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Computerized Prescriber Order Entry Medication Safety (CPOEMS): Uncovering and Learning From Issues and Errors. | PSNet

psnet.ahrq.gov/issue/computerized-prescriber-order-entry-medication-safety-cpoems-uncovering-and-learning-issues

February 05, 2014 - Book/Report Computerized Prescriber Order Entry Medication Safety (CPOEMS): Uncovering and Learning From Issues and Errors. Citation Text: Computerized Prescriber Order Entry Medication Safety (CPOEMS): Uncovering and Learning From Issues and Errors. Brigham and Women's Hospital, Harvard…

Diet order entry by registered dietitians results in a reduction in error rates and time delays compared with other health professionals. | PSNet

psnet.ahrq.gov/issue/diet-order-entry-registered-dietitians-results-reduction-error-rates-and-time-delays-compared

September 23, 2020 - Study Diet order entry by registered dietitians results in a reduction in error rates and time delays compared with other health professionals. Citation Text: Imfeld K, Keith M, Stoyanoff L, et al. Diet order entry by registered dietitians results in a reduction in error rates and time …

Patient whiteboards as a communication tool in the hospital setting: A survey of practices and recommendations. | PSNet

psnet.ahrq.gov/issue/patient-whiteboards-communication-tool-hospital-setting-survey-practices-and-recommendations

February 18, 2011 - Study Patient whiteboards as a communication tool in the hospital setting: A survey of practices and recommendations. Citation Text: Sehgal NL, Green A, Vidyarthi A, et al. Patient whiteboards as a communication tool in the hospital setting: a survey of practices and recommendations. J …

An observational study of the frequency, severity, and etiology of failures in postoperative care after major elective general surgery. | PSNet

psnet.ahrq.gov/issue/observational-study-frequency-severity-and-etiology-failures-postoperative-care-after-major

August 11, 2010 - Study An observational study of the frequency, severity, and etiology of failures in postoperative care after major elective general surgery. Citation Text: Symons NRA, Almoudaris AM, Nagpal K, et al. An observational study of the frequency, severity, and etiology of failures in postop…

Liability associated with obstetric anesthesia: a closed claims analysis. | PSNet

psnet.ahrq.gov/issue/liability-associated-obstetric-anesthesia-closed-claims-analysis

July 13, 2010 - Study Liability associated with obstetric anesthesia: a closed claims analysis. Citation Text: Davies JM, Posner KL, Lee LA, et al. Liability associated with obstetric anesthesia: a closed claims analysis. Anesthesiology. 2009;110(1):131-139. doi:10.1097/ALN.0b013e318190e16a. Copy Cita…

Root cause analysis of reported patient falls in ORs in the Veterans Health Administration. | PSNet

psnet.ahrq.gov/issue/root-cause-analysis-reported-patient-falls-ors-veterans-health-administration

January 17, 2019 - Commentary Root cause analysis of reported patient falls in ORs in the Veterans Health Administration. Citation Text: Soncrant CM, Warner LJ, Neily J, et al. Root Cause Analysis of Reported Patient Falls in ORs in the Veterans Health Administration. AORN J. 2018;108(4):386-397. doi:10.10…

Applying requisite imagination to safeguard electronic health record transitions. | PSNet

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August 25, 2021 - Commentary Applying requisite imagination to safeguard electronic health record transitions. Citation Text: Sittig DF, Lakhani P, Singh H. Applying requisite imagination to safeguard electronic health record transitions. J Am Med Inform Assoc. 2022;29(5):1014-1018. doi:10.1093/jamia/ocab…

Context matters: toward a multilevel perspective on context in clinical reasoning and error. | PSNet

psnet.ahrq.gov/issue/context-matters-toward-multilevel-perspective-context-clinical-reasoning-and-error

April 12, 2023 - Commentary Context matters: toward a multilevel perspective on context in clinical reasoning and error. Citation Text: Choi JJ, Durning SJ. Context matters: toward a multilevel perspective on context in clinical reasoning and error. Diagnosis (Berl). 2023;10(2):89-95. doi:10.1515/dx-2022…

ASHP national survey of pharmacy practice in hospital settings: prescribing and transcribing-2019. | PSNet

psnet.ahrq.gov/issue/ashp-national-survey-pharmacy-practice-hospital-settings-prescribing-and-transcribing-2019

October 19, 2022 - Study ASHP national survey of pharmacy practice in hospital settings: prescribing and transcribing-2019. Citation Text: Pedersen CA, Schneider PJ, Ganio MC, et al. ASHP national survey of pharmacy practice in hospital settings: prescribing and transcribing—2019. Am J Health Syst Pharm. 2…

Reflections on implementing a hospital-wide provider-based electronic inpatient mortality review system: lessons learnt. | PSNet

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August 12, 2020 - Study Reflections on implementing a hospital-wide provider-based electronic inpatient mortality review system: lessons learnt. Citation Text: Mendu ML, Lu Y, Petersen A, et al. Reflections on implementing a hospital-wide provider-based electronic inpatient mortality review system: lesson…

Overcoming barriers to the implementation of a pharmacy bar code scanning system for medication dispensing: a case study. | PSNet

psnet.ahrq.gov/issue/overcoming-barriers-implementation-pharmacy-bar-code-scanning-system-medication-dispensing

October 25, 2010 - Commentary Overcoming barriers to the implementation of a pharmacy bar code scanning system for medication dispensing: a case study. Citation Text: Nanji KC, Cina J, Patel N, et al. Overcoming barriers to the implementation of a pharmacy bar code scanning system for medication dispensi…

Medication safety in acute care in Australia: where are we now? Part 1: a review of the extent and causes of medication problems 2002-2008. | PSNet

psnet.ahrq.gov/issue/medication-safety-acute-care-australia-where-are-we-now-part-1-review-extent-and-causes

October 14, 2009 - Review Medication safety in acute care in Australia: where are we now? Part 1: a review of the extent and causes of medication problems 2002-2008. Citation Text: Roughead EE, Semple SJ. Medication safety in acute care in Australia: where are we now? Part 1: a review of the extent and c…

Medication safety in acute care in Australia: where are we now? Part 2: a review of strategies and activities for improving medication safety 2002-2008. | PSNet

psnet.ahrq.gov/issue/medication-safety-acute-care-australia-where-are-we-now-part-2-review-strategies-and

January 04, 2010 - Review Medication safety in acute care in Australia: where are we now? Part 2: a review of strategies and activities for improving medication safety 2002-2008. Citation Text: Semple SJ, Roughead EE. Medication safety in acute care in Australia: where are we now? Part 2: a review of stra…

Reasons provided by prescribers when overriding drug–drug interaction alerts. | PSNet

psnet.ahrq.gov/issue/reasons-provided-prescribers-when-overriding-drug-drug-interaction-alerts

April 27, 2010 - Study Reasons provided by prescribers when overriding drug–drug interaction alerts. Citation Text: Grizzle AJ, Mahmood MH, Ko Y, et al. Reasons provided by prescribers when overriding drug-drug interaction alerts. Am J Manag Care. 2007;13(10):573-578. Copy Citation Format: …

A toolkit to disseminate best practices in inpatient medication reconciliation: Multi-Center Medication Reconciliation Quality Improvement Study (MARQUIS). | PSNet

psnet.ahrq.gov/issue/toolkit-disseminate-best-practices-inpatient-medication-reconciliation-multi-center

January 23, 2019 - Commentary A toolkit to disseminate best practices in inpatient medication reconciliation: Multi-Center Medication Reconciliation Quality Improvement Study (MARQUIS). Citation Text: Mueller SK, Kripalani S, Stein J, et al. A toolkit to disseminate best practices in inpatient medicatio…

Unintended adverse consequences of a clinical decision support system: two cases. | PSNet

psnet.ahrq.gov/issue/unintended-adverse-consequences-clinical-decision-support-system-two-cases

October 23, 2018 - Commentary Unintended adverse consequences of a clinical decision support system: two cases. Citation Text: Stone EG. Unintended adverse consequences of a clinical decision support system: two cases. J Am Med Inform Assoc. 2018;25(5):564-567. doi:10.1093/jamia/ocx096. Copy Citation …

To the point: integrating patient safety education Into the obstetrics and gynecology undergraduate curriculum. | PSNet

psnet.ahrq.gov/issue/point-integrating-patient-safety-education-obstetrics-and-gynecology-undergraduate-curriculum

January 02, 2017 - Review To the point: integrating patient safety education Into the obstetrics and gynecology undergraduate curriculum. Citation Text: Abbott JF, Pradhan A, Buery-Joyner S, et al. To the Point: Integrating Patient Safety Education Into the Obstetrics and Gynecology Undergraduate Curriculu…

Strategies to reduce errors associated with 2-component vaccines. | PSNet

psnet.ahrq.gov/issue/strategies-reduce-errors-associated-2-component-vaccines

December 16, 2020 - Study Strategies to reduce errors associated with 2-component vaccines. Citation Text: Samad F, Burton SJ, Kwan D, et al. Strategies to reduce errors associated with 2-component vaccines. Pharmaceut Med. 2021;35(1):1-9. doi:10.1007/s40290-020-00362-9. Copy Citation Format: …

The effects of emergency department staff rounding on patient safety and satisfaction. | PSNet

psnet.ahrq.gov/issue/effects-emergency-department-staff-rounding-patient-safety-and-satisfaction

November 16, 2022 - Study The effects of emergency department staff rounding on patient safety and satisfaction. Citation Text: Meade CM, Kennedy J, Kaplan J. The effects of emergency department staff rounding on patient safety and satisfaction. J Emerg Med. 2010;38(5):666-74. doi:10.1016/j.jemermed.2008.…

Prioritizing patient safety interventions in small and rural hospitals. | PSNet

psnet.ahrq.gov/issue/prioritizing-patient-safety-interventions-small-and-rural-hospitals

October 14, 2009 - Study Prioritizing patient safety interventions in small and rural hospitals. Citation Text: Casey M, Wakefield M, Coburn AF, et al. Prioritizing patient safety interventions in small and rural hospitals. Jt Comm J Qual Patient Saf. 2006;32(12):693-702. Copy Citation Format: …

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