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psnet.ahrq.gov/issue/using-failure-mode-and-effects-analysis-plan-implementation-smart-iv-pump-technology
July 14, 2010 - Study
Using failure mode and effects analysis to plan implementation of smart i.v. pump technology.
Citation Text:
Wetterneck TB, Skibinski K, Roberts TL, et al. Using failure mode and effects analysis to plan implementation of smart i.v. pump technology. Am J Health Syst Pharm. 2006;6…
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psnet.ahrq.gov/issue/association-between-opioid-prescribing-patterns-and-abuse-ophthalmology
April 12, 2019 - Study
Association between opioid prescribing patterns and abuse in ophthalmology.
Citation Text:
Patel S, Sternberg P. Association Between Opioid Prescribing Patterns and Abuse in Ophthalmology. JAMA Ophthalmol. 2017;135(11):1216-1220. doi:10.1001/jamaophthalmol.2017.4055.
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psnet.ahrq.gov/issue/lost-translation-medication-labeling-immigrant-families
May 31, 2017 - Commentary
Lost in translation: medication labeling for immigrant families.
Citation Text:
Smith MCJ, Yin S, Sanders LM. Lost in translation: Medication labeling for immigrant families. J Am Pharm Assoc (2003). 2016;56(6):677-679. doi:10.1016/j.japh.2016.07.002.
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psnet.ahrq.gov/issue/evidence-based-guidelines-fatigue-risk-management-ems-formulating-research-questions-and
March 14, 2018 - Study
Evidence-based guidelines for fatigue risk management in EMS: formulating research questions and selecting outcomes.
Citation Text:
Patterson D, Higgins S, Lang ES, et al. Evidence-Based Guidelines for Fatigue Risk Management in EMS: Formulating Research Questions and Selecting Out…
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psnet.ahrq.gov/issue/idea-safety-training-improve-critical-thinking-individuals-and-teams
May 25, 2016 - Commentary
An IDEA: safety training to improve critical thinking by individuals and teams.
Citation Text:
Browne AM, Deutsch ES, Corwin K, et al. An IDEA: Safety Training to Improve Critical Thinking by Individuals and Teams. Am J Med Qual. 2019;34(6):569-576. doi:10.1177/106286061882068…
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psnet.ahrq.gov/issue/medical-error-disclosure-among-pediatricians-choosing-carefully-what-we-might-say-parents
July 10, 2008 - Study
Classic
Medical error disclosure among pediatricians: choosing carefully what we might say to parents.
Citation Text:
Loren DJ, Klein EJ, Garbutt J, et al. Medical Error Disclosure Among Pediatricians. Arch Pediatr Adolesc Med. 2008;162(10):922-927. doi:10…
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psnet.ahrq.gov/issue/after-mid-staffordshire-acknowledgement-through-learning-improvement
August 28, 2024 - Special or Theme Issue
After Mid Staffordshire: from acknowledgement, through learning, to improvement.
Citation Text:
Martin G, Dixon-Woods M. After Mid Staffordshire: from acknowledgement, through learning, to improvement. BMJ Qual Saf. 2014;23(9):706-8. doi:10.1136/bmjqs-2014-003359. …
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www.ahrq.gov/hai/quality/tools/cauti-ltc/about-toolkit.html
May 01, 2017 - About the Toolkit Development
Toolkit To Reduce CAUTI and Other HAIs in Long-Term Care Facilities
The toolkit was developed based on the experiences of approximately 500 nursing homes across the country that participated in the AHRQ Safety Program for Long-Term Care: HAIs/CAUTI, a 3-year implementation projec…
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psnet.ahrq.gov/issue/using-system-analysis-build-safety-culture-improving-reliability-epidural-analgesia
January 14, 2009 - Study
Using system analysis to build a safety culture: improving the reliability of epidural analgesia.
Citation Text:
Garnerin P, Huchet-Belouard A, Diby M, et al. Using system analysis to build a safety culture: improving the reliability of epidural analgesia. Acta Anaesthesiol Scand…
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psnet.ahrq.gov/issue/patient-safety-assurance-age-defensive-medicine-review
March 09, 2022 - Commentary
Patient safety assurance in the age of defensive medicine: a review.
Citation Text:
Shenoy A, Shenoy GN, Shenoy GG. Patient safety assurance in the age of defensive medicine: a review. Patient Saf Surg. 2022;16(1):10. doi:10.1186/s13037-022-00319-8.
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psnet.ahrq.gov/issue/how-do-we-learn-about-error-cross-sectional-study-urology-trainees
October 21, 2010 - Study
How do we learn about error? A cross-sectional study of urology trainees.
Citation Text:
Browne C, Crone L, O'Connor E. How do we learn about error? A cross-sectional study of urology trainees. J Surg Educ. 2023;80(6):864-872. doi:10.1016/j.jsurg.2023.03.007.
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Fo…
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psnet.ahrq.gov/issue/health-care-professionals-views-implementing-policy-open-disclosure-errors
September 29, 2017 - Study
Health care professionals' views of implementing a policy of open disclosure of errors.
Citation Text:
Sorensen R, Iedema R, Piper D, et al. Health care professionals' views of implementing a policy of open disclosure of errors. J Health Serv Res Policy. 2008;13(4):227-32. doi:10.1…
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psnet.ahrq.gov/issue/patient-safety-womens-health-care-professional-colleges-can-make-difference-society
November 28, 2018 - Commentary
Patient safety in women's health-care: professional colleges can make a difference. The Society of Obstetricians and Gynaecologists of Canada MORE(OB) program.
Citation Text:
Milne JK, Lalonde AB. Patient safety in women's health-care: professional colleges can make a differ…
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www.ahrq.gov/news/newsroom/case-studies/201708.html
May 01, 2017 - Albuquerque Police Department Uses AHRQ Resources for Crisis Intervention Team Training
Search All Impact Case Studies
May 2017
In 2016, Albuquerque Police Department (APD) became the first law enforcement agency in the Nation to train its officers through videoconferencing with psychiatrists, based on the …
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psnet.ahrq.gov/issue/addressing-taboo-medical-error-through-igbos-i-got-burnt-once
October 31, 2014 - Study
Addressing the taboo of medical error through IGBOs: I got burnt once!
Citation Text:
Dumitrescu A, Ryan A. Addressing the taboo of medical error through IGBOs: I got burnt once!. Eur J Pediatr. 2014;173(4):503-8. doi:10.1007/s00431-013-2168-3.
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psnet.ahrq.gov/issue/every-error-treasure-improving-medication-use-nonpunitive-reporting-system
August 17, 2016 - Study
Every error a treasure: improving medication use with a nonpunitive reporting system.
Citation Text:
Lehmann DF, Page N, Kirschman K, et al. Every Error a Treasure: Improving Medication Use with a Nonpunitive Reporting System. Jt Comm J Qual Patient Saf. 2016;33(7):401-407. doi:10.…
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psnet.ahrq.gov/issue/maths-anxiety-and-medication-dosage-calculation-errors-scoping-review
September 01, 2016 - Review
Maths anxiety and medication dosage calculation errors: a scoping review.
Citation Text:
Williams B, Davis S. Maths anxiety and medication dosage calculation errors: A scoping review. Nurse Educ Pract. 2016;20:139-46. doi:10.1016/j.nepr.2016.08.005.
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www.ahrq.gov/hai/cauti-tools/guides/implguide-pt1.html
October 01, 2015 - Toolkit for Reducing Catheter-Associated Urinary Tract Infections in Hospital Units: Implementation Guide
Overview
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Table of Contents
Toolkit for Reducing Catheter-Associated Urinary Tract Infections in Hospital Units: Implementation Guide
Overview
Frameworks for Change an…
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www.ahrq.gov/takeheart/about/initiative/index.html
December 01, 2022 - The TAKEheart Initiative
Aims
AHRQ's TAKEheart initiative seeks to increase participation in cardiac rehabilitation (CR) among eligible patients nationwide.
Key Components
TAKEheart promotes two proven strategies for increasing referral and enrollment in CR:
Implementing automatic referral to make …
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psnet.ahrq.gov/issue/ashp-ppag-guidelines-providing-pediatric-pharmacy-services-hospitals-and-health-systems
April 24, 2018 - Commentary
ASHP–PPAG Guidelines for Providing Pediatric Pharmacy Services in Hospitals and Health Systems.
Citation Text:
Eiland LS, Benner K, Gumpper KF, et al. ASHP-PPAG Guidelines for Providing Pediatric Pharmacy Services in Hospitals and Health Systems. J Pediatr Pharmacol Ther. 2018…