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www.ahrq.gov/sites/default/files/wysiwyg/hai/tools/mrsa/131-what-are-the-4-es-one-pager.docx
May 24, 2024 - The aim is to Engage hearts and minds and thus, change attitudes and behaviors.1-6
Raise awareness of the problem, communicate benefits of the solution, and lay out the goals for the intervention.
· Use unit data, published literature, and national benchmarks. Storytelling is an underrated tool.
Engagement is not a on…
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psnet.ahrq.gov/issue/promethazine-adverse-events-after-implementation-medication-shortage-interchange
October 26, 2010 - Study
Promethazine adverse events after implementation of a medication shortage interchange.
Citation Text:
Sheth HS, Verrico MM, Skledar S, et al. Promethazine adverse events after implementation of a medication shortage interchange. Ann Pharmacother. 2005;39(2):255-61.
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psnet.ahrq.gov/issue/clinical-alarms-improving-efficiency-and-effectiveness
February 22, 2010 - Study
Clinical alarms: improving efficiency and effectiveness.
Citation Text:
Phillips J, Barnsteiner JH. Clinical alarms: improving efficiency and effectiveness. Crit Care Nurs Q. 2005;28(4):317-323.
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psnet.ahrq.gov/issue/learning-safe-prescribing-during-post-take-ward-rounds
August 14, 2013 - Newspaper/Magazine Article
Learning safe prescribing during post-take ward rounds.
Citation Text:
Conroy-Smith E, Herring R, Caldwell G. Learning safe prescribing during post-take ward rounds. The clinical teacher. 2011;8(2):75-8. doi:10.1111/j.1743-498X.2011.00432.x.
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psnet.ahrq.gov/issue/characteristics-associated-postdischarge-medication-errors
April 12, 2023 - Study
Characteristics associated with postdischarge medication errors.
Citation Text:
Mixon A, Myers AP, Leak CL, et al. Characteristics associated with postdischarge medication errors. Mayo Clin Proc. 2014;89(8):1042-51. doi:10.1016/j.mayocp.2014.04.023.
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psnet.ahrq.gov/issue/systems-approach-and-systems-engineering-applied-health-care-improving-patient-safety-and
August 12, 2020 - Commentary
Systems approach and systems engineering applied to health care: improving patient safety and health care delivery.
Citation Text:
Systems approach and systems engineering applied to health care: improving patient safety and health care delivery. Ravitz AD, Sapirstein A, Pha…
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www.ahrq.gov/evidencenow/projects/heart-health/about/origin.html
March 01, 2021 - Origin
Origins of EvidenceNOW
The ability to integrate and implement new discoveries into patient care creates a stronger, more effective health care system. But not all discoveries are equal. We turn to evidence to understand what works and how best to integrate effective approaches and treatments into pat…
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psnet.ahrq.gov/issue/getting-moving-patient-safety-harnessing-electronic-data-safer-care
April 05, 2013 - Commentary
Getting moving on patient safety—harnessing electronic data for safer care.
Citation Text:
Jha AK, Classen D. Getting moving on patient safety--harnessing electronic data for safer care. N Engl J Med. 2011;365(19):1756-8. doi:10.1056/NEJMp1109398.
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psnet.ahrq.gov/issue/outcomes-card-development-systems-based-practice-educational-tool
July 13, 2010 - Study
The outcomes card: development of a systems-based practice educational tool.
Citation Text:
Tomolo A, Caron A, Perz ML, et al. The outcomes card. J Gen Intern Med. 2005;20(8). doi:10.1111/j.1525-1497.2005.0168.x.
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www.ahrq.gov/research/findings/evidence-based-reports/nutritn6tp.html
April 01, 2018 - Vol 6: Concordance Between the Findings of Epidemiological Studies and Randomized Trials in Nutrition: An Empirical Evaluation and Analysis
Structured Abstract
Full Title: Nutritional Research Series: Advancing the Role of Evidence-based Reviews in Nutrition Research and Applications
To facilitate a better …
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psnet.ahrq.gov/issue/designing-safer-process-prevent-retained-surgical-sponges-healthcare-failure-mode-and-effect
April 27, 2019 - Study
Designing a safer process to prevent retained surgical sponges: a healthcare failure mode and effect analysis.
Citation Text:
Steelman VM, Cullen JJ. Designing a safer process to prevent retained surgical sponges: a healthcare failure mode and effect analysis. AORN J. 2011;94(2):1…
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psnet.ahrq.gov/issue/detection-and-measurement-rotator-cuff-tears-sonography-analysis-diagnostic-errors
December 31, 2014 - Study
Detection and measurement of rotator cuff tears with sonography: analysis of diagnostic errors.
Citation Text:
Teefey SA, Middleton WD, Payne WT, et al. Detection and measurement of rotator cuff tears with sonography: analysis of diagnostic errors. AJR Am J Roentgenol. 2005;184(6…
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psnet.ahrq.gov/issue/twelve-tips-implementing-patient-safety-curriculum-undergraduate-programme-medicine
June 19, 2018 - Commentary
Twelve tips for implementing a patient safety curriculum in an undergraduate programme in medicine.
Citation Text:
Armitage G, Cracknell A, Forrest K, et al. Twelve tips for implementing a patient safety curriculum in an undergraduate programme in medicine. Med Teach. 2011;3…
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psnet.ahrq.gov/issue/developing-tool-assessing-competency-root-cause-analysis
May 01, 2014 - Study
Developing a tool for assessing competency in root cause analysis.
Citation Text:
Gupta P, Varkey P. Developing a tool for assessing competency in root cause analysis. Jt Comm J Qual Patient Saf. 2009;35(1):36-42.
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psnet.ahrq.gov/issue/implementation-perioperative-checklist-increases-patients-perioperative-safety-and-staff
April 03, 2013 - Study
The implementation of a perioperative checklist increases patients' perioperative safety and staff satisfaction.
Citation Text:
Böhmer AB, Wappler F, Tinschmann T, et al. The implementation of a perioperative checklist increases patients' perioperative safety and staff satisfacti…
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psnet.ahrq.gov/issue/minimizing-surgical-error-incorporating-objective-assessment-surgical-education
January 12, 2022 - Review
Minimizing surgical error by incorporating objective assessment into surgical education.
Citation Text:
Champion HR, Meglan DA, Shair EK. Minimizing Surgical Error by Incorporating Objective Assessment into Surgical Education. J Am Coll Surg. 2008;207(2). doi:10.1016/j.jamcollsu…
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psnet.ahrq.gov/issue/antibiotic-prescribing-ambulatory-pediatrics-united-states
May 25, 2016 - Study
Antibiotic prescribing in ambulatory pediatrics in the United States.
Citation Text:
Hersh AL, Shapiro DJ, Pavia AT, et al. Antibiotic prescribing in ambulatory pediatrics in the United States. Pediatrics. 2011;128(6):1053-61. doi:10.1542/peds.2011-1337.
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psnet.ahrq.gov/issue/full-work-analysis-resident-work-hours
June 06, 2018 - Study
Full work analysis of resident work hours.
Citation Text:
Dassinger MS, Eubanks JW, Langham MR. Full work analysis of resident work hours. J Surg Res. 2008;147(2):178-81. doi:10.1016/j.jss.2008.03.010.
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psnet.ahrq.gov/issue/effects-critical-care-nurses-work-hours-vigilance-and-patients-safety
February 19, 2010 - Study
Effects of critical care nurses' work hours on vigilance and patients' safety.
Citation Text:
Scott LD, Rogers AE, Hwang W-T, et al. Effects of critical care nurses' work hours on vigilance and patients' safety. Am J Crit Care. 2006;15(1):30-7.
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www.ahrq.gov/talkingquality/plan/pay.html
November 01, 2018 - How Will You Pay for a Health Care Quality Report?
A consumer reporting project is not cheap, although there are ways to reduce costs and spread them across multiple parties (including other sponsors and participating health plans or providers). Data collection costs can range from as little as a few thousand…