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psnet.ahrq.gov/node/49726/psn-pdf
March 01, 2015 - Two Wrongs Don't Make a Right (Kidney)
March 1, 2015
DeVine JG. Two Wrongs Don't Make a Right (Kidney). PSNet [internet]. 2015.
https://psnet.ahrq.gov/web-mm/two-wrongs-dont-make-right-kidney
Case Objectives
Review the current definition of wrong-site surgery.
Describe the incidence of wrong-site surgery, and the…
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/cauti-tools/archived-webinars/leveraging-cultural-change-080814.pptx
January 01, 2013 - Slide 1
Leveraging Cultural Change to Reduce Urinary Catheter Use
1
Linda Greene, RN,MPS,CIC
Manager Infection Prevention
Highland Hospital
Jennifer Tuttle, RN, MSNEd
Adult Critical Care Unit
Tucson Medical Center
Learning Objectives
Describe the way in which improvement in the clinical culture can facilitate e…
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psnet.ahrq.gov/node/49424/psn-pdf
November 01, 2003 - Waiting Too Long
November 1, 2003
Rosen MA. Waiting Too Long. PSNet [internet]. 2003.
https://psnet.ahrq.gov/web-mm/waiting-too-long
The Case
A 31-year-old gravida 1, para 1 woman presented at 40 weeks in the early stages of labor having received
limited prenatal care at an outside clinic. Physical exam performed…
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/surgery/modules/sustainability/sustainability_deep_root_data_facnotes.docx
December 01, 2017 - Facilitator Guide: Deep-Rooting Your Data
Deep-Rooting Your Data – Facilitator Notes
Slide Title and Commentary
Slide Number and Slide
Deep-Rooting your Data
SAY:
This module focuses on the concept of deep-rooting and setting up sustainable interaction with your quality improvement data.
Slide 1
Learning O…
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www.ahrq.gov/hai/tools/surgery/modules/sustainability/deep-root-data-fac-notes.html
December 01, 2017 - Deep-Rooting Your Data: Facilitator Notes
AHRQ Safety Program for Surgery
Slide 1: Deep-Rooting Your Data
Say:
This module focuses on the concept of deep-rooting and setting up sustainable interaction with your quality improvement data.
Slide 2: Learning Objectives
Say:
At the end of this sessio…
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www.ahrq.gov/patient-safety/settings/long-term-care/resource/injuries/fallspx/man1.html
December 01, 2017 - The Falls Management Program: A Quality Improvement Initiative for Nursing Facilities
Chapter 1. Introduction and Program Overview
Previous Page Next Page
Table of Contents
The Falls Management Program: A Quality Improvement Initiative for Nursing Facilities
Chapter 1. Introduction and Program Ove…
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www.ahrq.gov/patient-safety/settings/long-term-care/resource/injuries/fallspx/man5.html
December 01, 2017 - The Falls Management Program: A Quality Improvement Initiative for Nursing Facilities
Chapter 5. Information and Training for Staff, Primary Care Providers, and Residents and their Families
Previous Page Next Page
Table of Contents
The Falls Management Program: A Quality Improvement Initiative for N…
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/ambulatory-surgery/sections/sustainability/management/problem-solving/problem-solving-component-kit.docx
May 01, 2017 - Module 3: Component Kit
AHRQ Safety Program for Ambulatory Surgery
Management Practices for Sustainability
Module 3: Problem Solving and Escalation
Problem Solving and Escalation – Standards Component Kit
Contents
1. What Are Problem Solving and Escalation? 2
2. What Is a Problem and What Is a Solution? 2
3. Wher…
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psnet.ahrq.gov/node/853772/psn-pdf
September 27, 2023 - Insulin Administration: Pen vs Vial – Similar, but Not
Interchangeable
September 27, 2023
Camarillo H. Insulin Administration: Pen vs Vial – Similar, but Not Interchangeable. PSNet [internet]. 2023.
https://psnet.ahrq.gov/web-mm/insulin-administration-pen-vs-vial-similar-not-interchangeable
The Case
A fourteen-ye…
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www.ahrq.gov/sites/default/files/wysiwyg/policymakers/chipra/factsheets/fullreports/chipra-164-materials-x.pdf
June 02, 2025 - Materials X
PMCoE
Dental -‐ …
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/engagingfamilies/strategy4/Strat4_Tool_4_PPT_508.pdf
June 02, 2025 - Strategy 4: IDEA Discharge Planning (Tool 4)
Guide to Patient & Family Engagement
Insert hospital logo here
Care Transitions from Hospital to
Home: IDEAL Discharge Planning
Training
[Hospital Name | Presenter name and title | Date of presentation]
Strategy 4: IDEAL Discharge Planning (Tool 4)
Today…
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-family-engagement/pfeprimarycare/warmhandoff-quickstartfull.pdf
January 27, 2017 - Implementation Quick Start Guide: Warm Handoff
Implementation
Quick Start Guide
Warm Handoff
The Guide to Improving Patient Safety in Primary Care
Settings by Engaging Patients and Families
Implementation Quick Start Guide: Warm Handoff | III
Table of Contents
What Is a Warm Handoff? .......................…
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-family-engagement/pfeprimarycare/medmanagement_webinar_slides.pdf
January 01, 2015 - Medication Management
1
Medication Management
AHRQ
Guide to Improving Patient Safety in Primary
Care Settings by Engaging Patients and
Families
Speaker
Kelly Smith, PhD
Scientific Director, Quality & Safety
Co-PI, AHRQ Guide to Improve Patient Safety
in Primary Care Settings by Engaging
Patients …
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www.ahrq.gov/teamstepps-program/curriculum/implement/activity/change.html
June 01, 2023 - Implementation Change Management
The change management process must be carefully and strategically organized to attain widespread acceptance. To achieve an environment truly committed to patient safety, a successful TeamSTEPPS implementation requires a change in unit and organizational culture. This culture mus…
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www.ahrq.gov/patient-safety/quality-resources/tools/chtoolbx/measures/measure-2.html
November 01, 2017 - Established Child Health Care Quality Measures—CAHPS
Child Health Care Quality Toolbox
The Child Health Toolbox contains concepts, tips, and tools for evaluating the quality of health care for children.
Contents
Expanded CAHPS 3.0 Child Survey
Children with Chronic Conditions
Screener Questions
…
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digital.ahrq.gov/ahrq-funded-projects/finding-safer-way-novel-interaction-design-approaches-health-it-safety
January 01, 2023 - Finding the Safer Way: Novel Interaction Design Approaches to Health IT Safety
Project Final Report ( PDF , 1.13 MB) Disclaimer
Disclaimer
The findings and conclusions in this document are those of the author(s), who are responsible for its content, and do not necessarily repres…
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psnet.ahrq.gov/node/74242/psn-pdf
January 07, 2022 - The Next Step: Use of a Pre-Operative Checklist to
Prevent Missteps
January 7, 2022
Sauder C, Kleber KT. The Next Step: Use of a Pre-Operative Checklist to Prevent Missteps. PSNet
[internet]. 2022.
https://psnet.ahrq.gov/web-mm/next-step-use-pre-operative-checklist-prevent-missteps
The Case
A 52-year-old woman w…
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www.ahrq.gov/diagnostic-safety/resources/issue-briefs/dxsafety-reimagining-healthcare-teams-refs.html
July 01, 2023 - Reimagining Healthcare Teams: Leveraging the Patient-Clinician-AI Triad To Improve Diagnostic Safety
References
Previous Page
Table of Contents
Reimagining Healthcare Teams: Leveraging the Patient-Clinician-AI Triad To Improve Diagnostic Safety
Introduction
The Patient-Clinician Dyad
The P…
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www.ahrq.gov/sites/default/files/wysiwyg/antibiotic-use/improve/acute_care_implementation_guide.pdf
November 01, 2019 - Toolkit Implementation Guide for Acute Care Antibiotic Stewardship Programs
AHRQ Pub. No. 17(20)-0028-EF
November 2019
AHRQ Safety Program for Improving Antibiotic Use
Toolkit Implementation Guide for
Acute Care Antibiotic Stewardship Programs
Introduction
Developing an antibiotic stewardship pr…
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/engagingfamilies/howtogetstarted/How_PFE_Benefits_Hosp_508.pdf
January 01, 2012 - Information to Help Hospitals Get Started
Information to Help Hospitals Get Started
Guide to Patient and Family Engagement :: 1
How Patient and Family Engagement
Benefits Your Hospital
Patient and family engagement is an area of increasing
importance for hospitals. Not only is engaging patients
and families…