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psnet.ahrq.gov/issue/selected-medication-safety-risks-manage-2016-might-otherwise-fall-radar-screen-part-1-and
March 09, 2016 - Newspaper/Magazine Article
Selected medication safety risks to manage in 2016 that might otherwise fall off the radar screen—part 1 and part 2.
Citation Text:
Selected medication safety risks to manage in 2016 that might otherwise fall off the radar screen—part 1 and part 2. ISMP Medicat…
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psnet.ahrq.gov/issue/getting-closer-bulls-eye-2014-2015-targeted-medication-safety-best-practices
July 08, 2015 - Newspaper/Magazine Article
Getting closer to the bull's eye: 2014–2015 Targeted Medication Safety Best Practices.
Citation Text:
Getting closer to the bull's eye: 2014–2015 Targeted Medication Safety Best Practices. ISMP Medication Safety Alert! Acute Care Edition. February 12, 2015;20:1…
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psnet.ahrq.gov/issue/hardwiring-safety-computer-system-one-hospitals-actions-provide-technology-support-u-500
February 24, 2016 - Newspaper/Magazine Article
Hardwiring safety into the computer system: one hospital's actions to provide technology support for U-500 insulin.
Citation Text:
Hardwiring safety into the computer system: one hospital's actions to provide technology support for U-500 insulin. ISMP Medicatio…
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psnet.ahrq.gov/node/49632/psn-pdf
July 01, 2011 - Communication failures in patient sign-out
and suggestions for improvement: a critical incident analysis
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psnet.ahrq.gov/node/49756/psn-pdf
April 01, 2016 - A recent review found that management suggestions by
curbside consultants were often different from
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psnet.ahrq.gov/node/33835/psn-pdf
June 01, 2017 - Again, the paper
got a lot of publicity and some criticism and some useful suggestions. … weekend-mortality-emergency-admissions-large-multicentre-study
https://doi.org/10.1136/bmj.f2424
Another suggestion
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psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.167_slideshow.ppt
January 01, 2008 - Residents’ suggestions for reducing errors in teaching hospitals.
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psnet.ahrq.gov/node/49629/psn-pdf
June 01, 2011 - Communication failures in patient sign-out
and suggestions for improvement: a critical incident analysis
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psnet.ahrq.gov/node/49851/psn-pdf
January 01, 2019 - Adult bronchoscopy training: current state and suggestions for the
future: CHEST Expert Panel Report
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psnet.ahrq.gov/issue/safety-nebulized-medications-requires-interdisciplinary-team-approach
December 27, 2018 - Newspaper/Magazine Article
Safety with nebulized medications requires an interdisciplinary team approach.
Citation Text:
Safety with nebulized medications requires an interdisciplinary team approach. ISMP Medication Safety Alert! Acute care edition. February 22, 2018;23(4):1-5.
Copy Ci…
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psnet.ahrq.gov/node/35314/psn-pdf
August 31, 2005 - The health factory.
August 31, 2005
Spear SJ.
https://psnet.ahrq.gov/issue/health-factory
In this editorial, the author suggests that health care organizations approach error the way other industries
do, by constantly evaluating and solving problems, rather than working around them.
https://psnet.ahrq.gov/issue/h…
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psnet.ahrq.gov/node/33611/psn-pdf
July 01, 2005 - In Conversation with…Christopher P. Landrigan, MD
April 1, 2005
In Conversation with…Christopher P. Landrigan, MD. PSNet [internet]. 2005.
https://psnet.ahrq.gov/perspective/conversation-withchristopher-p-landrigan-md
Editor's Note: In October 2004, in what immediately became a landmark paper in patient safety, Dr.…
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psnet.ahrq.gov/node/49610/psn-pdf
October 01, 2010 - "Recurrent" Appendicitis
October 1, 2010
Greenberg CC. "Recurrent" Appendicitis. PSNet [internet]. 2010.
https://psnet.ahrq.gov/web-mm/recurrent-appendicitis
The Case
An 85-year-old man presented to the emergency department (ED) with right lower quadrant pain. On
physical examination, the patient showed rebound t…
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psnet.ahrq.gov/node/38247/psn-pdf
June 27, 2018 - Debriefing for patient safety.
June 27, 2018
Turner SH, Kurtz WD. Patient Saf Qual Healthc. November/December 2008:5:42-44,46.
https://psnet.ahrq.gov/issue/debriefing-patient-safety
This article provides guidelines for effective clinical debriefings and suggests how to position these
conversations as learning oppo…
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psnet.ahrq.gov/node/33910/psn-pdf
May 01, 2016 - Quick Tips—When Getting A Prescription.
May 1, 2016
Agency for Healthcare Research and Quality; AHRQ.
https://psnet.ahrq.gov/issue/quick-tips-when-getting-prescription
This Web site suggests questions that all patients should ask a physician, nurse, and/or pharmacist when
they receive a medication prescription.
h…
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psnet.ahrq.gov/node/36534/psn-pdf
March 09, 2009 - Standardizing hand-off processes.
March 9, 2009
Gregory BSC. Standardizing hand-off processes. AORN J. 2006;84(6):1059-61.
https://psnet.ahrq.gov/issue/standardizing-hand-processes
The author suggests ways to improve hand-off communications and provides an assessment form to assist
staff in detecting weaknesses in…
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psnet.ahrq.gov/node/40525/psn-pdf
June 15, 2011 - The normalization of deviance: what are the perioperative
risks?
June 15, 2011
McNamara SA. The normalization of deviance: what are the perioperative risks? AORN J. 2011;93(6):796-
801. doi:10.1016/j.aorn.2011.02.009.
https://psnet.ahrq.gov/issue/normalization-deviance-what-are-perioperative-risks
This commentary…
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psnet.ahrq.gov/node/40299/psn-pdf
April 16, 2018 - Medication errors in the emergency department: need for
pharmacy involvement?
April 16, 2018
https://psnet.ahrq.gov/issue/medication-errors-emergency-department-need-pharmacy-involvement
This piece reports on the prevalence of medication errors in the emergency department and suggests
expanding pharmacy involvemen…
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psnet.ahrq.gov/node/33824/psn-pdf
January 01, 2016 - Patient Safety and Opioid Medications
January 1, 2016
Sarkar U, Shojania KG. Patient Safety and Opioid Medications. PSNet [internet]. 2016.
https://psnet.ahrq.gov/perspective/patient-safety-and-opioid-medications
Annual Perspective 2016
Opioid medications confer significant risks of harm, including overdose death …
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psnet.ahrq.gov/node/35487/psn-pdf
September 12, 2016 - Safety improvements urged for MRI facilities.
September 12, 2016
Mitka M. Safety improvements urged for MRI facilities. JAMA. 2005;294(17):2145-8.
https://psnet.ahrq.gov/issue/safety-improvements-urged-mri-facilities
This news story from JAMA summarizes a teleconference on magnetic resonance imaging safety
and sha…