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  1. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/46676/psn-pdf
    December 13, 2017 - Diagnostic errors by medical students: results of a prospective qualitative study. December 13, 2017 Braun LT, Zwaan L, Kiesewetter J, et al. Diagnostic errors by medical students: results of a prospective qualitative study. BMC Med Educ. 2017;17(1):191. doi:10.1186/s12909-017-1044-7. https://psnet.ahrq.gov/issue/…
  2. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/45253/psn-pdf
    October 03, 2017 - Patient safety: disclosure of medical errors and risk mitigation. October 3, 2017 Moffatt-Bruce SD, Ferdinand FD, Fann J. Patient Safety: Disclosure of Medical Errors and Risk Mitigation. Ann Thorac Surg. 2016;102(2):358-62. doi:10.1016/j.athoracsur.2016.06.033. https://psnet.ahrq.gov/issue/patient-safety-disclosu…
  3. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/44772/psn-pdf
    January 13, 2016 - Post event debriefs: a commitment to learning how to better care for patients and staff. January 13, 2016 Campbell M, Miller K, McNicholas KW. Post Event Debriefs: A Commitment to Learning How to Better Care for Patients and Staff. Jt Comm J Qual Patient Saf. 2016;42(1):41-47. https://psnet.ahrq.gov/issue/post-eve…
  4. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/42672/psn-pdf
    October 23, 2013 - SBAR improves nurse–physician communication and reduces unexpected death: a pre and post intervention study. October 23, 2013 De Meester K, Verspuy M, Monsieurs KG, et al. SBAR improves nurse-physician communication and reduces unexpected death: a pre and post intervention study. Resuscitation. 2013;84(9):1192-6. …
  5. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/866561/psn-pdf
    August 21, 2024 - Medical malpractice litigation and daylight saving time. August 21, 2024 Gao C, Lage C, Scullin MK. Medical malpractice litigation and daylight saving time. J Clin Sleep Med. 2024;20(6):933-940. doi:10.5664/jcsm.11038. https://psnet.ahrq.gov/issue/medical-malpractice-litigation-and-daylight-saving-time Sleep depri…
  6. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/45246/psn-pdf
    August 15, 2016 - Reliability of verbal handoff assessment and handoff quality before and after implementation of a resident handoff bundle. August 15, 2016 Feraco AM, Starmer AJ, Sectish TC, et al. Reliability of Verbal Handoff Assessment and Handoff Quality Before and After Implementation of a Resident Handoff Bundle. Acad Pediat…
  7. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/35990/psn-pdf
    September 17, 2010 - Misunderstanding of prescription drug warning labels among patients with low literacy. September 17, 2010 Wolf MS, Davis TC, Tilson HH, et al. Misunderstanding of prescription drug warning labels among patients with low literacy. Am J Health Syst Pharm. 2006;63(11):1048-55. https://psnet.ahrq.gov/issue/misundersta…
  8. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/38228/psn-pdf
    July 14, 2010 - Timely follow-up of abnormal outpatient test results: perceived barriers and impact on patient safety. July 14, 2010 Moore C, Saigh O, Trikha A, et al. Timely Follow-Up of Abnormal Outpatient Test Results. J Patient Saf. 2008;4(4):241-244. doi:10.1097/pts.0b013e31818d1ca4. https://psnet.ahrq.gov/issue/timely-follo…
  9. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/40343/psn-pdf
    December 21, 2014 - Trends in central line–associated bloodstream infections in a trauma-surgical intensive care unit. December 21, 2014 Ong A, Dysert K, Herbert C, et al. Trends in central line-associated bloodstream infections in a trauma- surgical intensive care unit. Arch Surg. 2011;146(3):302-7. doi:10.1001/archsurg.2011.9. http…
  10. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/47503/psn-pdf
    October 24, 2018 - I-PASS checklist: a powerful tool for patient handoffs. October 24, 2018 Peeples L. Pharmacy Practice News. October 10, 2018. https://psnet.ahrq.gov/issue/i-pass-checklist-powerful-tool-patient-handoffs Structured handoffs can reduce communication problems that contribute to medical error. This magazine article re…
  11. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/855438/psn-pdf
    November 15, 2023 - Intravenous (IV) push medications – bridging the gap between education and clinical practice. November 15, 2023 ISMP Medication Safety Alert! Acute Care. November 2, 2023;28(22):1-4. https://psnet.ahrq.gov/issue/intravenous-iv-push-medications-bridging-gap-between-education-and-clinical- practice Intravenous…
  12. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/43001/psn-pdf
    March 19, 2014 - Variability in the measurement of hospital-wide mortality rates. March 19, 2014 Shahian DM, Wolf RE, Iezzoni LI, et al. Variability in the measurement of hospital-wide mortality rates. N Engl J Med. 2010;363(26):2530-9. doi:10.1056/NEJMsa1006396. https://psnet.ahrq.gov/issue/variability-measurement-hospital-wide-m…
  13. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/46289/psn-pdf
    January 01, 2021 - Communication training, adverse events, and quality measures: 2 retrospective database analyses in Washington State hospitals. August 9, 2017 Slade IR, Beck SJ, Kramer B, et al. Communication Training, Adverse Events, and Quality Measures: 2 Retrospective Database Analyses in Washington State Hospitals. J Patient …
  14. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/47979/psn-pdf
    May 01, 2019 - Inpatient notes: just what the doctor ordered—checklists to improve diagnosis. May 1, 2019 Gupta A, Graber ML. Web Exclusive. Annals for Hospitalists Inpatient Notes - Just What the Doctor Ordered-Checklists to Improve Diagnosis. Ann Intern Med. 2019;170(8):HO2-HO3. doi:10.7326/M19-0829. https://psnet.ahrq.gov/iss…
  15. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/845649/psn-pdf
    March 08, 2023 - Medication rounds: a tool to promote medication safety for children with medical complexity. March 8, 2023 Rojas CR, Moore A, Coffin A, et al. Medication rounds: a tool to promote medication safety for children with medical complexity. Jt Comm J Qual Patient Saf. 2023;49(4):226-234. doi:10.1016/j.jcjq.2023.01.003. …
  16. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/73995/psn-pdf
    October 20, 2021 - Potential for medication overdose with ENFit low dose tip syringe: FDA Safety Communication. October 20, 2021 MedWatch Safety Alert. Silver Spring, MD: US Food and Drug Administration; October 12, 2021. https://psnet.ahrq.gov/issue/potential-medication-overdose-enfit-low-dose-tip-syringe-fda-safety- communication …
  17. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/45421/psn-pdf
    December 14, 2016 - The medication reconciliation process and classification of discrepancies: a systematic review. December 14, 2016 Almanasreh E, Moles R, Chen TF. The medication reconciliation process and classification of discrepancies: a systematic review. Br J Clin Pharmacol. 2016;82(3):645-658. doi:10.1111/bcp.13017. https://p…
  18. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/45271/psn-pdf
    August 10, 2016 - Patient identification and tube labelling—a call for harmonisation. August 10, 2016 van Dongen-Lases EC, Cornes MP, Grankvist K, et al. Patient identification and tube labelling – a call for harmonisation. Clinical Chemistry and Laboratory Medicine (CCLM). 2016;54(7). doi:10.1515/cclm-2015- 1089. https://psnet.ah…
  19. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/38873/psn-pdf
    August 19, 2009 - What are covering doctors told about their patients? Analysis of sign-out among internal medicine house staff. August 19, 2009 Horwitz LI, Moin T, Krumholz HM, et al. What are covering doctors told about their patients? Analysis of sign-out among internal medicine house staff. Qual Saf Health Care. 2009;18(4):248-5…
  20. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/72702/psn-pdf
    February 03, 2021 - Outcomes from Wake Up Safe, the pediatric anesthesia quality improvement initiative. February 3, 2021 Haché M, Sun LS, Gadi G, et al. Outcomes from Wake Up Safe, the pediatric anesthesia quality improvement initiative. Paediatr Anaesth. 2020;30(12):1348-1354. doi:10.1111/pan.14044. https://psnet.ahrq.gov/issue/out…