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psnet.ahrq.gov/issue/seven-potentially-deadly-prescribing-errors
June 12, 2013 - Newspaper/Magazine Article
Seven (potentially) deadly prescribing errors.
Citation Text:
Seven (potentially) deadly prescribing errors. Graham LR, Scudder L, Stokowski L. Medscape. October 22, 2015.
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psnet.ahrq.gov/issue/cause-concern-drug-shortages-disrupt-operations-tax-hospitalists-treatment-patterns
March 27, 2005 - Newspaper/Magazine Article
Cause for concern: drug shortages disrupt operations, tax hospitalists' treatment patterns.
Citation Text:
Cause for concern: drug shortages disrupt operations, tax hospitalists' treatment patterns. Collins TR. The Hospitalist. July 2011.
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psnet.ahrq.gov/issue/anesthesia-patient-safety-foundation-newsletter
August 14, 2019 - Newsletter/Journal
Anesthesia Patient Safety Foundation Newsletter.
Citation Text:
Anesthesia Patient Safety Foundation Newsletter. Greenberg S, Banayan J, eds. Rochester, MN; Anesthesia Patient Safety Foundation.
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psnet.ahrq.gov/issue/ana-cauti-prevention-tool
September 14, 2016 - Toolkit
ANA CAUTI Prevention Tool.
Citation Text:
ANA CAUTI Prevention Tool. Silver Spring, MD: American Nurses Association; 2015.
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psnet.ahrq.gov/issue/proper-positioning-pharmacy-label-hospira-pca-vials-will-avoid-interference-scanning
May 05, 2018 - Newspaper/Magazine Article
Proper positioning of pharmacy label on Hospira PCA vials will avoid interference with scanning.
Citation Text:
Proper positioning of pharmacy label on Hospira PCA vials will avoid interference with scanning. ISMP Medication Safety Alert! Acute Care Edition. Au…
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psnet.ahrq.gov/issue/american-geriatrics-society-ags-policy-brief-covid-19-and-nursing-homes
October 12, 2022 - Organizational Policy/Guidelines
American Geriatrics Society (AGS) Policy Brief: COVID-19 and nursing homes.
Citation Text:
American Geriatrics Society (AGS) Policy Brief: COVID-19 and nursing homes. Am Geriatr Soc. 2020;68(5):908-911. doi:10.1111/jgs.16477.
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digital.ahrq.gov/health-it-tools-and-resources/evaluation-resources/workflow-assessment-health-it-toolkit/all-workflow-tools/kepner-tregoe-matrix
January 01, 2023 - Kepner-Tregoe Matrix
Also Known As
Is-Is Not Matrix
Kepner and Tregoe Method
Description
A Kepner-Tregoe matrix is used to find causes of a problem. It isolates the who, what, when, where, and how aspects of an event, keeping the focus on the elements that have an impact on the event and…
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psnet.ahrq.gov/issue/ongoing-preventable-fatal-events-fentanyl-transdermal-patches-are-alarming
May 07, 2018 - Newspaper/Magazine Article
Ongoing, preventable fatal events with fentanyl transdermal patches are alarming!
Citation Text:
Ongoing, preventable fatal events with fentanyl transdermal patches are alarming! ISMP Medication Safety Alert! Acute Care Edition. June 28, 2007;12:1-3.
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www.ahrq.gov/sites/default/files/wysiwyg/cahps/news-and-events/events/20150122/1_carla_zema_intro.pdf
January 22, 2015 - Introducing the CAHPS Child Hospital Survey
Introducing the CAHPS Child
Hospital Survey
A Webcast Presented by the AHRQ CAHPS User Network
January 22, 2015
1:00 – 2:00 pm EST
What is CAHPS?
• Consumer Assessment of Healthcare Providers
and Systems (CAHPS) Program
• Funded primarily by the Agency for Hea…
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www.ahrq.gov/sites/default/files/wysiwyg/cahps/news-and-events/events/webinars/addressing-emerging-needs-09132023-hays.pdf
June 02, 2025 - AHRQ CAHPS Program: Addressing Emergining Needs for Patient Experience Measurement & Improvement webcast-HAYS
Improving the Survey Instruments
Ron D. Hays, PhD
University of California, Los Angeles, CA
RAND Corporation, Santa Monica, CA
CAHPS Clinician and Group Survey 4.0 (beta)
• Created in response to:
► In…
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www.ahrq.gov/sites/default/files/wysiwyg/sops/events/webinar/02-nh_webcast-ginsberg.pdf
July 01, 2018 - SOPS Nursing Home Survey: What You Need To Know - Caren Ginsberg, Ph.D.
AHRQ’s Surveys on Patient Safety Culture™
(SOPS®) Program
Caren Ginsberg, Ph.D.
Center for Quality Improvement and Patient Safety, AHRQ
Agency for Healthcare Research and Quality
• AHRQ is:
► A research and science-based agency of the US De…
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psnet.ahrq.gov/issue/human-factors-pediatric-anesthesia-incidents
June 06, 2018 - Study
Human factors in pediatric anesthesia incidents.
Citation Text:
Human factors in pediatric anesthesia incidents. Marcus R.
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www.ahrq.gov/sites/default/files/wysiwyg/policymakers/chipra/factsheets/fullreports/chipra-88-measure-1-section-6-attachment-1.xlsx
June 01, 2012 - ADHD Chart Review Elements
ADHD Chart Abstraction Tool Template (with example data)
Patient ID Race Ethnicity Gender Payer Preferred Language Age Patient diagnosed between Dec 2011 and June 2012 (Yes-1/No -2) Evidence of ADHD diagnostic clinical exam by physician in the chart (Yes - 1/No - 2) Evidence in the chart…
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psnet.ahrq.gov/issue/educating-safety
December 09, 2020 - Special or Theme Issue
Educating for Safety.
Citation Text:
Educating for Safety. Am J Pharm Edu. 2011;75(7):e140-e143.
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www.ahrq.gov/sites/default/files/wysiwyg/ncepcr/pbrn/pbrn-impact-profile-nortex.pdf
June 27, 2025 - PBRN Impact Profile: North Texas Primary Care
RESEARCH
Recruiting Practice-based Research Network (PBRN)
physicians to be research participants: Lessons learned from
the North Texas (NorTex) needs assessment study.
Coronary Artery Calcium Progression Is Associated with
Cardiovascular Events Among Asymptomati…
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www.ahrq.gov/talkingquality/resources/writing/guidelines.html
September 01, 2019 - Guidelines and Other Resources To Fine-tune Your Writing
Guidelines for writing, checklists, and tip sheets give you a systematic way to help make sure you are doing all you can to produce clear, compelling text.
The guidelines and checklist tools listed below focus on writing in plain language. These tools w…
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psnet.ahrq.gov/issue/safety-i-and-safety-ii-past-and-future-safety-management
July 22, 2019 - Book/Report
Classic
Safety-I and Safety-II: The Past and Future of Safety Management.
Citation Text:
Safety-I and Safety-II: The Past and Future of Safety Management. Hollnagel E. Aldershot, Hampshire, England: Ashgate; 2014. ISBN: 9781472423085.
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psnet.ahrq.gov/issue/principles-risk-management-and-patient-safety
March 27, 2005 - Book/Report
Principles of Risk Management and Patient Safety.
Citation Text:
Principles of Risk Management and Patient Safety. Youngberg BJ, ed. Sudbury, MA: Jones Bartlett; 2011. ISBN: 9780763774059.
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digital.ahrq.gov/2020-year-review/research-summary/engaging-disadvantaged-patients-using-mobile-technology-share
January 01, 2020 - Engaging Disadvantaged Patients by Using Mobile Technology to Share Patient Reported Outcomes
Commercial off-the-shelf technology, including mobile phones, can successfully engage disadvantaged patients to collect patient-generated health data and patient-reported outcomes that can be integrated into electronic hea…
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digital.ahrq.gov/2019-year-review/research-summary/emerging-innovative-newly-funded-research/optimization-patient-reported-outcome-data-visualization-improve
January 01, 2019 - Optimization of Patient-Reported Outcome Data Visualization to Improve Shared Decision Making
Optimizing PRO data visualization with clinicians’ and patients’ input will improve clinicians’ ability to effectively synthesize and communicate complex data to provide patient-centered clinical management.
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