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psnet.ahrq.gov/perspective/opioid-overdose-patient-safety-problem
May 01, 2017 - Atlanta, GA: Centers for Disease Control and Prevention, National Center for Health Statistics, National … Atlanta, GA: Centers for Disease Control and Prevention. Available at [ Available at ] 8. … opioid therapy for chronic pain: a systematic review for a National Institutes of Health Pathways to Prevention … Delirium, falls, fractures, subdurals, testosterone suppression, motor vehicle collisions. … opioid therapy for chronic pain: a systematic review for a National Institutes of Health Pathways to Prevention
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effectivehealthcare.ahrq.gov/sites/default/files/related_files/diabetic-neuropathy-disposition-170707.pdf
March 24, 2017 - Something should be said that it is a limitation that
studies on prevention of progression to more severe … 24, 2017
12
Commentator
& Affiliation Section Comment Response
Peer reviewer #1 General For prevention … is insufficient evidence to evaluate whether
physical therapy, exercise or balance training reduce
falls … Peer reviewer #1 General Conclusions: For prevention of complications,
intensive glycemic control is … more effective than
standard control for prevention of amputation, and
home monitoring of foot skin
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effectivehealthcare.ahrq.gov/sites/default/files/diabetic-neuropathy-disposition-170707.pdf
March 24, 2017 - Something should be said that it is a limitation that
studies on prevention of progression to more severe … 24, 2017
12
Commentator
& Affiliation Section Comment Response
Peer reviewer #1 General For prevention … is insufficient evidence to evaluate whether
physical therapy, exercise or balance training reduce
falls … Peer reviewer #1 General Conclusions: For prevention of complications,
intensive glycemic control is … more effective than
standard control for prevention of amputation, and
home monitoring of foot skin
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psnet.ahrq.gov/perspective/conversation-poonam-sharma-md-mph-senior-clinical-data-analyst-atrium-health-and-rhonda
January 12, 2022 - Our hospitals have great protocols in place for pressure injury prevention, but prone positioning brought … They had been a common strategy for fall prevention, but with the requirement to put on PPE, there was … We also experienced, as Rhonda mentioned, difficulties with pressure ulcer prevention and timely response … For example, the Centers for Disease Control and Prevention has produced guidance for optimizing PPE … of pressure injuries , all of which are specifically focused on harm prevention in COVID-19 patients
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psnet.ahrq.gov/perspective/patient-safety-events-and-role-patient-safety-organizations-during-covid-19-pandemic
January 12, 2022 - For example, the Centers for Disease Control and Prevention has produced guidance for optimizing PPE … of pressure injuries , all of which are specifically focused on harm prevention in COVID-19 patients … Our hospitals have great protocols in place for pressure injury prevention, but prone positioning brought … They had been a common strategy for fall prevention, but with the requirement to put on PPE, there was … We also experienced, as Rhonda mentioned, difficulties with pressure ulcer prevention and timely response
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psnet.ahrq.gov/web-mm/engaging-seriously-ill-older-patients-advance-care-planning
December 22, 2018 - August 23, 2023
Patient Safety Innovations
Preventing Falls … Through Patient and Family Engagement to Create Customized Prevention Plans
May 31, 2023
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psnet.ahrq.gov/web-mm/volume-too-low-and-out
July 01, 2017 - Related Resources
Patient Safety Innovations
Preventing Falls … Through Patient and Family Engagement to Create Customized Prevention Plans
May 31, 2023
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www.ahrq.gov/sites/default/files/wysiwyg/antibiotic-use/best-practices/ASB-UTI-slides.pptx
November 01, 2019 - Although patients with a symptomatic UTI may present with delirium, no evidence suggests that delirium, falls … Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in Adults: 2009 International
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hcup-us.ahrq.gov/toolssoftware/ccs/ccs.jsp
July 01, 2025 - Child and adolescent injury as a result of falls from buildings and structures. … Injury Prevention . 11; 267-273, 2005. http://ip.bmjjournals.com/cgi/reprint/11/5/267 .
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www.ahrq.gov/sites/default/files/wysiwyg/news/events/ahrq-research-summit/dzau-summit2016.pdf
September 28, 2016 - .
• Develop a knowledge base for learning
about errors' causes and effective error
prevention. … Pressure
Ulcers
Catheter
Associated
Urinary
Tract
Infections
Surgical
Site
Infections
Falls
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psnet.ahrq.gov/node/49772/psn-pdf
October 01, 2016 - Lapse in Antibiotics Leads to Sepsis
October 1, 2016
Levy MM. Lapse in Antibiotics Leads to Sepsis. PSNet [internet]. 2016.
https://psnet.ahrq.gov/web-mm/lapse-antibiotics-leads-sepsis
The Case
A 34-year-old near-term pregnant woman presented to the emergency department (ED) with abdominal
pain, fevers, and short…
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psnet.ahrq.gov/node/49704/psn-pdf
March 01, 2014 - Late Anemia Following Rh Disease in a Newborn
March 1, 2014
Newman TB, Maisels JM. Late Anemia Following Rh Disease in a Newborn. PSNet [internet]. 2014.
https://psnet.ahrq.gov/web-mm/late-anemia-following-rh-disease-newborn
The Case
A full-term neonate was delivered uneventfully to an Rh-negative woman who had re…
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www.ahrq.gov/diagnostic-safety/resources/issue-briefs/dxsafety-patients-source-understanding-dx-error-vol1-3.html
June 01, 2023 - Patient Experience as a Source for Understanding the Origins, Impact, and Remediation of Diagnostic Errors
Past Research on Patient Perceptions of Safety and Diagnostic Mishaps
Previous Page Next Page
Table of Contents
Patient Experience as a Source for Understanding the Origins, Impact, and Remedia…
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psnet.ahrq.gov/primer/improving-patient-safety-and-team-communication-through-daily-huddles
December 15, 2024 - Examples include patients who may be on medications that could increase their risk of falls or bleeding
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psnet.ahrq.gov/perspective/ensuring-patient-and-workforce-safety-culture-healthcare
March 27, 2024 - significantly improve a number of patient outcomes, including lower rates of surgical site infections , falls … November 27, 2023
Perspectives on Safety
Suicide Prevention … Interview
In Conversation with Edwin Boudreaux about Suicide Prevention
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digital.ahrq.gov/sites/default/files/docs/publication/uc1hs015270-hayden-final-report-2008.pdf
January 01, 2008 - and that all appropriate precautions have been taken to insure a safe
and accurate procedure, Fall Prevention … achievement of national recognition for quality, along with two safety-related strategies.
10
fall prevention … and aspiration prevention protocols, had begun to be introduced to improve the
quality of care and … procedures,
protocols for patient care of specific types
(e.g. infection control, crisis intervention,
prevention … of falls, specific medical
procedures)
X X X X
Care Plans Clarity and appropriateness of patient
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www.ahrq.gov/sites/default/files/wysiwyg/sops/surveys/medical-office/2020_MOSOPS_Part_I-rev0921.pdf
January 01, 2020 - %ile Max
Item 1 36% 12.26 8% 10% 25% 35% 49%
If your medical office’s score is 55%, your score falls … here:
62%
If your medical office’s score is 65%, your score falls here:
96%
2020 SOPS Medical … Office Database Report 48
If your medical office’s score is 55 percent positive, it falls above the … If your medical office’s score is 65 percent positive, it falls above the 90th percentile, meaning
your
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www.ahrq.gov/research/findings/final-reports/iomracereport/reldata2a.html
May 01, 2018 - The same study found that 20 percent of Asian Indians and 21 percent of those falling into the Other … Asian and Pacific Islander children using NHIS data from 1997-2000 showed that children identified as falling … The Centers for Disease Control and Prevention ( CDC, 2008, p. 2 ) states that "although cancer mortality … The Census has published only one in depth analysis of an ancestry grouping that falls within the White
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www.ahrq.gov/research/findings/evidence-based-reports/er208-overview.html
October 01, 2014 - improvement strategies related to chronic conditions (diabetes, asthma, hypertension), practice areas (prevention … Prevention of healthcare-associated infections (HAI). … Closing the Quality Gap: A Critical Analysis of Quality Improvement Strategies, Volume 6—Prevention of
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www.ahrq.gov/sites/default/files/wysiwyg/sops/quality-patient-safety/patientsafetyculture/hospitalscanform.pdf
June 02, 2025 - • “Patient safety” is defined as the avoidance and prevention of patient injuries
or adverse events