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psnet.ahrq.gov/node/60635/psn-pdf
January 01, 2021 - Systemic defenses to prevent intravenous medication
errors in hospitals: a systematic review.
July 1, 2020
Kuitunen SK, Niittynen I, Airaksinen M, et al. Systemic Defenses to Prevent Intravenous Medication Errors
in Hospitals. J Patient Saf. 2021;17(8):e1669-e1680. doi:10.1097/pts.0000000000000688.
https://psnet.a…
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psnet.ahrq.gov/node/47426/psn-pdf
October 13, 2018 - Patient-centered insights: using health care complaints to
reveal hot spots and blind spots in quality and safety.
October 13, 2018
Gillespie A, Reader TW. Patient-Centered Insights: Using Health Care Complaints to Reveal Hot Spots and
Blind Spots in Quality and Safety. Milbank Q. 2018;96(3):530-567. doi:10.1111/14…
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psnet.ahrq.gov/node/46421/psn-pdf
November 08, 2017 - A novel ICU hand-over tool: the glass door of the patient
room.
November 8, 2017
Wessman BT, Sona C, Schallom M. A Novel ICU Hand-Over Tool: The Glass Door of the Patient Room. J
Intensive Care Med. 2017;32(8):514-519. doi:10.1177/0885066616653947.
https://psnet.ahrq.gov/issue/novel-icu-hand-over-tool-glass-door-p…
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psnet.ahrq.gov/web-mm/perils-contrast-media
March 01, 2007 - definitions for CIAKI.( 2 ) Some examples include the RIFLE criteria (Risk, Injury, Failure, Loss, End-stage … systematic review found that these definitions do not differ significantly in their ability to diagnose and stage … genuinely at risk of CIAKI if they have an eGFR less than 45 mL/min/1.73 m2 (i.e., chronic kidney disease stage
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psnet.ahrq.gov/node/612828/psn-pdf
February 23, 2022 - The Case
A 69-year-old man with End-Stage Kidney Disease (ESKD) secondary to diabetes mellitus and
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psnet.ahrq.gov/issue/inside-closed-loop-medication-strategy-medication-management-targets-stages-which-errors
January 30, 2013 - Study
Inside a closed-loop medication strategy: medication management targets stages in which errors occur, step by step.
Citation Text:
Williams CT. Inside a closed-loop medication strategy. Nurs Manag. 2004;35 Suppl 5:8-9, 24.
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Format:
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psnet.ahrq.gov/issue/methodological-variability-detecting-prescribing-errors-and-consequences-evaluation
March 05, 2010 - Impact of health information technology on detection of potential adverse drug events at the ordering stage
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psnet.ahrq.gov/issue/world-health-organization-world-federation-societies-anaesthesiologists-who-wfsa
November 16, 2015 - January 23, 2017
Guidance for health care leaders during the recovery stage of the COVID
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psnet.ahrq.gov/issue/differences-reasons-alert-overrides-contraindicated-co-prescriptions-admitting-department
January 23, 2017 - WebM&M Cases
Overdose of Gabapentin and Oxycodone in a Patient with End-Stage
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psnet.ahrq.gov/issue/patterns-opioid-administration-among-opioid-naive-inpatients-and-associations-postdischarge
November 05, 2008 - July 10, 2019
Guidance for health care leaders during the recovery stage of the COVID
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psnet.ahrq.gov/issue/systematic-review-computerized-prescriber-order-entry-and-clinical-decision-support
August 23, 2017 - WebM&M Cases
Overdose of Gabapentin and Oxycodone in a Patient with End-Stage
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psnet.ahrq.gov/issue/more-1000-preventable-deaths-day-too-many-need-improve-patient-safety
September 02, 2016 - October 1, 2014
Hearing on Patient Safety and Quality Issues in End Stage Renal Disease
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psnet.ahrq.gov/issue/transferring-responsibility-and-accountability-maternity-care-clinicians-defining-their
August 19, 2009 - December 21, 2017
Guidance for health care leaders during the recovery stage of the COVID
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psnet.ahrq.gov/issue/impact-medical-errors-ninety-day-costs-and-outcomes-examination-surgical-patients
August 03, 2017 - July 5, 2017
Meaningful Use stage 2 e-prescribing threshold and adverse drug events in
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psnet.ahrq.gov/issue/what-would-you-ideally-do-if-there-were-no-targets-ethnographic-study-unintended-consequences
July 27, 2011 - May 27, 2015
High Quality Care for All: NHS Next Stage Review Final Report.
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psnet.ahrq.gov/issue/exploration-factors-associated-reported-medication-administration-errors-north-carolina
September 20, 2012 - September 20, 2012
Guidance for health care leaders during the recovery stage of the
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psnet.ahrq.gov/issue/validation-and-use-second-victim-experience-and-support-tool-questionnaire-scoping-review
July 09, 2008 - July 1, 2016
Guidance for health care leaders during the recovery stage of the COVID-
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psnet.ahrq.gov/issue/comparison-methods-identifying-patients-risk-medication-related-harm
March 04, 2011 - Impact of health information technology on detection of potential adverse drug events at the ordering stage
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psnet.ahrq.gov/issue/reducing-health-care-hazards-lessons-commercial-aviation-safety-team
September 17, 2010 - August 17, 2016
High Quality Care for All: NHS Next Stage Review Final Report.
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psnet.ahrq.gov/issue/more-1-million-potential-second-victims-how-many-could-nursing-education-prevent
May 30, 2018 - July 5, 2013
Guidance for health care leaders during the recovery stage of the COVID-