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psnet.ahrq.gov/node/73255/psn-pdf
May 12, 2021 - Implementing High-Quality Primary Care: Rebuilding the
Foundation of Health Care.
May 12, 2021
National Academies of Sciences, Engineering, and Medicine 2021. Washington, DC: The National
Academies Press.
https://psnet.ahrq.gov/issue/implementing-high-quality-primary-care-rebuilding-foundation-health-care
Primary…
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psnet.ahrq.gov/node/837982/psn-pdf
August 31, 2022 - Patient Safety Incident Response Framework.
August 31, 2022
London, England: NHS England; August 2022.
https://psnet.ahrq.gov/issue/patient-safety-incident-response-framework
Effective response to medical error requires a comprehensive systemic and process-focused incident
examination approach to ensure organizati…
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psnet.ahrq.gov/node/47518/psn-pdf
January 23, 2019 - Evaluation of a measurement system to assess ICU team
performance.
January 23, 2019
Dietz AS, Salas E, Pronovost P, et al. Evaluation of a Measurement System to Assess ICU Team
Performance. Crit Care Med. 2018;46(12):1898-1905. doi:10.1097/CCM.0000000000003431.
https://psnet.ahrq.gov/issue/evaluation-measurement-s…
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psnet.ahrq.gov/training-catalog/national-action-alliance-webinars
National Action Alliance: Webinars
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Organization:
Organization
Agency for Healthcare Research and Quality (AHRQ)
Event Des…
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psnet.ahrq.gov/node/35676/psn-pdf
June 25, 2010 - Implementation of patient centeredness to enhance
patient safety.
June 25, 2010
Berntsen KJ. Implementation of patient centeredness to enhance patient safety. J Nurs Care Qual.
2006;21(1):15-19.
https://psnet.ahrq.gov/issue/implementation-patient-centeredness-enhance-patient-safety
The author reviews the six aims…
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psnet.ahrq.gov/node/46397/psn-pdf
August 30, 2017 - Making Dialysis Safer for Patients Coalition.
August 30, 2017
Centers for Disease Control and Prevention.
https://psnet.ahrq.gov/issue/making-dialysis-safer-patients-coalition
Dialysis is a common procedure that carries risks if not performed correctly. This initiative represents a
collective effort that aims to d…
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psnet.ahrq.gov/node/838221/psn-pdf
September 28, 2022 - healthcare providers how to integrate population health
into primary care to achieve the quintuple aim … But I think if the goal is
really to achieve the quintuple aim of improving health outcomes, improving … Then we implement, evaluate, and determine the return on investment and the impact on the quintuple aim
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psnet.ahrq.gov/node/72618/psn-pdf
December 23, 2020 - Nudges to clinicians focus on the design
of practice environments that aim to improve workflow and steer … Aim for projects that are of high impact but feasible
with available capacity and resources.
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psnet.ahrq.gov/node/858167/psn-pdf
December 13, 2023 - A proposed approach to allegations of sexual boundary
violation in health care.
December 13, 2023
Cooper WO, Foster JJ, Hickson GB, et al. A proposed approach to allegations of sexual boundary violation
in health care. Jt Comm J Qual Patient Saf. 2023;49(12):671-679. doi:10.1016/j.jcjq.2023.08.006.
https://psnet.a…
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psnet.ahrq.gov/node/43318/psn-pdf
July 02, 2014 - Sign up to Safety.
July 2, 2014
National Health Service.
https://psnet.ahrq.gov/issue/sign-safety
Through a coordinated effort to set goals and devise plans to improve safety in hospitals, the Sign up to
Safety campaign aims to prevent 6000 patient deaths in the next 3 years in National Health Service
facilities.…
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psnet.ahrq.gov/node/40773/psn-pdf
January 04, 2012 - Complementary telephone strategies to improve
postdischarge communication.
January 4, 2012
Rennke S, Kesh S, Neeman N, et al. Complementary telephone strategies to improve postdischarge
communication. Am J Med. 2012;125(1):28-30. doi:10.1016/j.amjmed.2011.05.011.
https://psnet.ahrq.gov/issue/complementary-telephon…
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psnet.ahrq.gov/node/50705/psn-pdf
January 01, 2020 - Closing the loop with ambulatory staff on safety reports.
December 4, 2019
Williams S, Fiumara K, Kachalia A, et al. Closing the Loop with Ambulatory Staff on Safety Reports. Jt
Comm J Qual Saf. 2020;46(1):44-50. doi:10.1016/j.jcjq.2019.09.009.
https://psnet.ahrq.gov/issue/closing-loop-ambulatory-staff-safety-repor…
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psnet.ahrq.gov/node/46384/psn-pdf
November 14, 2018 - Peggy Lillis Foundation.
November 14, 2018
266 12th Street #6, Brooklyn, NY 11215.
https://psnet.ahrq.gov/issue/peggy-lillis-foundation
Clostridium difficile infections are considered a serious hospital-acquired infection. This grassroots
foundation employs educational, policy, and advocacy strategies aimed at red…
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psnet.ahrq.gov/node/74749/psn-pdf
February 09, 2022 - A safety maturity model for technology-induced errors.
February 9, 2022
Borycki EM, Kushniruk AW. A safety maturity model for technology-induced errors. Stud Health Technol
Inform. 2022;289:447-451. doi:10.3233/shti210954.
https://psnet.ahrq.gov/issue/safety-maturity-model-technology-induced-errors
Although health…
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psnet.ahrq.gov/node/47708/psn-pdf
February 13, 2019 - The role of purple pens in learning to prescribe.
February 13, 2019
Kinston R, McCarville N, Hassell A. The role of purple pens in learning to prescribe. Clin Teach.
2019;16(6):598-603. doi:10.1111/tct.12991.
https://psnet.ahrq.gov/issue/role-purple-pens-learning-prescribe
Interventions utilizing color as visual c…
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psnet.ahrq.gov/node/73249/psn-pdf
May 12, 2021 - I-PASS handover system: a decade of evidence demands
action.
May 12, 2021
Shahian DM. I-PASS handover system: a decade of evidence demands action. BMJ Qual Saf.
2021;30(10):769-774. doi:10.1136/bmjqs-2021-013314.
https://psnet.ahrq.gov/issue/i-pass-handover-system-decade-evidence-demands-action
The I-PASS structu…
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psnet.ahrq.gov/node/60800/psn-pdf
January 01, 2021 - Changing hospital organisational culture for improved
patient outcomes: developing and implementing the
Leadership Saves Lives intervention.
August 12, 2020
Linnander EL, McNatt Z, Boehmer K, et al. Changing hospital organisational culture for improved patient
outcomes: developing and implementing the leadership s…
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psnet.ahrq.gov/node/39982/psn-pdf
January 17, 2012 - Hand-off Communications.
January 17, 2012
DeRosier JM, Stalhandske E, Bagian JP, et al. Using health care Failure Mode and Effect Analysis: the VA
National Center for Patient Safety's prospective risk analysis system.
https://psnet.ahrq.gov/issue/hand-communications
The Joint Commission Center for Transforming Hea…
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psnet.ahrq.gov/node/867649/psn-pdf
January 01, 2015 - Improving Pain Management for Hospitalized Medical
Patients.
January 1, 2015
Society of Hospital Medicine. Improving Pain Management for Hospitalized Medical Patients.
https://psnet.ahrq.gov/issue/improving-pain-management-hospitalized-medical-patients
Pain management presents complex patient safety concerns. Info…
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psnet.ahrq.gov/node/35985/psn-pdf
January 02, 2017 - The Sorry Works! Coalition: making the case for full
disclosure.
January 2, 2017
Wojcieszak D, Banja J, Houk C. The Sorry Works! Coalition: Making the Case for Full Disclosure. The Joint
Commission Journal on Quality and Patient Safety. 2016;32(6). doi:10.1016/s1553-7250(06)32044-2.
https://psnet.ahrq.gov/issue/so…