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4041. Strategies for Improving Clinician Psychological Safety in Reporting and Discussing Diagnostic Error (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/topics/dxsafety-psychological-safety.pdf
      September 01, 2023 - Strategies for Improving Clinician Psychological Safety in Reporting and Discussing Diagnostic Error Issue Brief 15 Strategies for Improving Clinician Psychological Safety in Reporting and Discussing Diagnostic Error PATIENT SAFETY e This page intentionally left blank. e Issue Brief 15 Strategies for I…

4042. Impact of Pharmacy-led Dyslipidemia Interventions on Medication Safety and Therapeutic Failure in Patients (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol1/Weaver.pdf
      January 01, 2003 - Impact of Pharmacy-led Dyslipidemia Interventions on Medication Safety and Therapeutic Failure in Patients 173 Impact of Pharmacy-led Dyslipidemia Interventions on Medication Safety and Therapeutic Failure in Patients Joseph G. Weaver, Judy Enders McManus, Tammy Leung, Rhonda B. Mangione, Heidi R. Snow, Staci…

4043. 015-Ss-Hand-Hygiene-Periop-Fg (doc file)
      www.ahrq.gov/sites/default/files/wysiwyg/hai/tools/mrsa-2/015-ss-hand-hygiene-periop-fg.docx
      April 01, 2025 - AHRQ Safety Program for MRSA Prevention: Targeting SSI Hand Hygiene in the Perioperative Setting Surgical Services For: Cardiac, Hip and Knee Joint Replacement, and Spinal Fusion Surgeries Slide Title and Commentary Slide Number and Slide Hand Hygiene in the Perioperative Setting SAY: Welcome to this presentatio…

4044. Implementation of a Data-based Medical Event Reporting System in the U.S. Department of Defense (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol3/Davis.pdf
      February 12, 2004 - Implementation of a Data-based Medical Event Reporting System in the U.S. Department of Defense 235 Implementation of a Data-based Medical Event Reporting System in the U.S. Department of Defense Mary Ann Davis, Geoffrey W. Rake Abstract Objective: As a result of the Institute of Medicine (IOM) report, To…

4045. Challenges to Real-Time Decision Support in Health Care (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol2/Advances-Fitzgerald_108.pdf
      January 01, 2007 - Challenges to Real-Time Decision Support in Health Care Challenges to Real-Time Decision Support in Health Care Mark Fitzgerald, MB, BS, FACEM; Nathan Farrow, RN, BN (Hons) Adv Nur (Critical Care); Pamela Scicluna, BSc; Angela Murray, RN; Yan Xiao, PhD; Colin F. Mackenzie, MBChB, FRCA, FCCM Abstract This …

4046. Department of Veterans Affairs Emergency Airway Management Initiative (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol1/Advances-Stalhandske_71.pdf
      February 23, 2008 - Department of Veterans Affairs Emergency Airway Management Initiative Department of Veterans Affairs Emergency Airway Management Initiative Erik J. Stalhandske, MPP, MHSA; Michael J. Bishop, MD; James P. Bagian, MD, PE Abstract Over the last 2 years, the U.S. Department of Veterans Affairs (VA) undertook a …

4047. Best Practices in the Diagnosis and Treatment of Sepsis (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/antibiotic-use/best-practices/sepsis-facilitator-guide.pdf
      November 01, 2019 - Best Practices in the Diagnosis and Treatment of Sepsis AHRQ Safety Program for Improving Antibiotic Use 1AHRQ Pub. No. 17(20)-0028-EF November 2019 AHRQ Pub. No. 17(20)-0028-EF November 2019 Best Practices in the Diagnosis and Treatment of Sepsis Acute Care Slide Title and Commen…

4048. On-Time Pressure Ulcer Healing Facilitator Training Implementation of the Healing Reports: Handouts | Agency for Healthcare Research and Quality
      www.ahrq.gov/patient-safety/settings/long-term-care/resource/ontime/pruhealing/handouts.html
      December 01, 2017 - Dietitian: I would like to see them continue to attend.

4049. AHRQ's Safety Program for Nursing Homes: On-Time Falls Prevention Training (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/long-term-care/resources/ontime/fallsprev/ontimefallpxreports-ig.pdf
      June 02, 2025 - On-Time Falls Prevention: Reports Slide 5: Postfall Assessment Data Elements SAY: To continue

4050. Final Progress Report: TOP-MEDS CERT: Tools for Optimizing Medication Safety (pdf file)
      www.ahrq.gov/sites/default/files/2024-01/lambert-report.pdf
      January 01, 2024 - We continue to work on the idea of indications-based prescribing using non-CERT AHRQ funds awarded to

4051. The Guide to Improving Patient Safety in Primary Care Settings by Engaging Patients and Families (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-family-engagement/pfeprimarycare/pfepc-fullguide-final508.pdf
      April 01, 2018 - during the visit improved.5 More than 80 percent of the clinicians in the study wanted patients to continue

4052. Final Progress Report: Evaluating treatment options and patterns of care in early pregnancy failure (pdf file)
      www.ahrq.gov/sites/default/files/2024-12/dalton-report.pdf
      January 01, 2024 - Our experienced team will continue to monitor the impact of change in EPF care over time. 7.

4053. Puh-Implementation-Handouts (doc file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/long-term-care/resources/ontime/pruhealing/puh-implementation-handouts.docx
      July 01, 2016 - Dietitian: I would like to see them continue to attend.

4054. Puh-Implementation-Handouts (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/long-term-care/resources/ontime/pruhealing/puh-implementation-handouts.pdf
      July 01, 2016 - Dietitian: I would like to see them continue to attend.

4055. Multiple Chronic Conditions Chartbook (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/prevention-chronic-care/decision/mcc/mccchartbook.pdf
      April 01, 2014 - And as the US population ages, and people live longer, the number of people with MCC is expected to continue

4056. Final Progress Report: Developing and Disseminating a Patient Safety Risk Assessment (PSRA) Toolkit (pdf file)
      www.ahrq.gov/sites/default/files/2024-01/joseph2-report.pdf
      January 01, 2024 - Final Progress Report: Developing and Disseminating a Patient Safety Risk Assessment (PSRA) Toolkit Final Progress Report 1. TITLE PAGE Grant Number: 5R13HS021824-03 FAIN: R13HS021824 Principal Investigator: Anjali Joseph Project Title: Developing and disseminating a Patient Safety Risk Assessment (PSRA) toolkit …

4057. Final Progress Report: Emergency Department Overcrowding and Quality of Acute Asthma Care for Children (pdf file)
      www.ahrq.gov/sites/default/files/2024-10/sills-report.pdf
      January 01, 2024 - Final Progress Report: Emergency Department Overcrowding and Quality of Acute Asthma Care for Children Title of Project: Emergency Department Overcrowding and Quality of Acute Asthma Care for Children Principal Investigator and Team Members: Marion R. Sills, MD, MPH, Principal Investigator Diane Fairclough, DrPH,…

4058. Final Progress Report: Clinical Decision Support Simulations for Medication Administration Safety (pdf file)
      www.ahrq.gov/sites/default/files/2024-01/moss-berner-report.pdf
      January 01, 2024 - Final Progress Report: Clinical Decision Support Simulations for Medication Administration Safety Clinical Decision Support Simulations for Medication Administration Safety Principal Investigator: Jacqueline Moss, PhD, RN Co-Investigator: Eta S. Berner, EdD University of Alabama at Birmingham Dates of Aw…

4059. PowerPoint Presentation: Learn From Defects Through Sensemaking
      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…

4060. Cognitive Load Theory and Its Impact on Diagnostic Accuracy: Issue Brief (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/diagnostic/resources/issue-briefs/dxsafety-cognitive-load-theory.pdf
      May 01, 2024 - Cognitive Load Theory and Its Impact on Diagnostic Accuracy: Issue Brief PATIENT SAFETY e Issue Brief 17 Cognitive Load Theory and Its Impact on Diagnostic Accuracy This page intentionally left blank. e Issue Brief 17 Cognitive Load Theory and Its Impact on Diagnostic Accuracy Prepared for: Agency for…