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  1. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/60194/psn-pdf
    April 01, 2020 - Do you know what doses are being programmed in the OR? Make it an expectation to use smart infusion pumps with DERS. April 1, 2020 Do you know what doses are being programmed in the OR? Make it an expectation to use smart infusion pumps with DERS. ISMP Medication Safety Alert! Acute care edition!. 25(5):1-5. http…
  2. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/44970/psn-pdf
    May 09, 2017 - Analysis of prescribers' notes in electronic prescriptions in ambulatory practice. May 9, 2017 Dhavle AA, Yang Y, Rupp MT, et al. Analysis of Prescribers' Notes in Electronic Prescriptions in Ambulatory Practice. JAMA Intern Med. 2016;176(4):463-70. doi:10.1001/jamainternmed.2015.7786. https://psnet.ahrq.gov/issue…
  3. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/854630/psn-pdf
    October 18, 2023 - Physician behaviors associated with increased physician and nurse communication during bedside interdisciplinary rounds. October 18, 2023 Huang KX, Chen CK, Pessegueiro AM, et al. Physician behaviors associated with increased physician and nurse communication during bedside interdisciplinary rounds. J Hosp Med. 20…
  4. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/851647/psn-pdf
    July 26, 2023 - Statewide perinatal quality improvement, teamwork, and communication activities in Oklahoma and Texas. July 26, 2023 Stierman EK, O'Brien BT, Stagg J, et al. Statewide perinatal quality improvement, teamwork, and communication activities in Oklahoma and Texas. Qual Manag Health Care. 2023;32(3):177-188. doi:10.109…
  5. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/47198/psn-pdf
    August 22, 2018 - Health IT Safe Practices for Closing the Loop. August 22, 2018 Partnership for Health IT Patient Safety. Plymouth Meeting, PA: ECRI; August 2018. https://psnet.ahrq.gov/issue/health-it-safe-practices-closing-loop Inadequate follow-up of test results can contribute to missed and delayed diagnoses. Developing optimal…
  6. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/60540/psn-pdf
    November 01, 2016 - Quality improvement initiatives lead to reduction in nulliparous term singleton vertex cesarean delivery rate. November 1, 2016 Vadnais MA, Hacker MR, Shah NT, et al. Quality improvement initiatives lead to reduction in nulliparous term singleton vertex cesarean delivery rate. Jt Comm J Qual Patient Saf. 2016;43(2)…
  7. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/842421/psn-pdf
    January 11, 2023 - Weight and size descriptors for drug dosing: too many options and too many errors. January 11, 2023 Erstad BL, Romero AV, Barletta JF. Weight and size descriptors for drug dosing: Too many options and too many errors. Am J Health Syst Pharm. 2023;80(2):87-91. doi:10.1093/ajhp/zxac283. https://psnet.ahrq.gov/issue/…
  8. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/41211/psn-pdf
    January 03, 2017 - He thought the "lady in the door" was the "lady in the window": a qualitative study of patient identification practices. January 3, 2017 Phipps E, Turkel M, Mackenzie ER, et al. He thought the "lady in the door" was the "lady in the window": a qualitative study of patient identification practices. Jt Comm J Qual P…
  9. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/39533/psn-pdf
    May 25, 2015 - The relationship between patient safety culture and the implementation of organizational patient safety defences at emergency departments. May 25, 2015 van Noord I, de Bruijne M, Twisk JWR. The relationship between patient safety culture and the implementation of organizational patient safety defences at emergency…
  10. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/42980/psn-pdf
    February 17, 2017 - Disclosing adverse events to patients: international norms and trends. February 17, 2017 Wu AW, McCay L, Levinson W, et al. Disclosing Adverse Events to Patients: International Norms and Trends. J Patient Saf. 2017;13(1):43-49. doi:10.1097/PTS.0000000000000107. https://psnet.ahrq.gov/issue/disclosing-adverse-event…
  11. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/40128/psn-pdf
    January 12, 2011 - Impact of a comprehensive safety initiative on patient- controlled analgesia errors. January 12, 2011 Paul JE, Bertram B, Antoni K, et al. Impact of a comprehensive safety initiative on patient-controlled analgesia errors. Anesthesiology. 2010;113(6):1427-32. doi:10.1097/ALN.0b013e3181fcb427. https://psnet.ahrq.go…
  12. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/37092/psn-pdf
    August 21, 2008 - Enhancing patient safety during pediatric sedation: the impact of simulation-based training of nonanesthesiologists. August 21, 2008 Shavit I, Keidan I, Hoffmann Y, et al. Enhancing patient safety during pediatric sedation: the impact of simulation-based training of nonanesthesiologists. Arch Pediatr Adolesc Med. …
  13. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/47454/psn-pdf
    May 29, 2019 - Development and implementation of a subcutaneous insulin pen label bar code scanning protocol to prevent wrong-patient insulin pen errors. May 29, 2019 MacMaster HW, Gonzalez S, Maruoka A, et al. Development and Implementation of a Subcutaneous Insulin Pen Label Bar Code Scanning Protocol to Prevent Wrong-Patient …
  14. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/41951/psn-pdf
    September 07, 2016 - The impact of drug shortages on children with cancer—the example of mechlorethamine. September 7, 2016 Metzger ML, Billett A, Link MP. The impact of drug shortages on children with cancer--the example of mechlorethamine. N Engl J Med. 2012;367(26):2461-2463. doi:10.1056/NEJMp1212468. https://psnet.ahrq.gov/issue/i…
  15. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/44580/psn-pdf
    January 13, 2016 - Computerized Prescriber Order Entry Medication Safety (CPOEMS): Uncovering and Learning From Issues and Errors. January 13, 2016 Brigham and Women's Hospital, Harvard Medical School, Partners HealthCare. Silver Spring, MD: US Food and Drug Administration; December 15, 2015. https://psnet.ahrq.gov/issue/computeriz…
  16. www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patientsafetyculture/pharmacy/pharmwebinar/amermanslides.pdf
    June 02, 2025 - Using the AHRQ Pharmacy Survey on Patient Safety Culture Safety Survey Dawn Amerman Manager Dexter Pharmacy and Village Pharmacy II Reasons for Taking the Survey • Provided staff with an opportunity to give uncensored feedback • Offered staff a sense of being part of the solutions • Let staff know t…
  17. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/837799/psn-pdf
    August 10, 2022 - Effect of a pharmacy-based centralized intravenous admixture service on the prevalence of medication errors: a before-and-after study. August 10, 2022 Jessurun JG, Hunfeld NGM, Van Rosmalen J, et al. Effect of a pharmacy-based centralized intravenous admixture service on the prevalence of medication errors: a befo…
  18. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/853432/psn-pdf
    September 13, 2023 - Healthcare leaders' and elected politicians' approach to support-systems and requirements for complying with quality and safety regulation in nursing homes - a case study. September 13, 2023 Magerøy MR, Braut GS, Macrae C, et al. Healthcare leaders’ and elected politicians’ approach to support- systems and requir…
  19. www.ahrq.gov/sites/default/files/wysiwyg/cahps/news-and-events/events/webinars/nyp-webinar-ginsberg.pdf
    June 02, 2025 - Implementing the New CAHPS® Protocol for Obtaining Patient Comments About Their Care AHRQ and AHRQ’s CAHPS® Program Caren Ginsberg, Ph.D. Director, CAHPS Division, Center for Quality Improvement and Patient Safety Agency for Healthcare Research and Quality www.ahrq.gov/cahps AHRQ’s Core Competencies Resea…
  20. HHCEB Presentation (ppt file)

    www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/vtguide/umich-slides.ppt
    May 20, 2012 - HHCEB Presentation * VTE Prevention: An Institution-wide Initiative University of Michigan Caprini VTE risk assessment May 20, 2012 Marc Moote, PA-C Chief Physician Assistant University of Michigan Health System * * Key Strategies Scope: ALL adult inpatients Standardized VTE Protocol – Caprini model Mandato…