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  1. www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/long-term-care/resources/ontime/pruhealing/puh-factraining-guide.pdf
    June 02, 2025 - AHRQ’s Safety Program for Nursing Homes: On-Time Pressure Ulcer Healing 1 Overview Slide AHRQ’s Safety Program for Nursing Homes On-Time Pressure Ulcer Healing Facilitator Training Overview of On-Time Note: This version of the On-Time introduction is for training Facilitators who have not had pre…
  2. www.ahrq.gov/sites/default/files/2024-01/greenwald-report.pdf
    January 01, 2024 - Final Progress Report: Medication Reconciliation: A Team Approach AHRQ Small Conference Grant Final Report Title of Project: Medication Reconciliation: A Team Appr oach Principal Investigator: Jeffrey L . Greenwald, MD, FHM Team Members: Jeffrey L. Greenwald, MD, FHM (SHM), PI and Conference Chair; …
  3. www.ahrq.gov/sites/default/files/2024-03/small-report.pdf
    January 01, 2024 - Final Progress report: Creating High Reliability Organizations Creating High Reliability Organizations Principal Investigator: Stephen D. Small, MD Key Team Members: Kay Metis, MS, MA Bobbie J. Sweitzer, MD Paul Barach, MD (2001-2002) Additional funded collaborators: Julie Mohr, PhD David Meltzer, MD, …
  4. www.ahrq.gov/sites/default/files/wysiwyg/hai/tools/perinatal-care-2/hemorrhage_7-implementation-speaker-notes.pdf
    July 01, 2023 - Implementing the SPPC-II Teamwork Toolkit Hospital AI Tea Lea SPPC‐ M m ds II Implementing the SPPC‐II Teamwork Toolkit Module 7 of 8 SPPC‐II Toolkit SCRIPT Welcome to Module 7 of the SPPC‐II Teamwork Toolkit. In this module, we’ll discuss tactics and planning for the SPPC‐II Teamwork Toolkit implement…
  5. www.ahrq.gov/sites/default/files/wysiwyg/hai/tools/perinatal-care-2/hypertension_7-implementation-speaker-notes.pdf
    July 01, 2023 - Implementing the SPPC‐II Teamwork Toolkit Hospital AIM Team Leads SPPC‐II Implementing the SPPC‐II Teamwork Toolkit Module 7 of 8 SPPC‐II Toolkit SCRIPT Welcome to Module 7 of the SPPC‐II Teamwork Toolkit. In this module, we’ll discuss tactics and planning for the SPPC‐II Teamwork Toolkit implementation…
  6. www.ahrq.gov/es/patient-safety/settings/hospital/vtguide/appa.html
    July 01, 2018 - Preventing Hospital-Associated Venous Thromboembolism Appendix A: Tools and Resources Previous Page Next Page Table of Contents Preventing Hospital-Associated Venous Thromboembolism Preface Executive Summary Chapter 1. The Framework for Improvement Chapter 2. Analyze Care Delivery Chapter …
  7. www.ahrq.gov/sites/default/files/wysiwyg/ncepcr/tools/PCMH/pcpf-module-10-workflow-mapping.pdf
    September 01, 2015 - Primary Care Practice Facilitation Curriculum Module 10: Mapping and Redesigning Workflow Primary Care Practice Facilitation Curriculum Module 10: Mapping and Redesigning Workfow Agency for Healthcare Research and Quality Advancing Excellence in Health Care www.ahrq.gov Primary Care Practice Facili…
  8. www.ahrq.gov/research/findings/final-reports/iomracereport/reldatasum.html
    October 01, 2018 - Race, Ethnicity, and Language Data: Standardization for Health Care Quality Improvement Summary Previous Page Next Page Table of Contents Race, Ethnicity, and Language Data: Standardization for Health Care Quality Improvement Summary Reviewers 1. Introduction 2. Evidence of Disparities among…
  9. 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 …
  10. www.ahrq.gov/patient-safety/settings/hospital/vtguide/appa.html
    July 01, 2018 - Preventing Hospital-Associated Venous Thromboembolism Appendix A: Tools and Resources Previous Page Next Page Table of Contents Preventing Hospital-Associated Venous Thromboembolism Preface Executive Summary Chapter 1. The Framework for Improvement Chapter 2. Analyze Care Delivery Chapter …
  11. 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…
  12. www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol3/Furmaga.pdf
    January 01, 2005 - Reducing the Use of Short-acting Nifedipine by Hypertensives Using a Pharmaceutical Database 277 Reducing the Use of Short-acting Nifedipine by Hypertensives Using a Pharmaceutical Database Elaine M. Furmaga, Peter A. Glassman, Francesca E. Cunningham, Chester B. Good Abstract Objective: In view of the wi…
  13. www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol4/Mitchell.pdf
    March 31, 2004 - Creating a Curriculum for Training Health Profession Faculty Leaders 299 Creating a Curriculum for Training Health Profession Faculty Leaders Pamela H. Mitchell, Lynne S. Robins, Douglas Schaad Abstract Objectives: An interprofessional, collaborative group of educators, patient safety officers, and Federal …
  14. www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol1/Advances-Browne_5.pdf
    January 20, 2008 - Common Cause Analysis: Focus on Institutional Change Common Cause Analysis: Focus on Institutional Change Anne Marie Browne, MSN, RN; Robert Mullen, PharmD; Jeanette Teets, MSN, CRNP, RN; Annette Bollig, MSN, RN; James Steven, MD, SM Abstract The Children’s Hospital of Philadelphia has created a mechanism …
  15. www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol3/Advances-Nemeth_116.pdf
    April 27, 2008 - Minding the Gaps: Creating Resilience in Health Care Minding the Gaps: Creating Resilience in Health Care Christopher Nemeth, PhD; Robert Wears, MD; David Woods, PhD; Erik Hollnagel, PhD; Richard Cook, MD Abstract Resilience is the intrinsic ability of a system to adjust its functioning prior to, during, or …
  16. www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol3/Advances-Drews_15.pdf
    February 26, 2008 - Error Producing Conditions in the Intensive Care Unit Error Producing Conditions in the Intensive Care Unit Frank A. Drews, PhD; Adrian Musters, BS; Matthew H. Samore, MD Abstract Up to 98,000 patients die because of human error in U.S. hospitals each year. Among the areas where errors occur frequently is t…
  17. www.ahrq.gov/sites/default/files/publications2/files/distributed-cognition-er-nurses_0.pdf
    August 01, 2022 - From Novice to Expert. Excellence and Power in Clinical Nursing Practice Series.
  18. www.ahrq.gov/sites/default/files/wysiwyg/patient-safety/reports/issue-briefs/distributed-cognition-er-nurses.pdf
    August 01, 2022 - From Novice to Expert. Excellence and Power in Clinical Nursing Practice Series.
  19. www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol2/Croskerry.pdf
    January 01, 2004 - It is estimated that becoming an expert in any field takes approximately 10 years.25 Past experience
  20. www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol2/Comden.pdf
    January 01, 2003 - their experience, the experience of others where applicable, published rates, and human-reliability expert

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