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Showing results for "culture of safety".

2481. Care Management: Implications for Medical Practice, Health Policy, and Health Services Research (pdf file)
      www.ahrq.gov/sites/default/files/publications/files/caremgmt-brief.pdf
      April 01, 2015 - of appropriate clinical preventive services), safety (e.g., medication reconciliation to avoid duplication … Similarly, the care team’s culture must be receptive to the integration of the individuals delivering … This may require culture change among the care team. … should be considered to incentivize training that supports culture change toward coordinated, team-based … interprofessional practice, culture change embracing CM services will be difficult to achieve.

2482. Slide 1
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/cauti-tools/archived-webinars/navigating-hierarchy-121013.pptx
      January 01, 2006 - Pronovost, medical director of the Quality and Safety Research Group at Johns Hopkins Hospital in Baltimore … , describes his quest for patient safety after the misdiagnosis of his father and the death of a child … we have a duty to speak up when patient safety is at risk. … 8 Hierarchies: the Berlin Wall of Patient Safety 9 “To maximize patient safety considerations the … -Hierarchies: the Berlin Wall of Patient Safety MM Walton Qual Saf Health Care. 2006 August; 15(4):

2483. Appendix B. Clinical Materials to Share With Primary Care Providers (continued) | Agency for Healthcare Research and Quality
      www.ahrq.gov/es/patient-safety/settings/hospital/resource/nicu/packet/apb2.html
      December 01, 2013 - Parental report of current skills is predictive of developmental delay. … airway, as well as thickening of secretions and increased risk of mucous plugging. … Failure of fixation. Leakage of gastric acid. … Send swab for culture and treat with appropriate topical or systemic antibiotics. … Obtain stool sample for culture. Ask dietician to review feed and rate.

2484. From Science to Service: A Framework for the Transfer of Patient Safety Research into Practice (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol2/Nieva.pdf
      January 07, 2005 - From Science to Service: A Framework for the Transfer of Patient Safety Research into Practice 441 … From Science to Service: A Framework for the Transfer of Patient Safety Research into Practice … from AHRQ’s patient safety portfolio of grants and contracts. … The eventual users of patient safety research include a large and complex set of institutions and many … For example, in order for change to occur, the organization’s practice culture needs to support action

2485. Strategy 3: Nurse Bedside Shift Report Implementation Handbook (doc file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/engagingfamilies/strategy3/Strat3_Implement_Hndbook_508.docx
      August 01, 2010 - improving multiple aspects of hospital quality and safety. … safety. … The Nurse Bedside Shift Report strategy is flexible and adaptable to each hospital’s environment and culture … Creating this new culture of bedside shift report for nurses was a process and a challenging one at that … Culture change through patient engagement. Nursing 2010 Oct;40(10):50–2.

2486. Final Progress Report: Risk-Informed Clinical Network for Safe Pediatric Emergency Transfers (pdf file)
      www.ahrq.gov/sites/default/files/2025-02/woods-report.pdf
      January 01, 2025 - of the behavioral aspect of the culture of communication during a transfer. … Child-Specific Risk Factors and Patient Safety. The Journal of Patient Safety. 2005;1(1):5. 3. … Boys in White: Student Culture in Medical School. … Anatomy of a patient safety event: a taxonomy for pediatric patient safety. … Quality and Safety in Healthcare. 2005;14:422-427. 86. Mission of the Center for Patient Safety.

2487. Improving-Facnotes (doc file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/ambulatory-surgery/sections/implementation/training-tools/improving/improving-facnotes.docx
      May 01, 2017 - Furthermore, lack of communication has resulted in serious patient safety events such as teams performing … Before you start work to improve communication and teamwork, consider administering a culture survey … One example used by many facilities is the AHRQ Survey on Patient Safety culture. … They can help promote patient safety by reinforcing the importance of discussions that might improve … First, “Is this a critical safety step at the risk of being missed?”

2488. Qi-Strategies-Practices (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/ncepcr/tools/PCMH/qi-strategies-practices.pdf
      March 01, 2015 - reasons, including a lack of the following: financial resources, time, a culture that supports change … • Practice culture: Regardless of whether there are financial incentives in place, sustained QI and … Safety Net Medical Home Initiative. … Practice Culture Assessment (developed by Perry Dickinson, MD, Professor, Department of Family Medicine … Culture.

2489. Patient and Family Engagement for Perinatal Safety: Facilitator Guide | Agency for Healthcare Research and Quality
      www.ahrq.gov/patient-safety/settings/labor-delivery/perinatal-care/modules/teamwork/pf-engagement-fac-guide.html
      July 01, 2023 - Patient and Family Engagement for Perinatal Safety: Facilitator Guide AHRQ Safety Program for … Perinatal Care Slide 1: Patient and Family Engagement for Perinatal Safety Say: The Patient … Hospitals can present a very unfamiliar setting, system, and culture for patients. … family members, clinicians, and hospital staff work together as partners to improve the quality and safety … This partnership is important because health care quality and safety directly affect patients and families

2490. AHRQ-Funded Patient Safety Project Highlights: Improving Healthcare Safety by Enhancing Health Information Technology and Health Information Exchange (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/patient-safety/highlights/ps-project-highlights-hit-hie-2025.pdf
      January 01, 2025 - of Funding Approaches to Improving Patient Safety (No. of Projects)iii HIT-HIE Patient Safety Improvement … medication safety in a variety of healthcare settings … Safety Culture Survey. … Investigators created a 16-item survey to measure the degree to which a culture of medication safety … the improvement of medication management safety.

2491. Racial Disparities in Patient Safety Indicator (PSI) Rates in the Veterans Health Administration (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol1/Advances-Shimada_65.pdf
      April 04, 2008 - outcomes in addition to the patient characteristics in our model, such as patient safety culture. … The influence of patient safety events primarily depends on the frequency of the event and the potential … A national profile of patient safety in U.S. hospitals. … Hypertensive patients' race, health beliefs, process of care, and medication adherence. … National Center for Patient Safety. Ann Arbor, MI: Department of Veterans Affairs; 2007.

2492. Advancing the Impact of Consumer Experience of Care Measurement: What’s Next? | Agency for Healthcare Research and Quality
      www.ahrq.gov/news/blog/ahrqviews/consumer-experience-measurement.html
      September 01, 2023 - AHRQ Views: Blog posts from AHRQ leaders Advancing the Impact of Consumer Experience of Care Measurement … We need to dig in on safety. … As we ask about measurements of the consumer experience, we are mindful of the contributions that AHRQ … In fact, a commitment to quality and safety requires us to learn more about our patients’ perspectives … Elizabeth Mort is a primary care physician and the former Senior Vice President of Quality and Safety

2493. Table 5.A.1. Evidence Table (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/acute/chipra-143-section-5a-evidence-table.pdf
      January 01, 2014 - Therefore, reviewers had to screen chest X-rays and culture results for all hospitalization days … quality assurance review with the Office of Patient Safety. … The positive blood culture trigger had the highest percent yield for AE detection. … The patient safety program intervention included formation of a patient safety council, hiring of … of Quality Measuring Patient Safety To Drive Quality Improvement

2494. AHRQ Timeline | Agency for Healthcare Research and Quality
      www.ahrq.gov/cpi/about/timeline/index.html
      March 01, 2025 - practice by engaging clinicians in quality improvement activities and encouraging an evidence-based culture … Patient Safety Practices. … The report lists 73 patient safety practices that are likely to improve patient safety and describes … On June 29, 2020, AHRQ published an impact case study showing the influence of AHRQ’s medication safety … A Vermont-based based trio of health clinics improved medication use and safety for approximately 8,000

2495. Chapter 1. Building the Project Foundation: Gaining Leadership Support Within the Organization | Agency for Healthcare Research and Quality
      www.ahrq.gov/es/patient-safety/settings/hospital/match/chapter-1.html
      July 01, 2022 - as a patient safety issue. … Medication Reconciliation as a Patient Safety Issue A review of the literature notes several decades … Meisel, PharmD, Director of Medication Safety at Fairview Health Services in Minneapolis, Minnesota. … care quality, safety, and efficiency through the promotion of health information technology (IT), including … The leadership team should promote the concepts of this toolkit into culture and practice for safe medication

2496. Breaking-Down-Barriers-Transcript (doc file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/cauti-tools/archived-webinars/breaking-down-barriers-transcript.docx
      May 12, 2015 - a comprehensive unit-based safety program to reduce CAUTI, and also the national implementation of CUSP … This is a big emphasis in the CUSP program, is this whole evidence of developing a culture. … Other strategies that can help improve execution is a non-punitive culture, as I mentioned before. … Visible and supportive leadership, which is also part of a culture. … At that time, as a result of the introduction of the national patient safety goals and reporting and

2497. Improving Healthcare Safety by Enhancing Care Coordination (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/patient-safety/highlights/ps-project-highlights-care-coordination.pdf
      June 30, 2025 - of Funding Approaches to Improving Care Coordination (No. of Projects)i Patient Safety Care Coordination … PATIENT SAFETY 2 Examples of Project Findings Most projects included in this collection of work … poor usability), physical environment (e.g., cluttered workspace), organization (e.g., hierarchical culture … [Grant] Patient Safety Learning Laboratory to Enhance the Value and Safety of Neonatal Interfacility … statistically significant increases in patient ambulation and change in nursing practice and unit culture

2498. Final Progress Report: Improving Warfarin Management in Competitive Healthcare (pdf file)
      www.ahrq.gov/sites/default/files/2024-04/levett-report.pdf
      January 01, 2024 - Levett, MD Structured Abstract Purpose: Create a community model of care delivery/patient safety … The goal of the project is to create a community model of care delivery and patient safety using IS0 … These features of the clinic will improve the culture and safety within the community and reduce errors … a healthcare culture of safety, and 18, Utilization of dedicated anti-thrombotic services that facilitate … Other system problems outlined by the Institute of Medicine include issues of patient safety; practice

2499. Module 3: Conversations Around Device Necessity | Agency for Healthcare Research and Quality
      www.ahrq.gov/hai/cauti-tools/cauti-icu/facil-guide/mod3.html
      February 01, 2023 - In the process, learners see issues connected to communication and culture around catheter use. … What elements of the situation led Sally to make her decision? … But, would you agree that patient safety is our highest priority? … You are an important part of this process. I tell you what. … However, Sally’s decision to remove the catheter was based on a unit protocol which optimizes patient safety

2500. Structure and Features of a Care Enhancement Model Implementing the Patient Safety and Quality Improvement Act (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol1/Advances-Riley_59.pdf
      April 06, 2008 - Furthermore, the Act provides for a national Network of Patient Safety Databases (NPSD) of voluntary … complement of 1 components of patient safety improvement and error management programs.12 Clearly … This methodology helps enhance the culture of safety and provides a real-time understanding of system … Examining near misses provides two types of information relevant for patient safety: weaknesses of the … S. 544 [109th]: Patient Safety and Quality Improvement Act of 2005.