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psnet.ahrq.gov/issue/effect-distractions-operative-performance-and-ability-multitask-case-deliberate-practice
September 15, 2010 - Study
Effect of distractions on operative performance and ability to multitask—a case for deliberate practice.
Citation Text:
Ahmed A, Ahmad M, Stewart M, et al. Effect of distractions on operative performance and ability to multitask--a case for deliberate practice. Laryngoscope. 2015;1…
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www.ahrq.gov/news/newsroom/case-studies/coe1304.html
April 01, 2013 - Maryland Guides Prescribers on Use of Atypical Antipsychotic Medications
Search All Impact Case Studies
April 2013
The Maryland Department of Health and Mental Hygiene used materials created by AHRQ's Effective Health Care Program to help set up a new program for appropriate use of antipsychotic medications…
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www.ahrq.gov/patient-safety/settings/long-term-care/resource/facilities/ltc/gdmodap2b.html
October 01, 2014 - Improving Patient Safety in Long-Term Care Facilities
Appendix 2-B. Pre/Post-Test Questions and Answers for Module 2
Previous Page Next Page
Table of Contents
Improving Patient Safety in Long-Term Care Facilities
Introduction
Module 1. Detecting Change in a Resident's Condition
Module 2. Commu…
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www.ahrq.gov/news/blog/ahrqviews/financial-strains-healthcare.html
November 01, 2023 - AHRQ Views: Blog posts from AHRQ leaders
Biden Administration Tackles Financial Strains on Healthcare Consumers
NOV
30
2023
By
Robert Otto
Valdez,
Ph.D., M.H.S.A.
Robert Otto Valdez, Ph.D., M.H.S.A.
Americans have long been facing a healthcare affordability crisis. …
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psnet.ahrq.gov/issue/preventing-patient-falls-systematic-approach-joint-commission-center-transforming-healthcare
October 19, 2016 - Book/Report
Preventing Patient Falls: A Systematic Approach From the Joint Commission Center for Transforming Healthcare Project.
Citation Text:
Preventing Patient Falls: A Systematic Approach From the Joint Commission Center for Transforming Healthcare Project. Chicago, IL: Health Resea…
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www.uspreventiveservicestaskforce.org/uspstf/sites/default/files/file/supporting_documents/vitamin-d-calcium-falls-bulletin.pdf
January 21, 2025 - Task Force Issues Draft Recommendation Statement on Vitamin D and Calcium to Prevent Falls and Fractures in Older Adults
1
www.uspreventiveservicestaskforce.org
Task Force Issues Draft Recommendation Statement on Vitamin D
and Calcium to Prevent Falls and Fractures in Older Adults
Vitamin D and calcium s…
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psnet.ahrq.gov/node/50647/psn-pdf
November 06, 2019 - ‘Fear of falling’: how hospitals do even more harm by
keeping patients in bed.
November 6, 2019
Bailey M. Kaiser Health News. October 17, 2019.
https://psnet.ahrq.gov/issue/fear-falling-how-hospitals-do-even-more-harm-keeping-patients-bed
Patient falls with harm are a common sentinel event. This news story discuss…
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psnet.ahrq.gov/node/47901/psn-pdf
April 10, 2019 - A systematic review of falls in hospital for patients with
communication disability: highlighting an invisible
population.
April 10, 2019
Hemsley B, Steel J, Worrall L, et al. A systematic review of falls in hospital for patients with communication
disability: Highlighting an invisible population. J Safety Res. 20…
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psnet.ahrq.gov/node/837863/psn-pdf
August 17, 2022 - The Nursing Home Expert Panel’s Falls Investigation
Guide Toolkit: How-To Guide.
August 17, 2022
Portland, OR: Oregon Patient Safety Commission; 2022.
https://psnet.ahrq.gov/issue/nursing-home-expert-panels-falls-investigation-guide-toolkit-how-guide
Patient falls are common sentinel events. The latest revis…
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psnet.ahrq.gov/node/50862/psn-pdf
February 05, 2020 - Assessment of nursing home reporting of major injury
falls for quality measurement on Nursing Home Compare.
February 5, 2020
Sanghavi P, Pan S, Caudry D. Assessment of nursing home reporting of major injury falls for quality
measurement on nursing home compare. Health Serv Res. 2020;55(2):201-210. doi:10.1111/1475-…
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psnet.ahrq.gov/issue/using-root-cause-analysis-reduce-falls-injury-community-settings
April 25, 2016 - Study
Using root cause analysis to reduce falls with injury in community settings.
Citation Text:
Lee A, Mills PD, Neily J. Using root cause analysis to reduce falls with injury in community settings. Jt Comm J Qual Patient Saf. 2012;38(8):366-374.
Copy Citation
Format:
Goo…
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psnet.ahrq.gov/node/38715/psn-pdf
February 17, 2011 - Medicare nonpayment, hospital falls, and unintended
consequences.
February 17, 2011
Inouye SK, Brown CJ, Tinetti ME. Medicare nonpayment, hospital falls, and unintended consequences. N
Engl J Med. 2009;360(23):2390-3. doi:10.1056/NEJMp0900963.
https://psnet.ahrq.gov/issue/medicare-nonpayment-hospital-falls-and-uni…
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psnet.ahrq.gov/issue/falling-through-cracks-invisible-hospital-cleaning-workforce
June 19, 2013 - Commentary
Falling through the cracks: the invisible hospital cleaning workforce.
Citation Text:
Hacker CE, Debono D, Travaglia J, et al. Falling through the cracks: the invisible hospital cleaning workforce. J Health Organ Manag. 2022;36(8):981-986. doi:10.1108/jhom-02-2022-0035.
Copy…
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psnet.ahrq.gov/node/73363/psn-pdf
June 09, 2021 - Shift-to-shift nursing handover interventions associated
with improved inpatient outcomes - falls, pressure
injuries and medication administration errors: an
integrative review.
June 9, 2021
Hada A, Coyer F. Shift?to?shift nursing handover interventions associated with improved inpatient
outcomes—falls, pressure …
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psnet.ahrq.gov/node/37792/psn-pdf
February 15, 2011 - Exploring organizational context and structure as
predictors of medication errors and patient falls.
February 15, 2011
Mark BA, Hughes LC, Belyea M, et al. Exploring Organizational Context and Structure as Predictors of
Medication Errors and Patient Falls. J Patient Saf. 2008;4(2). doi:10.1097/pts.0b013e3181695671.…
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psnet.ahrq.gov/node/37518/psn-pdf
March 13, 2008 - Innovation in patient safety: a new task design in
reducing patient falls.
March 13, 2008
Tzeng H-M, Yin C-Y. Innovation in patient safety: a new task design in reducing patient falls. J Nurs Care
Qual. 2008;23(1):34-42. doi:10.1097/01.NCQ.0000303803.07457.e5.
https://psnet.ahrq.gov/issue/innovation-patient-safety…
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psnet.ahrq.gov/node/40454/psn-pdf
June 01, 2012 - Influence of unit-level staffing on medication errors and
falls in military hospitals.
June 1, 2012
Breckenridge-Sproat S, Johantgen M, Patrician PA. Influence of unit-level staffing on medication errors and
falls in military hospitals. West J Nurs Res. 2012;34(4):455-74. doi:10.1177/0193945911407090.
https://psne…
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psnet.ahrq.gov/node/39255/psn-pdf
February 02, 2011 - The patient who falls: "It's always a trade-off."
February 2, 2011
Tinetti ME, Kumar C. The patient who falls: "It's always a trade-off". JAMA. 2010;303(3):258-66.
doi:10.1001/jama.2009.2024.
https://psnet.ahrq.gov/issue/patient-who-falls-its-always-trade
Through a case study, this article reviews evidence on risk…
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psnet.ahrq.gov/node/47508/psn-pdf
October 24, 2018 - Root cause analysis of reported patient falls in ORs in the
Veterans Health Administration.
October 24, 2018
Soncrant CM, Warner LJ, Neily J, et al. Root Cause Analysis of Reported Patient Falls in ORs in the
Veterans Health Administration. AORN J. 2018;108(4):386-397. doi:10.1002/aorn.12372.
https://psnet.ahrq.go…
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psnet.ahrq.gov/node/41554/psn-pdf
January 03, 2017 - Using root cause analysis to reduce falls with injury in
community settings.
January 3, 2017
Lee A, Mills PD, Neily J. Using root cause analysis to reduce falls with injury in community settings. Jt
Comm J Qual Patient Saf. 2012;38(8):366-374.
https://psnet.ahrq.gov/issue/using-root-cause-analysis-reduce-falls-inj…