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www.ahrq.gov/sites/default/files/2024-05/bonafide-report.pdf
January 01, 2024 - Final Progress Report: Pediatric patient safety learning laboratory to re-engineer continuous physiologic … interventions that
improved outcomes, including reduction in alarm notifications, reductions in nurse reports … IPD graduate
students performed an in-depth review of the findings of problem analysis, including reports … monitored at CHOP, a nurse caring for four patients would typically experience 36-100 alarms per 12-hour
shift … Twenty-six nurses provided repeated reports (n=394) of their subjective
workload in the preceding 2
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psnet.ahrq.gov/issue/emergency-nursing-and-medical-error-survey-two-states
January 25, 2010 - August 4, 2010
Bedside shift report improves patient safety and nurse accountability.
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psnet.ahrq.gov/issue/how-master-new-art-training-teamwork-fly
June 28, 2011 - November 2, 2010
Bedside shift report improves patient safety and nurse accountability
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ce.effectivehealthcare.ahrq.gov/research/findings/final-reports/ptfamilyscan/ptfamily3b.html
July 01, 2018 - rounds, bedside change of shift reports, patient/family-activated rapid response teams, access of medical … shift reports . … Conducting bedside change of shift reports is another strategy used to encourage patient and family involvement … Conducting change of shift reports at the bedside, instead of at the nurses' station or in the hallway … rounds, bedside change of shift reports, patient- or family-activated rapid response teams, specific
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psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.188_slideshow.ppt
November 01, 2008 - Spotlight Case [MONTH] 2003
Spotlight Case November 2008
Dangerous Shift
Source and Credits … changes
Understand the limits of standardizing handoffs in preventing errors at shift change
Explain … This transfer happened to coincide with a shift change for both the nursing staff and the physicians … Case: Dangerous Shift (2)
The off-going nurse assumed the transfer would take place immediately and … Approximately 45 minutes later, the unit clerk called the infant’s bedside nurse to report that the infant
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www.ahrq.gov/sites/default/files/2024-09/czeisler-report.pdf
January 01, 2024 - Final Progress Report: Effects of Extended Work Hours on ICU Patient Safety
Final Progress Report … quantify work hours and sleep in interns during a traditional work schedule;
2) to compare subjective reports … Activity was defined as any bedside patient
interaction with the immediate surroundings; an average … of two nurse chart reviewers and six physician observers collected data,
supplemented by voluntary reports … In Press N Engl J Med 2005.
15
Final Progress Report
Abstract
Purpose
Scope
Methods
Results
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www.ahrq.gov/news/newsroom/case-studies/201701.html
March 01, 2017 - "We wanted to sustain quality improvement efforts at the bedside. … The mobile technology platform included CAUTI modules from the AHRQ toolkit for shift-to-shift reporting
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psnet.ahrq.gov/web-mm/safety-challenges-supervision-and-night-coverage-academic-residency
February 21, 2024 - The bedside nurse paged the intern night float, who was cross-covering this patient, to come to the bedside … colleagues, which is rare on the inpatient wards of academic hospitals where trainee rotations and shift … Readers should not interpret any statement in this report as an official position of AHRQ or of the U.S … May 22, 2024
Care home safety incidents and safeguarding reports relating to hospital … History
March 21, 2009
WebM&M Cases
Dangerous Shift
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pcmh.ahrq.gov/patient-safety/patients-families/engagingfamilies/index.html
March 01, 2023 - Patient Safety Research Summaries
Patient Safety Resources by Setting
Quality Measures
Reports … Implement safe continuity of care by keeping the patient and family informed through nurse bedside change-of-shift … reports. … , at Guide to Patient and Family Engagement: Final Environmental Scan Report . … Based on the environmental scan report, AHRQ developed the Guide to Patient and Family Engagement in
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pbrn.ahrq.gov/patient-safety/patients-families/engagingfamilies/index.html
March 01, 2023 - Patient Safety Research Summaries
Patient Safety Resources by Setting
Quality Measures
Reports … Implement safe continuity of care by keeping the patient and family informed through nurse bedside change-of-shift … reports. … , at Guide to Patient and Family Engagement: Final Environmental Scan Report . … Based on the environmental scan report, AHRQ developed the Guide to Patient and Family Engagement in
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psnet.ahrq.gov/node/49772/psn-pdf
October 01, 2016 - A recent
systematic study suggested that bedside handoffs during nursing shift transition is a potential … solution to
the communication errors associated with shift-to-shift handoffs.(10)
Problems arising … Nursing staff, physicians in the receiving units, and pharmacy staff all report
reminding physicians … Bedside shift-to-shift handoffs: a systematic review of the literature. … Readers should not interpret any statement in this report as an official position of AHRQ or
of the
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psnet.ahrq.gov/issue/people-are-more-error-prone-after-committing-error
June 29, 2011 - July 20, 2022
Bedside shift-to-shift handoffs: a systematic review of the literature. … September 11, 2024
Care home safety incidents and safeguarding reports relating to hospital
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psnet.ahrq.gov/issue/racial-and-ethnic-harm-patient-care-patient-safety-issue
October 21, 2020 - Analysis of incident reports from a patient safety organization. … August 17, 2018
Bedside shift-to-shift handoffs: a systematic review of the literature
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psnet.ahrq.gov/issue/lives-lost-lives-saved-updated-comparative-analysis-avoidable-deaths-hospitals-graded
July 09, 2019 - Book/Report
Lives Lost, Lives Saved: An Updated Comparative Analysis of Avoidable … April 17, 2025
- April 18, 2025
Training Program for Nurses on Shift Work and Long … October 11, 2017
Diagnostic Strategy for the COVID-19 Pandemic – Bench to Bedside to … December 18, 2019
FDA to end program that hid millions of reports on faulty medical devices … The Report of the Gosport Independent Panel.
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pcmh.ahrq.gov/patient-safety/patients-families/engagingfamilies/howtogetstarted/index.html
December 01, 2017 - Patient Safety Research Summaries
Patient Safety Resources by Setting
Quality Measures
Reports … Patients and Families as Advisors
Strategy 2: Communicating to Improve Quality
Strategy 3: Nurse Bedside … Shift Report
Strategy 4: Care Transitions From Hospital to Home: IDEAL Discharge Planning
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pbrn.ahrq.gov/patient-safety/patients-families/engagingfamilies/howtogetstarted/index.html
December 01, 2017 - Patient Safety Research Summaries
Patient Safety Resources by Setting
Quality Measures
Reports … Patients and Families as Advisors
Strategy 2: Communicating to Improve Quality
Strategy 3: Nurse Bedside … Shift Report
Strategy 4: Care Transitions From Hospital to Home: IDEAL Discharge Planning
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psnet.ahrq.gov/issue/deploying-med-reconciliation
January 06, 2017 - February 17, 2011
Bedside shift report improves patient safety and nurse accountability
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psnet.ahrq.gov/issue/condition-concern-innovative-response-system-enhancing-hospitalized-patient-care-and-safety
April 24, 2018 - commentary describes the design, launch, and impact of a program that enabled patients and families to report … July 6, 2022
Association of patient and family reports of hospital safety climate with … December 4, 2016
New system for patients to report medical mistakes. … November 23, 2016
Bringing change-of-shift report to the bedside: a patient- and family-centered
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psnet.ahrq.gov/issue/strategically-advancing-patient-and-family-advisory-councils-new-york-state-hospitals
February 22, 2017 - Book/Report
Strategically Advancing Patient and Family Advisory Councils in New York … This report discusses characteristics of hospital-based patient and family advisory councils in the state … July 10, 2019
Bringing change-of-shift report to the bedside: a patient- and family-centered … June 27, 2018
AHRQ Health Information Technology Division's 2017 Annual Report.
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psnet.ahrq.gov/web-mm/workaround-error
October 30, 2024 - insulin from the refrigerator and place them in portable medication carts that are then taken to the bedside … infrequently and had an especially heavy workload that evening (she was caring for nine patients on her shift … improvise to save time and steps by using portable carts instead of making trips back and forth from the bedside … Hospitals must include some excess nurse capacity into each shift to provide for unexpected situations … flexible scheduling for some nurses, especially older nurses, who may not be able to work a 12-hour shift