-
psnet.ahrq.gov/node/837426/psn-pdf
June 15, 2022 - training in the United Kingdom identified a high rate of
prescribing errors (8.9% of prescriptions reviewed
-
psnet.ahrq.gov/node/849136/psn-pdf
May 17, 2023 - This peer-reviewed article discusses how one organization implemented an
M&M program.
-
psnet.ahrq.gov/issue/costs-and-benefits-health-information-technology
July 27, 2018 - The authors reviewed the literature on health information technology (HIT).
-
psnet.ahrq.gov/issue/strategies-and-tips-maximizing-failure-mode-and-effect-analysis-your-organization
January 13, 2016 - The implementation and application of proactive risk assessment is reviewed.
-
psnet.ahrq.gov/issue/your-high-alert-medication-list-relatively-useless-without-associated-risk-reduction
May 07, 2014 - This newsletter article recommends that high-alert medication lists be updated and reviewed regularly
-
psnet.ahrq.gov/issue/risk-medication-errors-hospital-discharge-and-barriers-problem-resolution
November 03, 2015 - The authors reviewed discharge medication records for elderly patients to assess documentation problems
-
psnet.ahrq.gov/issue/fail-safe-patient-id-matching-remains-just-out-reach
October 05, 2016 - A past WebM&M commentary reviewed an incident involving a patient mix-up.
-
psnet.ahrq.gov/issue/disclosure-unanticipated-events-next-step-better-communication-patients-part-1-3
January 13, 2016 - has taken place since 2001 about the role disclosure plays in supporting safe and effective care is reviewed
-
psnet.ahrq.gov/node/36368/psn-pdf
July 08, 2008 - https://psnet.ahrq.gov/issue/systematic-review-medication-errors-pediatric-patients
The authors reviewed
-
psnet.ahrq.gov/node/854261/psn-pdf
October 04, 2023 - Using a medical malpractice
claims database, researchers in this study reviewed 50 conditions identified
-
psnet.ahrq.gov/node/854990/psn-pdf
November 01, 2023 - Of 439 charts reviewed,
13% contained at least one AE.
-
psnet.ahrq.gov/issue/john-m-eisenberg-patient-safety-awards-lvhhn-patient-safety-video-patients-partners-safe-care
January 02, 2017 - The development process for a patient safety educational video is reviewed.
-
psnet.ahrq.gov/web-mm/missing-abscess-radiology-reads-digital-era
January 01, 2009 - substantially in the PACS/digital environment.( 8 ) Before the advent of PACS, a radiologist typically reviewed … separation of the report (EHR) from the images (PACS) has increased the frequency with which reports are reviewed … by clinicians without the images (as in this case) and images are reviewed without the report. … In this case, the gynecologist should have reviewed the images personally before entering the OR for … quickly and efficiently launch the EHR and find pertinent information based on the imaging study being reviewed
-
psnet.ahrq.gov/node/867590/psn-pdf
January 22, 2025 - Each of the four case-finding
strategies was used, 703 cases were reviewed, and 32% of cases had at
-
psnet.ahrq.gov/node/866249/psn-pdf
July 10, 2024 - In this study, twelve months of health information technology (HIT) incidents were retrospectively
reviewed
-
psnet.ahrq.gov/node/865484/psn-pdf
April 03, 2024 - In this study, records of patients with incidental imaging findings (IIF) were
reviewed to determine
-
psnet.ahrq.gov/node/866744/psn-pdf
September 18, 2024 - care-concerns-and-deficiencies-facility-leaders-and-staffs-responses-following-
medical
This investigation from the VA Office of Inspector General (OIG) reviewed
-
psnet.ahrq.gov/node/35727/psn-pdf
February 22, 2006 - psnet.ahrq.gov/issue/risk-medication-errors-hospital-discharge-and-barriers-problem-resolution
The authors reviewed
-
psnet.ahrq.gov/node/35592/psn-pdf
June 17, 2010 - noise-levels-johns-hopkins-hospital
The investigators conducted a noise survey at Johns Hopkins Hospital and reviewed
-
psnet.ahrq.gov/node/35457/psn-pdf
January 05, 2017 - examining-nurses-decision-process-medication-management-home-care
In this AHRQ-funded study, the investigators reviewed