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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/surgery/modules/implementation/imp_learn_from_defects.pptx
December 01, 2017 - PowerPoint Presentation: Learn From Defects Through Sensemaking
Learning From Defects
Through Sensemaking
AHRQ Safety Program for Surgery
Implementation
AHRQ Pub. No. 16(18)-0004-15-EF
December 2017
AHRQ Safety Program For Surgery – Implementation
This module focuses on the process of Learning from Defects throug…
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www.ahrq.gov/sites/default/files/wysiwyg/action-alliance/action-alliance-diagnostic-excellence-webinar.pdf
June 01, 2025 - Advancing Patient Safety Through Diagnostic Excellence
Advancing Patient Safety Through
Diagnostic Excellence
NATIONAL WEBINAR SERIES
September 17, 2024
Housekeeping Instructions
• This webinar will be recorded and available for viewing on the NAA website
• Please use the ‘Chat’ function to engage with us thro…
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www.ahrq.gov/sites/default/files/wysiwyg/policymakers/chipra/factsheets/fullreports/chipra-89-adhd-behavior-section-6-attach-2.pdf
June 02, 2025 - ADHD Summary of Public Comments
SNAC Submission Form ADHD Measure 2: Behavior Therapy
Section 6: Scientific Soundness
Attachment 2: Summary of Public Comments
Attention Deficit Hyperactivi…
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www.ahrq.gov/hai/cauti-tools/impl-guide/implementation-guide-appendix-m.html
October 01, 2020 - Toolkit for Reducing Catheter-Associated Urinary Tract Infections in Hospital Units: Implementation Guide
Appendix M. Example of a Nurse-Driven Protocol for Catheter Removal
Previous Page Next Page
Table of Contents
Toolkit for Reducing Catheter-Associated Urinary Tract Infections in Hospital Units…
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www.ahrq.gov/sites/default/files/wysiwyg/sops/quality-patient-safety/patientsafetyculture/hospital/healthitwebinar/sops-hit-webcast3-gandhi.pdf
January 01, 2018 - New AHRQ SOPS™ Health Information Technology Patient Safety Supplemental Items for Hospitals - Optimizing (Gandhi)
Optimizing
the Use of HIT
to Improve
Safety
Tejal Gandhi
Handwriting
16
Ways IT Can Improve Safety
• Prevent errors and adverse events
• Facilitating a more rapid response after an
…
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol3/Advances-Singh-R_68.pdf
April 20, 2008 - Building Self-Empowered Teams for Improving Safety in Postoperative Pain Management
Building Self-Empowered Teams for Improving Safety
in Postoperative Pain Management
Ranjit Singh, MA, MB, BChir (Cantab), MBA; Bruce Naughton, MD;
Diana Anderson, EdM; Donna McCourt, RN, BSN; Gurdev Singh, MScEng, PhD
Abstrac…
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www.ahrq.gov/patient-safety/settings/long-term-care/resource/ontime/case.html
December 01, 2017 - AHRQ's Safety Program for Nursing Homes
Case Studies
These case studies follow three nursing home facilities that implemented the On-Time Pressure Ulcer Prevention Program.
Select for more AHRQ Impact Case Studies .
Contents
New York Nursing Facility Sees 56 Percent Drop in Pressure Ulcers with AHRQ-Fu…
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www.ahrq.gov/patient-safety/settings/long-term-care/resource/ontime/pruhealing/facslides.html
December 01, 2017 - On-Time Pressure Ulcer Healing: Facilitator Training Slide Presentation
AHRQ’s Safety Program for Nursing Homes
Text version of slide presentation.
Slide 1: Overview of On-Time
AHRQ’s Safety Program for Nursing Homes:
On-Time Pressure Ulcer Healing Facilitator Training
Slide 2: On-Time Pressure Ulcer…
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www.ahrq.gov/patient-safety/settings/long-term-care/resource/ontime/fallspx/factraining-slides.html
October 01, 2017 - AHRQ’s Safety Program for Nursing Homes: On-Time Falls Prevention Facilitator Training
Overview of On-Time
Text version of slide presentation.
Slide 1: Overview of On-Time
AHRQ’s Safety Program for Nursing Homes: On-Time Falls Prevention Facilitator Training
Overview of On-Time
Slide 2: On-Time Fall…
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www.ahrq.gov/patient-safety/settings/long-term-care/resource/ontime/prevhosp/facslides.html
September 01, 2017 - AHRQ’s Safety Program for Nursing Homes: On-Time Preventable Hospital and Emergency Department Visits
Facilitator Training Slide Presentation
Text version of slide presentation.
Slide 1: Overview of On-Time
AHRQ’s Safety Program for Nursing Homes: On-Time Preventable Hospital and Emergency Department V…
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www.ahrq.gov/sites/default/files/wysiwyg/hai/tools/clabsi-cauti-icu/urinary-catheter-alternatives.pptx
April 01, 2022 - Central Venous Catheter Indications and Alternatives
Indwelling Urinary Catheter Alternatives
Avoiding Placement and Determining Appropriateness
AHRQ Safety Program for Intensive Care Units: Preventing CLABSI and CAUTI
AHRQ Pub. No. 17(22)-0019
April 2022
1
Avoid Unnecessary Urinary Catheter Placement1,2
Patel…
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www.ahrq.gov/sites/default/files/wysiwyg/nursing-home/materials/hand-hygiene-audit-tool-userguide.pdf
April 01, 2021 - USER GUIDE: Hand Hygiene Observational Audit Data Tracking Tool for Use in Skilled Nursing Facilities
USER GUIDE: Hand Hygiene Observational Audit Data
Tracking Tool for Use in Skilled Nursing Facilities
Introduction
This user guide provides step-by-step instructions for nursing home staff to use the Hand Hygien…
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www.ahrq.gov/sites/default/files/wysiwyg/sops/events/webinar/04-new_sops_diagnostic_safety-yount.pdf
October 20, 2021 - New AHRQ SOPS® Diagnostic Safety Supplemental Items for Medical Offices - Yount
Diagnostic Safety Supplemental Items
for the SOPS Medical Office Survey
Naomi Yount, PhD
Westat
39
Diagnostic Safety Supplemental Items
40
• Designed as a supplemental item set that can be added to the
end of the SOPS Medical Off…
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www.ahrq.gov/sites/default/files/wysiwyg/research/findings/ta/topicrefinement/ced-appendix3-data-abstraction.xlsx
June 24, 2022 - NAM2019 Could real-world providers in these settings accurately recognize or evaluate this event or … Could available sensing technologies accurately detect this event or health state?
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/surgery/tools/applying-cusp/learn_from_defects.docx
December 01, 2017 - Learn From Defects Tool
AHRQ Safety Program for Surgery
Learn From Defects Tool – Perioperative Setting
What is a defect? A defect is any event or situation that you don’t want to repeat. This could include an incident that caused patient harm or put patients at risk for harm, such as a patient fall.
Problem statem…
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www.ahrq.gov/patient-safety/reports/engage/findings.html
March 01, 2017 - Guide to Improving Patient Safety in Primary Care Settings by Engaging Patients and Families
Discussion of Findings
Previous Page Next Page
Table of Contents
Guide to Improving Patient Safety in Primary Care Settings by Engaging Patients and Families
Executive Summary
Introduction
Limitation…
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www.ahrq.gov/news/newsroom/case-studies/ktcquips92.html
October 01, 2014 - Maryland Hospitals Revise Medication Reconciliation Process With AHRQ Toolkit
Search All Impact Case Studies
April 2012
After participating in AHRQ-sponsored learning sessions and provider support calls, Delmarva Foundation for Medical Care, the Maryland Quality Improvement Organization (QIO), worked with h…
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www.ahrq.gov/sites/default/files/wysiwyg/cahps/news-and-events/events/20141022_cg/3_julie_susi.pdf
April 01, 2014 - Achieving Excellence Across All CG-CAHPS Core Measures: Lessons from Top-Performing Medical Practices
Mercy Hospital
Fore River Campus
Portland, Maine
23
Breast Care Specialists of Maine
A two-surgeon practice, we take pride in offering
timely, accurate consultation and treatment for
benign and malignant …
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www.ahrq.gov/sites/default/files/wysiwyg/sops/events/webinar/sops-101-webcast-overview-surveys.pdf
January 01, 2022 - Understanding SOPS® Surveys: A Primer for New Users - Gray
Overview of the SOPS Surveys
Laura Gray, MPH
Senior Study Director
User Network for the AHRQ Surveys on Patient Safety Culture (SOPS)
Westat
What is Patient Safety Culture?
Organization
13
What are the SOPS Surveys?
• Surveys of providers and st…
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www.ahrq.gov/healthsystemsresearch/hspc-research-study/appendix-a.html
June 01, 2020 - threshold that maximizes the sum of sensitivity and specificity, perform poorly when attempting to accurately … Table A.8 provides various measures of how accurately the machine learning algorithm was able to reproduce