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psnet.ahrq.gov/node/46473/psn-pdf
December 18, 2017 - Diagnostic errors: impact of an educational intervention
on pediatric primary care.
December 18, 2017
Walsh JN, Knight M, Lee AJ. Diagnostic Errors: Impact of an Educational Intervention on Pediatric Primary
Care. Journal of Pediatric Health Care. 2017;32(1). doi:10.1016/j.pedhc.2017.07.004.
https://psnet.ahrq.gov…
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psnet.ahrq.gov/node/50916/psn-pdf
February 19, 2020 - Patient safety and suicide prevention in mental health
services: time for a new paradigm?
February 19, 2020
Quinlivan L, Littlewood DL, Webb RT, et al. Patient safety and suicide prevention in mental health services:
time for a new paradigm? J Mental Health. 2020;29(1):1-5. doi:10.1080/09638237.2020.1714013.
https…
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psnet.ahrq.gov/node/74271/psn-pdf
January 19, 2022 - Improving shared situation awareness for high-risk
therapies in hospitalized children.
January 19, 2022
Sosa T, Mayer B, Chakkalakkal B, et al. Improving shared situation awareness for high-risk therapies in
hospitalized children. Hosp Pediatr. 2022;12(1):37-46. doi:10.1542/hpeds.2021-006193.
https://psnet.ahrq.go…
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psnet.ahrq.gov/node/48034/psn-pdf
May 22, 2019 - Chasing zero harm in radiation oncology: using pre-
treatment peer review.
May 22, 2019
Vijayakumar S, Duggar WN, Packianathan S, et al. Chasing Zero Harm in Radiation Oncology: Using Pre-
treatment Peer Review. Front Oncol. 2019;9:302. doi:10.3389/fonc.2019.00302.
https://psnet.ahrq.gov/issue/chasing-zero-harm-ra…
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psnet.ahrq.gov/node/73069/psn-pdf
March 24, 2021 - Evaluation of the quality of 'do not use' medication
abbreviation audits: a key enabler to successful
implementation of audit and feedback.
March 24, 2021
Li E, Marrandino J, Marshall S, et al. Evaluation of the quality of ‘do not use’ medication abbreviation
audits: a key enabler to successful implementation of a…
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psnet.ahrq.gov/node/837971/psn-pdf
September 01, 2022 - Frailty and potentially inappropriate prescribing in older
people with polypharmacy: a bi-directional relationship?
September 1, 2022
Randles MA. Frailty and potentially inappropriate prescribing in older people with polypharmacy: a bi-
directional relationship? Drugs Aging. 2022;39(8):597-606. doi:10.1007/s40266-0…
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psnet.ahrq.gov/node/46815/psn-pdf
April 29, 2018 - Designing and evaluating an automated system for real-
time medication administration error detection in a
neonatal intensive care unit.
April 29, 2018
Ni Y, Lingren T, Hall ES, et al. Designing and evaluating an automated system for real-time medication
administration error detection in a neonatal intensive care …
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psnet.ahrq.gov/node/73987/psn-pdf
October 20, 2021 - Impact of clinical decision support therapeutic
interchanges on hospital discharge medication omissions
and duplications.
October 20, 2021
Maxwell E, Amerine J, Carlton G, et al. Impact of clinical decision support therapeutic interchanges on
hospital discharge medication omissions and duplications. Am J Health Sy…
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psnet.ahrq.gov/node/38993/psn-pdf
January 04, 2010 - Relationship between call light use and response time
and inpatient falls in acute care settings.
January 4, 2010
Tzeng H-M, Yin C-Y. Relationship between call light use and response time and inpatient falls in acute care
settings. J Clin Nurs. 2009;18(23):3333-41. doi:10.1111/j.1365-2702.2009.02916.x.
https://psn…
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psnet.ahrq.gov/node/60018/psn-pdf
March 04, 2020 - 2019 update on pediatric medical overuse: a systematic
review.
March 4, 2020
Money NM, Schroeder AR, Quinonez RA, et al. 2019 Update on Pediatric Medical Overuse. JAMA Pediatr.
2020;174(4):375-382. doi:10.1001/jamapediatrics.2019.5849.
https://psnet.ahrq.gov/issue/2019-update-pediatric-medical-overuse-systematic-r…
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psnet.ahrq.gov/node/43693/psn-pdf
January 20, 2015 - Effectiveness of facilitated introduction of a standard
operating procedure into routine processes in the
operating theatre: a controlled interrupted time series.
January 20, 2015
Morgan L, New S, Robertson ER, et al. Effectiveness of facilitated introduction of a standard operating
procedure into routine processe…
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psnet.ahrq.gov/node/46249/psn-pdf
July 12, 2017 - Zero preventable deaths after traumatic injury: an
achievable goal.
July 12, 2017
Spinella PC. Zero preventable deaths after traumatic injury. J Trauma Acute Care Surg. 2017;82:S2-S8.
doi:10.1097/ta.0000000000001425.
https://psnet.ahrq.gov/issue/zero-preventable-deaths-after-traumatic-injury-achievable-goal
Criti…
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psnet.ahrq.gov/node/46079/psn-pdf
June 28, 2017 - Death due to pharmacy compounding error reinforces
need for safety focus.
June 28, 2017
ISMP Medication Safety Alert! Acute Care Edition. June 15, 2017;22:1-4.
https://psnet.ahrq.gov/issue/death-due-pharmacy-compounding-error-reinforces-need-safety-focus
Compounding pharmacies prepare medicines for patients that a…
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psnet.ahrq.gov/node/44368/psn-pdf
September 29, 2017 - A systematic review of the effect of distraction on
surgeon performance: directions for operating room
policy and surgical training.
September 29, 2017
Mentis HM, Chellali A, Manser K, et al. A systematic review of the effect of distraction on surgeon
performance: directions for operating room policy and surgical …
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psnet.ahrq.gov/node/854826/psn-pdf
October 25, 2023 - Observing sources of system resilience using in situ
alarm simulations.
October 25, 2023
McLoone M, McNamara M, Jennings MA, et al. Observing sources of system resilience using in situ alarm
simulations. J Hosp Med. 2023;18(11):994-998. doi:10.1002/jhm.13217.
https://psnet.ahrq.gov/issue/observing-sources-system-r…
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psnet.ahrq.gov/node/43398/psn-pdf
July 30, 2014 - Strategies to prevent healthcare-associated infections
through hand hygiene.
July 30, 2014
Ellingson K, Haas JP, Aiello AE, et al. Strategies to prevent healthcare-associated infections through hand
hygiene. Infect Control Hosp Epidemiol. 2014;35(8):937-960. doi:10.1086/677145.
https://psnet.ahrq.gov/issue/strateg…
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psnet.ahrq.gov/node/43182/psn-pdf
May 14, 2014 - Quality and safety in pediatric anesthesia: how can
guidelines, checklists, and initiatives improve the
outcome?
May 14, 2014
Hagerman NS, Varughese AM, Kurth D. Quality and safety in pediatric anesthesia: how can guidelines,
checklists, and initiatives improve the outcome? Curr Opin Anaesthesiol. 2014;27(3):323-9…
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psnet.ahrq.gov/node/50938/psn-pdf
February 26, 2020 - Risks and medication errors analysis to evaluate the
impact of a chemotherapy compounding workflow
management system on cancer patients' safety.
February 26, 2020
Marzal-Alfaro MB, Rodriguez-Gonzalez CG, Escudero-Vilaplana V, et al. Risks and medication errors
analysis to evaluate the impact of a chemotherapy comp…
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psnet.ahrq.gov/node/866746/psn-pdf
September 18, 2024 - Looking beyond LinkedIn: the case for excellence and
academic rigor in quality and safety programs.
September 18, 2024
Bearman G, Nori P. Looking beyond LinkedIn: the case for excellence and academic rigor in quality and
safety programs. Am J Med. 2024;137(8):694-697. doi:10.1016/j.amjmed.2024.04.018.
https://psne…
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psnet.ahrq.gov/node/46816/psn-pdf
March 21, 2018 - Results of an enhanced clinic handoff and resident
education on resident patient ownership and patient
safety.
March 21, 2018
Pincavage A, Dahlstrom M, Prochaska M, et al. Results of an enhanced clinic handoff and resident
education on resident patient ownership and patient safety. Acad Med. 2013;88(6):795-801.
d…