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psnet.ahrq.gov/node/60550/psn-pdf
June 03, 2020 - Clinical efficacy of combined surgical patient safety
system and the World Health Organization's checklists in
surgery: a nonrandomized clinical trial.
June 3, 2020
Storesund A, Haugen AS, Flaatten H, et al. Clinical Efficacy of Combined Surgical Patient Safety System
and the World Health Organization’s Checklists…
-
psnet.ahrq.gov/node/72530/psn-pdf
January 01, 2021 - A realist synthesis of pharmacist-conducted medication
reviews in primary care after leaving hospital: what works
for whom and why?
December 2, 2020
Luetsch K, Rowett D, Twigg MJ. A realist synthesis of pharmacist-conducted medication reviews in primary
care after leaving hospital: what works for whom and why? BMJ…
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psnet.ahrq.gov/node/38625/psn-pdf
November 19, 2009 - The design of the SAFE or SORRY? study: a cluster
randomised trial on the development and testing of an
evidence based inpatient safety program for the
prevention of adverse events.
November 19, 2009
van Gaal BGI, Schoonhoven L, Hulscher M, et al. The design of the SAFE or SORRY? study: a cluster
randomised trial…
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psnet.ahrq.gov/node/72669/psn-pdf
January 27, 2021 - Nosocomial transmission and outbreaks of coronavirus
disease 2019: the need to protect both patients and
healthcare workers.
January 27, 2021
Abbas M, Robalo Nunes T, Martischang R, et al. Nosocomial transmission and outbreaks of coronavirus
disease 2019: the need to protect both patients and healthcare workers. A…
-
psnet.ahrq.gov/node/37706/psn-pdf
December 23, 2016 - Preventing pediatric medication errors.
December 23, 2016
Preventing pediatric medication errors. Sentinel event alert. 2008;39:1-4.
https://psnet.ahrq.gov/issue/preventing-pediatric-medication-errors
The Joint Commission issues sentinel event alerts one to two times yearly to highlight areas of high risk
and to p…
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psnet.ahrq.gov/node/866407/psn-pdf
July 31, 2024 - Effect of digital tools to promote hospital quality and
safety on adverse events after discharge.
July 31, 2024
Vasudevan A, Plombon S, Piniella N, et al. Effect of digital tools to promote hospital quality and safety on
adverse events after discharge. J Am Med Inform Assoc. 2024;31(10):2304-2314.
doi:10.1093/jami…
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psnet.ahrq.gov/node/36303/psn-pdf
October 25, 2010 - Medication dispensing errors and potential adverse drug
events before and after implementing bar code
technology in the pharmacy.
October 25, 2010
Poon EG, Cina J, Churchill WW, et al. Medication dispensing errors and potential adverse drug events
before and after implementing bar code technology in the pharmacy. …
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psnet.ahrq.gov/node/73608/psn-pdf
January 01, 2022 - Pharmacist-led intervention on the reduction of
inappropriate medication use in patients with heart
failure: a systematic review of randomized trials and non-
randomized intervention studies.
August 18, 2021
Hernández-Prats C, López-Pintor E, Lumbreras B. Pharmacist-led intervention on the reduction of
inappropri…
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psnet.ahrq.gov/node/60910/psn-pdf
January 01, 2021 - Hospital- and system-wide interventions for health care-
associated infections: a systematic review.
September 16, 2020
Maurer NR, Hogan TH, Walker DM. Hospital- and system-wide interventions for health care-associated
infections: a systematic review. Med Care Res Rev. 2021;78(6):643-659. doi:10.1177/10775587209529…
-
psnet.ahrq.gov/node/73880/psn-pdf
January 01, 2022 - Decreased incidence of cesarean surgical site infection
rate with hospital-wide perioperative bundle.
September 29, 2021
Sood N, Lee RE, To JK, et al. Decreased incidence of cesarean surgical site infection rate with hospital?
wide perioperative bundle. Birth. 2022;49(1):141-146. doi:10.1111/birt.12586.
https://ps…
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psnet.ahrq.gov/node/837804/psn-pdf
August 10, 2022 - Nurses' harm prevention practices during admission of an
older person to the hospital: a multi-method qualitative
study.
August 10, 2022
Redley B, Douglas T, Hoon L, et al. Nurses' harm prevention practices during admission of an older person
to the hospital: a multi?method qualitative study. J Adv Nurs. 2022;78(1…
-
psnet.ahrq.gov/node/46325/psn-pdf
November 30, 2018 - Physician Burnout.
November 30, 2018
Rockville, MD: Agency for Healthcare Research and Quality; July 2017. AHRQ Publication No. 17-M018-1-
EF.
https://psnet.ahrq.gov/issue/physician-burnout
Clinician burnout can affect patient safety. This report highlights AHRQ-supported research to examine
burnout in health car…
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psnet.ahrq.gov/node/45350/psn-pdf
October 21, 2016 - A National Trauma Care System: Integrating Military and
Civilian Trauma Systems to Achieve Zero Preventable
Deaths After Injury.
October 21, 2016
National Academies of Sciences, Engineering, and Medicine. Washington, DC: National Academies Press;
2016.
https://psnet.ahrq.gov/issue/national-trauma-care-system-inte…
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psnet.ahrq.gov/node/842772/psn-pdf
January 18, 2023 - Short- and long-term effects of an electronic medication
management system on paediatric prescribing errors.
January 18, 2023
Westbrook JI, Li L, Raban MZ, et al. Short- and long-term effects of an electronic medication management
system on paediatric prescribing errors. NPJ Digit Med. 2022;5(1):179. doi:10.1038/s4…
-
psnet.ahrq.gov/node/73399/psn-pdf
June 16, 2021 - Examining causes and prevention strategies of adverse
events in deceased hospital patients: a retrospective
patient record review study in the Netherlands.
June 16, 2021
Smits M, Langelaan M, de Groot J, et al. Examining causes and prevention strategies of adverse events in
deceased hospital patients: a retrospect…
-
psnet.ahrq.gov/node/43787/psn-pdf
June 22, 2016 - Measuring variation in use of the WHO surgical safety
checklist in the operating room: a multicenter prospective
cross-sectional study.
June 22, 2016
Russ S, Rout S, Caris J, et al. Measuring variation in use of the WHO surgical safety checklist in the
operating room: a multicenter prospective cross-sectional stud…
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psnet.ahrq.gov/node/856589/psn-pdf
January 01, 2024 - Prevented harm and cost avoidance with pharmacist
intervention while utilizing a discharge medication
reconciliation tool.
November 29, 2023
Hoffman AM, Walls JL, Prusch A, et al. Prevented harm and cost avoidance with pharmacist intervention
while utilizing a discharge medication reconciliation tool. Am J Health …
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psnet.ahrq.gov/node/72857/psn-pdf
March 17, 2021 - Results and lessons from a hospital-wide initiative
incentivised by delivery system reform to improve
infection prevention and sepsis care.
March 17, 2021
Sreeramoju P, Voy-Hatter K, White C, et al. Results and lessons from a hospital-wide initiative incentivised
by delivery system reform to improve infection prev…
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psnet.ahrq.gov/node/838242/psn-pdf
January 01, 2023 - Are pathologists self-aware of their diagnostic accuracy?
Metacognition and the diagnostic process in pathology.
October 5, 2022
Clayton DA, Eguchi MM, Kerr KF, et al. Are pathologists self-aware of their diagnostic accuracy?
Metacognition and the diagnostic process in pathology. Med Decis Making. 2023;43(2):164-17…
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psnet.ahrq.gov/node/43273/psn-pdf
April 25, 2016 - Cardiopulmonary arrest and mortality trends, and their
association with rapid response system expansion.
April 25, 2016
Chen J, Ou L, Hillman KM, et al. Cardiopulmonary arrest and mortality trends, and their association with
rapid response system expansion. Med J Aust. 2014;201(3):167-70.
https://psnet.ahrq.gov/is…