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5141. Using an Anonymous Web-Based Incident Reporting Tool to Embed the Principles of a High-Reliability Organization (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol1/Advances-Conlon_50.pdf
      May 06, 2008 - Using an Anonymous Web-Based Incident Reporting Tool to Embed the Principles of a High-Reliability Organization Using an Anonymous Web-Based Incident Reporting Tool to Embed the Principles of a High-Reliability Organization Paul Conlon, PharmD, JD; Rebecca Havlisch, RN, JD; Narendra Kini, MD, MSHA; Christine P…

5142. The Nature, Characteristics and Patterns of Perinatal Critical Events Teams (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol3/Advances-Riley_58.pdf
      April 02, 2008 - The Nature, Characteristics and Patterns of Perinatal Critical Events Teams The Nature, Characteristics and Patterns of Perinatal Critical Events Teams William Riley, PhD; Helen Hansen, PhD, RN; Ayse P. Gürses, PhD; Stanley Davis, MD; Kristi Miller, RN, MS; Reinhard Priester, JD Abstract The Institute …

5143. Continuous Respiratory Monitoring and a “Smart” Infusion System Improve Safety of Patient-Controlled Analgesia in the Postoperative Period (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol4/Advances-Maddox_111.pdf
      June 18, 2008 - Continuous Respiratory Monitoring and a “Smart” Infusion System Improve Safety of Patient-Controlled Analgesia in the Postoperative Period Continuous Respiratory Monitoring and a “Smart” Infusion System Improve Safety of Patient-Controlled Analgesia in the Postoperative Period Ray R. Maddox, PharmD; Harold Oglesby…

5144. Beyond Nursing Quality Measurement: The Nation’s First Regional Nursing Virtual Dashboard (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol1/Advances-Aydin_2.pdf
      January 01, 2021 - Beyond Nursing Quality Measurement: The Nation’s First Regional Nursing Virtual Dashboard rds Beyond Nursing Quality Measurement: The Nation’s First Regional Nursing Virtual Dashboard Carolyn E. Aydin, PhD; Linda Burnes Bolton, DrPH, RN, FAAN; Nancy Donaldson, DNSc, RN, FAAN; Diane Storer Brown, PhD, RN, FN…

5145. Hospital Administrative Staff vs. Nursing Staff Responses to the AHRQ Hospital Survey on Patient Safety Culture (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol2/Advances-Hannah_23.pdf
      February 24, 2008 - Hospital Administrative Staff vs. Nursing Staff Responses to the AHRQ Hospital Survey on Patient Safety Culture Hospital Administrative Staff vs. Nursing Staff Responses to the AHRQ Hospital Survey on Patient Safety Culture Karen L. Hannah, MBA; Charles P. Schade, MD, MPH; David R. Lomely, BS; Patricia Ruddick,…

5146. Creating Safety in the Testing Process in Primary Care Offices (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol2/Advances-Elder_18.pdf
      February 19, 2008 - Creating Safety in the Testing Process in Primary Care Offices Creating Safety in the Testing Process in Primary Care Offices Nancy C. Elder, MD, MSPH; Timothy R. McEwen; John M. Flach, PhD; Jennie J. Gallimore, PhD Abstract Background: The testing process in primary care is complex, and it varies from o…

5147. Imbedding Research in Practice to Improve Medication Safety (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol4/Advances-Raebel_53.pdf
      May 07, 2008 - Imbedding Research in Practice to Improve Medication Safety Imbedding Research in Practice to Improve Medication Safety Marsha A. Raebel, PharmD; Elizabeth A. Chester, PharmD; David W. Brand, MSPH; David J. Magid, MD, MPH Abstract Objective: The objective of this project was to improve medication saf…

5148. Final Progress Report: A Pilot Study for Intrgrating Facility Information With Healthcare Information to Improve Patient Safety (pdf file)
      www.ahrq.gov/sites/default/files/2024-01/anumba-report_0.pdf
      January 01, 2024 - Final Progress Report: A Pilot Study for Intrgrating Facility Information With Healthcare Information to Improve Patient Safety FINAL PROGRESS REPORT PROJECT TITLE: A PILOT STUDY FOR INTEGRATING FACILITY INFORMATION WITH HEALTHCARE INFORMATION TO IMPROVE PATIENT SAFETY PRINCIPAL INVESTIGATOR: DR C. J. ANUMBA (Penn…

5149. Final Progress Report: Oral Chemotherapy Safety in Ambulatory Oncology: A Proactive Risk Assessment (pdf file)
      www.ahrq.gov/sites/default/files/2024-01/weingart-report.pdf
      January 01, 2024 - Final Progress Report: Oral Chemotherapy Safety in Ambulatory Oncology: A Proactive Risk Assessment Final Progress Report 1.0 TITLE PAGE Oral Chemotherapy Safety in Ambulatory Oncology: A Proactive Risk Assessment Principal Investigator Saul N. Weingart, MD, PhD Co-Investigators Maureen Connor, RN, MPH Syl…

5150. Implementing Shared Decision-Making: Barriers and Solutions—An Orthopedic Case Study | Agency for Healthcare Research and Quality
      www.ahrq.gov/patient-safety/reports/liability/mincer.html
      August 01, 2017 - Advances in Patient Safety and Medical Liability Implementing Shared Decision-Making: Barriers and Solutions—An Orthopedic Case Study Previous Page Next Page Table of Contents Advances in Patient Safety and Medical Liability Preface Acknowledgments Prologue Silence A Commentary Reforming t…

5151. Measuring Safety: A New Perspective on Outcomes of a Long-term Intensive Case Management Program (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol1/Cotayo.pdf
      April 22, 2004 - Measuring Safety: A New Perspective on Outcomes of a Long-term Intensive Case Management Program 291 Measuring Safety: A New Perspective on Outcomes of a Long-term Intensive Case Management Program Rosa M. Cotayo, Holly A. Grems, Elizabeth Sloan Abstract Patient safety is a critical dimension of program e…

5152. Validation of AHRQ’s Patient Safety Indicator for Accidental Puncture or Laceration (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol2/Gallagher1.pdf
      January 01, 2004 - Validation of AHRQ’s Patient Safety Indicator for Accidental Puncture or Laceration 27 Validation of AHRQ’s Patient Safety Indicator for Accidental Puncture or Laceration Brian Gallagher, Liyi Cen, Edward L. Hannan Abstract Objectives: This study examined whether clinical evidence in medical records confirms…

5153. A Conceptual Framework for Studying the Safety of Transitions in Emergency Care (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol2/Behara.pdf
      January 01, 2004 - A Conceptual Framework for Studying the Safety of Transitions in Emergency Care 309 A Conceptual Framework for Studying the Safety of Transitions in Emergency Care Ravi Behara, Robert L. Wears, Shawna J. Perry, Eric Eisenberg, Lexa Murphy, Mary Vanderhoef, Marc Shapiro, Christopher Beach, Pat Croskerry, Ka…

5154. Using Specialized Information Technology to Reduce Errors in Emergency Cardiac Care (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol3/Daudelin.pdf
      January 01, 2000 - Using Specialized Information Technology to Reduce Errors in Emergency Cardiac Care 7 Using Specialized Information Technology to Reduce Errors in Emergency Cardiac Care Denise Hartnett Daudelin, Manlik Kwong, Joni R. Beshansky, Harry P. Selker Abstract Information Technology (IT) solutions to patient safe…

5155. An Analysis of Nurses' Cognitive Work: A New Perspective for Understanding Medical Errors (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol1/Potter.pdf
      January 01, 2003 - An Analysis of Nurses' Cognitive Work: A New Perspective for Understanding Medical Errors 39 An Analysis of Nurses’ Cognitive Work: A New Perspective for Understanding Medical Errors Patricia Potter, Laurie Wolf, Stuart Boxerman, Deborah Grayson, Jennifer Sledge, Clay Dunagan, Bradley Evanoff Abstract He…

5156. A Model-based Approach to Prioritizing Medical Safety Practices (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol2/Marken.pdf
      January 01, 2004 - A Model-based Approach to Prioritizing Medical Safety Practices 409 A Model-based Approach to Prioritizing Medical Safety Practices Richard S. Marken Abstract This report shows how a model of skilled human performance can be used to evaluate safety practices aimed at reducing medical error when randomized tr…

5157. Using Reported Primary Care Errors to Develop and Implement Patient Safety Interventions: A Report from the ASIPS Collaborative (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol3/West.pdf
      September 01, 2005 - Using Reported Primary Care Errors to Develop and Implement Patient Safety Interventions: A Report from the ASIPS Collaborative 105 Using Reported Primary Care Errors to Develop and Implement Patient Safety Interventions: A Report from the ASIPS Collaborative David R. West, John M. Westfall, Rodrigo Araya-G…

5158. Can an Academic Health Care System Overcome Barriers to Clinical Guideline Implementation? (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol3/Quinn.pdf
      January 01, 2004 - Can an Academic Health Care System Overcome Barriers to Clinical Guideline Implementation? 291 Can an Academic Health Care System Overcome Barriers to Clinical Guideline Implementation? Debra Quinn, Mary Cooper, Lynn Chevalier, Jerry Balentine, Lawrence Kadish, Steven Walerstein, Fredric Weinbaum, Mark Ca…

5159. Module-7-Implementation-Guide (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/takeheart/training/module-7-implementation-guide.pdf
      February 13, 2023 - 1 TAKEheart - Troubleshooting Your Automatic Referral System Implementation Guide - Module 7 Purpose and Overview This implementation guide is designed to help you think through the steps you can take to troubleshoot a successful automatic referral (AR) order set for your hospital/health system. …

5160. Appendix: State Overviews (continued) | Agency for Healthcare Research and Quality
      www.ahrq.gov/patient-safety/settings/long-term-care/resource/hcbs/medicaidmgmt/tap2.html
      October 01, 2014 - Designing and Implementing Medicaid Disease and Care Management Programs Appendix: State Overviews (continued) Previous Page   Table of Contents Designing and Implementing Medicaid Disease and Care Management Programs Introduction Section 1: Planning a Care Management Program Section 2: Engagi…