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The PSNet Collection: All Content

The AHRQ PSNet Collection comprises an extensive selection of resources relevant to the patient safety community. These resources come in a variety of formats, including literature, research, tools, and Web sites. Resources are identified using the National Library of Medicine’s Medline database, various news and content aggregators, and the expertise of the AHRQ PSNet editorial and technical teams.

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Displaying 1 - 7 of 7 Results
Bae J, Rask KJ, Becker ER. Am J Med Qual. 2018;33:72-80.
Electronic health records enhance patient safety, but they also have unintended consequences. This retrospective study found that hospitals with a single-source electronic health record were less likely to have hospital-acquired safety events compared to hospitals with multiple systems in place. These results suggest that safety gaps may arise at the interface of multiple electronic systems.
Kripalani S, Roumie CL, Dalal A, et al. Ann Intern Med. 2012;157:1-10.
Hospital discharge remains a particularly vulnerable time for adverse drug events, despite the use of medication reconciliation and other strategies to prevent medication errors at discharge. Previously, pharmacist involvement has also been shown to be beneficial in reducing medication errors, and even led to decreased readmissions in at least one study. However, in this randomized, controlled trial, approximately 50% of adult patients who received a robust pharmacist-driven intervention still experienced a clinically important medication error within one month following discharge for an episode of acute coronary syndrome or acute decompensated heart failure. The four-component intervention included pharmacist-assisted medication reconciliation, inpatient pharmacist counseling, low-literacy adherence aids, and individualized telephone follow-up after discharge. A case of a preventable readmission due to a medication error is discussed in this AHRQ WebM&M commentary.
Culler SD, Hawley JN, Naylor V, et al. J Med Syst. 2007;31:319-327.
J Med Syst … J Med Syst … This study found no association between the … Indicator outcomes. … Culler SD, Hawley JN, Naylor V, Rask KJ. Is the availability of hospital IT applications … safety indicators: results from 66 Georgia hospitals.  J Med Syst . 2007;31(5):319-327. doi:10.1007/s10916-007-9071-2 …