational-leadership-patient-safety-culture-and-work-engagement-home-care
October 09, 2024 - Study
Emerging Classic
Linking transformational leadership, patient safety culture and work engagement in home care services.
Citation Text:
Ree E, Wiig S. Linking transformational leadership, patient safety culture and work engagement in home care services. Nu…
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psnet.ahrq.gov/issue/clinical-diagnoses-vs-autopsy-findings-early-deceased-septic-patients-intensive-care
September 22, 2021 - Study
Clinical diagnoses vs. autopsy findings in early deceased septic patients in the intensive care: a retrospective cohort study.
Citation Text:
Driessen RGH, Latten BGH, Bergmans DCJJ, et al. Clinical diagnoses vs. autopsy findings in early deceased septic patients in the intensive c…
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psnet.ahrq.gov/issue/source-purchased-medications-and-its-impact-medication-mistakes-and-hospitalizations
March 11, 2020 - Study
The source of purchased medications and its impact on medication mistakes and hospitalizations.
Citation Text:
Coates MC, Granche J, Sefcik JS, et al. The source of purchased medications and its impact on medication mistakes and hospitalizations. Res Gerontol Nurs. 2022;15(2):69-75…