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psnet.ahrq.gov/node/37595/psn-pdf
March 05, 2008 - An evaluation of medication errors—the pediatric surgical
service experience.
March 5, 2008
Engum SA, Breckler FD. An evaluation of medication errors-the pediatric surgical service experience. J
Pediatr Surg. 2008;43(2):348-52. doi:10.1016/j.jpedsurg.2007.10.042.
https://psnet.ahrq.gov/issue/evaluation-medication-…
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psnet.ahrq.gov/node/41523/psn-pdf
July 18, 2012 - Long-term reduction in adverse drug events: an evidence-
based improvement model.
July 18, 2012
Gazarian M, Graudins LV. Long-term reduction in adverse drug events: an evidence-based improvement
model. Pediatrics. 2012;129(5):e1334-42. doi:10.1542/peds.2011-1902.
https://psnet.ahrq.gov/issue/long-term-reduction-ad…
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psnet.ahrq.gov/node/36261/psn-pdf
August 04, 2009 - Malpractice liability, patient safety, and the
personification of medical injury: opportunities for
academic medicine.
August 4, 2009
Sage WM. Malpractice liability, patient safety, and the personification of medical injury: opportunities for
academic medicine. Acad Med. 2006;81(9):823-6.
https://psnet.ahrq.gov/i…
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psnet.ahrq.gov/node/39626/psn-pdf
June 23, 2010 - The Medication Manager: results of a medication at the
bedside pilot in a pediatric teaching institution.
June 23, 2010
Wagner D, Pasko D, Glenn D, et al. The Medication Manager. J Patient Saf. 2010;6(2).
doi:10.1097/pts.0b013e3181cb43b4.
https://psnet.ahrq.gov/issue/medication-manager-results-medication-bedside-p…
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psnet.ahrq.gov/node/867699/psn-pdf
June 01, 2023 - Toolkit for Improving Surgical Care and Recovery.
June 1, 2023
Agency for Healthcare Research and Quality. Toolkit for Improving Surgical Care and Recovery. June
2023.
https://psnet.ahrq.gov/issue/toolkit-improving-surgical-care-and-recovery
Improving patient experience fosters better communication, trust, and col…
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psnet.ahrq.gov/node/45336/psn-pdf
September 21, 2016 - Medical misdiagnoses put pressure on patients to stay
engaged.
September 21, 2016
Innes S. Arizona Daily Star. September 12, 2016.
https://psnet.ahrq.gov/issue/medical-misdiagnoses-put-pressure-patients-stay-engaged
Delayed diagnoses can have serious consequences. This news article reviews several examples of
mis…
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psnet.ahrq.gov/node/41608/psn-pdf
August 22, 2012 - Reduction in pediatric identification band errors: a quality
collaborative.
August 22, 2012
Phillips SC, Saysana M, Worley S, et al. Reduction in pediatric identification band errors: a quality
collaborative. Pediatrics. 2012;129(6):e1587-93. doi:10.1542/peds.2011-1911.
https://psnet.ahrq.gov/issue/reduction-pedia…
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digital.ahrq.gov/organization/university-georgia
January 01, 2023 - University of Georgia
Machine Learning Validation of Medication Regimen Complexity for Critical Care Pharmacist Resource Prediction
Description
This research will develop and validate machine learning enhanced predictive models improving the allocation of critical care pharmac…
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digital.ahrq.gov/organization/university-chicago
January 01, 2023 - University of Chicago
TELE-TOC Telehealth Education Leveraging Electronic Transitions of Care for COPD Patients
Description
This research will study the effectiveness of a virtual in-home program designed to reduce hospital readmissions among COPD patients post-hospitalization…
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www.ahrq.gov/patients-consumers/patient-involvement/index.html
November 01, 2016 - Patient Involvement
Get more involved with your health care by asking questions, talking to your clinician, and understanding your condition. Patients and families who engage with health care providers ask good questions and help reduce the risk of errors and hospital admissions. Browse these resources to get s…
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psnet.ahrq.gov/node/36976/psn-pdf
June 15, 2011 - Evaluation of an intervention aimed at improving
voluntary incident reporting in hospitals.
June 15, 2011
Evans S, Smith B, Esterman A, et al. Evaluation of an intervention aimed at improving voluntary incident
reporting in hospitals. Qual Saf Health Care. 2007;16(3):169-75.
https://psnet.ahrq.gov/issue/evaluation…
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psnet.ahrq.gov/node/40765/psn-pdf
September 14, 2011 - Medication errors reported in a pediatric intensive care
unit for oncologic patients.
September 14, 2011
Belela ASC, Peterlini MAS, Pedreira MLG. Medication errors reported in a pediatric intensive care unit for
oncologic patients. Cancer Nurs. 2011;34(5):393-400. doi:10.1097/NCC.0b013e3182064a6a.
https://psnet.ah…
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psnet.ahrq.gov/node/60042/psn-pdf
March 11, 2020 - At Walgreens, complaints of medication errors go
missing.
March 11, 2020
Gabler E. New York Times. February 23, 2020.
https://psnet.ahrq.gov/issue/walgreens-complaints-medication-errors-go-missing
Response to reported safety concerns is a primary indicator of an organizational commitment to reducing
and lear…
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psnet.ahrq.gov/node/837679/psn-pdf
July 13, 2022 - Provider implicit bias: bringing awareness to clinical
practice.
July 13, 2022
Moss LD. Clinical Advisor. June 29, 2022.
https://psnet.ahrq.gov/issue/provider-implicit-bias-bringing-awareness-clinical-practice
Health disparities perpetuated by structural racism degrade patient safety. This article discusses the
i…
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psnet.ahrq.gov/node/41334/psn-pdf
April 25, 2012 - Understanding the role of non-technical skills in patient
safety.
April 25, 2012
White N. Understanding the role of non-technical skills in patient safety. Nurs Stand. 2012;26(26):43-8.
https://psnet.ahrq.gov/issue/understanding-role-non-technical-skills-patient-safety
Examining a case study in which a patient die…
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psnet.ahrq.gov/node/42951/psn-pdf
September 16, 2014 - Novel approach to cardiac alarm management on
telemetry units.
September 16, 2014
Whalen DA, Covelle PM, Piepenbrink JC, et al. Novel approach to cardiac alarm management on telemetry
units. J Cardiovasc Nurs. 2014;29(5):E13-22. doi:10.1097/JCN.0000000000000114.
https://psnet.ahrq.gov/issue/novel-approach-cardiac-…
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psnet.ahrq.gov/node/43941/psn-pdf
February 25, 2015 - How to make surgery safer.
February 25, 2015
https://psnet.ahrq.gov/issue/how-make-surgery-safer
This newspaper article reports on various ways hospitals are working to make surgical care safer and
reduce readmissions due to surgical complications, including checklists, teamwork training courses for
surgeons, preo…
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psnet.ahrq.gov/node/36387/psn-pdf
July 14, 2010 - Effectiveness of a community collaborative for
eliminating the use of high-risk abbreviations written by
physicians.
July 14, 2010
Leonhardt KK, Botticelli J. Effectiveness of a Community Collaborative for Eliminating the Use of High-risk
Abbreviations Written by Physicians. J Patient Saf. 2008;2(3). doi:10.1097/0…
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psnet.ahrq.gov/node/43748/psn-pdf
December 03, 2014 - New enteral connectors: raising awareness.
December 3, 2014
Guenter P. New Enteral Connectors. Nutrition in Clinical Practice. 2014;29(5).
doi:10.1177/0884533614543330.
https://psnet.ahrq.gov/issue/new-enteral-connectors-raising-awareness
Redesigning tubing connectors according to new ISO standards has the potenti…
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psnet.ahrq.gov/node/45990/psn-pdf
August 24, 2022 - Medication Safety Certificate Program.
August 24, 2022
American Society of Health-System Pharmacists, Institute for Safe Medication Practices.
https://psnet.ahrq.gov/issue/medication-safety-certificate-program
Leadership commitment to reduce medication errors can help address this safety problem. This certificate
…