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61. AHRQ Safety Program for Perinatal Care: Background Quality Improvement Team Information Form (doc file)
    www.cpsi.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/perinatal-care/modules/teamwork/supporting/team-info-form.docx
    May 01, 2017 - AHRQ Safety Program for Perinatal Care: Background Quality Improvement Team Information Form AHRQ Safety … Program for Perinatal Care Background Quality Improvement Team Information Form Who should use this

62. Research Datasets for CAHPS Surveys | Agency for Healthcare Research and Quality
    www.cpsi.ahrq.gov/cahps/cahps-database/research-datasets/index.html
    January 01, 2024 - Grant Application, Review & Award Process Grant Application Basics Application Forms … from the CAHPS Databases, please submit the following: CAHPS De-Identified Data Research Abstract Form … (PDF, 230 KB)—Please complete and submit this form to outline the proposed use of the data. … Sample CAHPS De-Identified Research Abstract Form (PDF, 247 KB)—Shows the form completed with sample … westat.com (Subject line: CAHPS De-Identified Data Request) Timeline All completed research abstract forms

63. PowerPoint Presentation (ppt file)
    www.cpsi.ahrq.gov/sites/default/files/wysiwyg/nhguide/4_TK2_T4-Common_Suspected_Infections_Tools_to_Improve_Communication_and_Decision_Making.ppt
    May 01, 2014 - * Evidence-based Communication Between Nurses and Prescribers: Using a Medical Care Referral Form … (MCRF) * Medical Care Referral Form (MCRF) Designed to facilitate evidence-based communication … Ideally, all long-term care facility residents should have a POLST accepted form on the chart and have … The form is on bright pink paper so it can be easily identified in case of an emergency. … A physician, physician assistant, or nurse practitioner must complete the POLST accepted form based on

64. Fillable Plan Do Study Act (PDSA) Tool for Health Care Quality Improvement (QI) | Agency for Healthcare Research and Quality
    www.cpsi.ahrq.gov/evidencenow/tools/pdsa-form.html
    November 01, 2018 - Grant Application, Review & Award Process Grant Application Basics Application Forms … Act (PDSA) Tool for Health Care Quality Improvement (QI) Resource: Plan Do Study Act (PDSA) Form … Using this form can be helpful to primary care practices following the Model for Improvement quality

65. Create a Culture of Safety Around Antibiotic Prescribing | Agency for Healthcare Research and Quality
    www.cpsi.ahrq.gov/antibiotic-use/long-term-care/safety/index.html
    January 01, 2024 - Grant Application, Review & Award Process Grant Application Basics Application Forms … Antibiotic Use Commitment Poster (DOCX, 870 KB) Staff Safety Assessment Form  (DOCX, 330 KB) Implementation … Guide  (PDF, 402 KB) Learning From Antibiotic–Associated Adverse Events Form (DOCX, 227 KB) Gap … Analysis Tool  (DOCX, 382 KB) The Four Moments of Antibiotic Decision Making Form and Guide

66. Checklist: Conducting a Warm Handoff Plus (pdf file)
    www.cpsi.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-family-engagement/pfeprimarycare/warm-handoff-checklist-508.pdf
    April 12, 2018 - Page does not require timed responses Navigation links Passed Navigation links are not repetitive Forms … Rule Name Status Description Tagged form fields Passed All form fields are tagged Field descriptions … Passed All form fields have description Alternate Text Rule Name Status Description Figures alternate

67. AHRQ Safety Program for Perinatal Care: Monitoring for Perinatal Safety: Sensemaking and Learn from Defects
    www.cpsi.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/perinatal-care/modules/teamwork/sensemaking/sensemaking.pptx
    May 01, 2017 - Defects 2 CUSP and Sensemaking Tools1 CUSP Tools Sensemaking Tools Staff Safety Assessment Discovery Form … Safety Issues Worksheet Root Cause Analysis Learn From Defects Form Failure Mode and Effects Analysis … identify defects or failure - Staff Safety Assessment - Status of Safety Issues Worksheet - Discovery Form … Analysis - Probabilistic Risk Assessment Tools to examine defects or failures Learn From Defects Form … Causal Tree Worksheet Coding defects or failures Learn From Defects Form Eindhoven Model 4 AHRQ Safety

68. Coaching Scenarios (pdf file)
    www.cpsi.ahrq.gov/sites/default/files/wysiwyg/teamstepps/longtermcare/module9/ts2-0ltc_module9_coaching_scenarios.pdf
    April 24, 2017 - Mark your observations on the coaching feedback form. … Mark your observations on the coaching feedback form. … Mark your observations on the coaching feedback form. … Mark your observations on the coaching feedback form. … Mark your observations on the coaching feedback form.

69. Develop and Improve Your Stewardship Program | Agency for Healthcare Research and Quality
    www.cpsi.ahrq.gov/antibiotic-use/acute-care/improve/index.html
    June 01, 2021 - Grant Application, Review & Award Process Grant Application Basics Application Forms … Stewardship Bedside Nurse Collaborate With Microbiology Lab Team Antibiotic Review Form … All ASPs should be making daily interventions to improve antibiotic use; the Team Antibiotic Review Form … AHRQ Safety Program for Acute Care (PDF, 328 KB) Gap Analysis Tool (DOCX) Team Antibiotic Review Form

70. TeamSTEPPS® 2.0 for Long-Term Care | Agency for Healthcare Research and Quality
    www.cpsi.ahrq.gov/teamstepps/longtermcare/index.html
    May 01, 2019 - Grant Application, Review & Award Process Grant Application Basics Application Forms … Coaching Self-Assessment Form (PDF; 4 pages; 287.6 KB). … Coaching Feedback Form (PDF; 1 page; 121.6 KB). … Coaching Self-Assessment Form (PDF; 4 pages; 287.6 KB). … Coaching Feedback Form (PDF; 1 page; 121.6 KB).

71. Creating a Safe Medicine List: Patient Information/Reminder Flyer (pdf file)
    www.cpsi.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-family-engagement/pfeprimarycare/medicinelist-patient-flier-final508.pdf
    April 12, 2018 - Page does not require timed responses Navigation links Passed Navigation links are not repetitive Forms … Rule Name Status Description Tagged form fields Passed All form fields are tagged Field descriptions … Passed All form fields have description Alternate Text Rule Name Status Description Figures alternate

72. Teach-Back Tips (pdf file)
    www.cpsi.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-family-engagement/pfeprimarycare/teach-back-tips-jobaid-final508.pdf
    April 04, 2018 - Page does not require timed responses Navigation links Passed Navigation links are not repetitive Forms … Rule Name Status Description Tagged form fields Passed All form fields are tagged Field descriptions … Passed All form fields have description Alternate Text Rule Name Status Description Figures alternate

73. TeamSTEPPS Course Evaluation (pdf file)
    www.cpsi.ahrq.gov/sites/default/files/wysiwyg/teamstepps/longtermcare/sitetools/ts2-0ltc_sample_course_evalform.pdf
    April 24, 2017 - TeamSTEPPS Course Evaluation TeamSTEPPS 2.0 for Long-Term Care Sample Course Evaluation Form – F … ..................................... 1 2 3 Comments: Sample Course Evaluation Form … ...... 1 2 3 Comments: TeamSTEPPS 2.0 for Long-Term Care Sample Course Evaluation Form … ....................................... 1 2 3 Comments: Sample Course Evaluation Form … ...... 1 2 3 Comments: TeamSTEPPS 2.0 for Long-Term Care Sample Course Evaluation Form

74. TeamSTEPPS 2.0: Module 12. Practice Teaching Session | Agency for Healthcare Research and Quality
    www.cpsi.ahrq.gov/teamstepps/instructor/fundamentals/module12/igpracticeteach.html
    March 01, 2014 - Grant Application, Review & Award Process Grant Application Basics Application Forms … Subsections: Practice Teaching Session Module Time: 4 hours Materials: Teaching Feedback Form … feedback from me (and/or any other Master Trainers present for the session) on the Teaching Feedback Form … After Module 1 is complete, have participants complete the Teaching Feedback Form. … Time: 4 hours Materials: Teaching Feedback Form Return to Contents Return to Index

75. Checklist: Creating a Medicine List When Patient Does NOT Bring Medicines (pdf file)
    www.cpsi.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-family-engagement/pfeprimarycare/medicinelist-checklist-nomeds-final508.pdf
    April 03, 2018 - Page does not require timed responses Navigation links Passed Navigation links are not repetitive Forms … Rule Name Status Description Tagged form fields Passed All form fields are tagged Field descriptions … Passed All form fields have description Alternate Text Rule Name Status Description Figures alternate

76. Please bring ALL your medicines to your next appointment. (pdf file)
    www.cpsi.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-family-engagement/pfeprimarycare/medmanage-ptfactsheet.pdf
    November 27, 2017 - Page does not require timed responses Navigation links Passed Navigation links are not repetitive Forms … Rule Name Status Description Tagged form fields Passed All form fields are tagged Field descriptions … Passed All form fields have description Alternate Text Rule Name Status Description Figures alternate

77. Toolkit 2. Common Suspected Infections: Communication and Decisionmaking for Four Infections | Agency for Healthcare Research and Quality
    www.cpsi.ahrq.gov/nhguide/toolkits/determine-whether-to-treat/toolkit2-communications-and-decisionmaking.html
    November 01, 2016 - Grant Application, Review & Award Process Grant Application Basics Application Forms … This toolkit includes the following tools: A Medical Care Referral Form to document information for … Use the Medical Care Referral form. … The form documents information clinicians need for prescribing decisions and reflects evidence-based … Prescribing clinicians should also be trained to use order forms for treatment other than antibiotics

78. Protection of Human Subjects | Agency for Healthcare Research and Quality
    www.cpsi.ahrq.gov/funding/policies/human-subjects/index.html
    June 01, 2022 - Grant Application, Review & Award Process Grant Application Basics Application Forms … for any clinical trial conducted or supported by a Common Rule department or agency, one consent form … The consent form must have been used in enrolling participants in order to satisfy this new provision … AHRQ Guidance on Posting Informed Consent Forms for AHRQ-Funded Clinical Trials . … AHRQ Guidance on Posting Informed Consent Forms for AHRQ-Funded Clinical Trials .

79. TeamSTEPPS® for Office-Based Care - Course Evaluation (pdf file)
    www.cpsi.ahrq.gov/sites/default/files/wysiwyg/professionals/education/curriculum-tools/teamstepps/officebasedcare/handouts/courseeval.pdf
    December 02, 2015 - ........................ 1 2 3 Comments: TeamSTEPPS for Office-Based Care Course Evaluation Form … ............................................ 1 2 3 Comments: Course Evaluation Form – 2 TeamSTEPPS … ...................... 1 2 3 Comments: TeamSTEPPS for Office-Based Care Course Evaluation Form … Course Evaluation Form – 4 TeamSTEPPS for Office-Based Care TeamSTEPPS® for Office-Based Care … Additional Comments: TeamSTEPPS for Office-Based Care Course Evaluation Form –

80. Creating A Handoff Checklist | Agency for Healthcare Research and Quality
    www.cpsi.ahrq.gov/teamstepps/officebasedcare/handouts/checklist.html
    November 01, 2015 - Grant Application, Review & Award Process Grant Application Basics Application Forms … Creating A Handoff Checklist TeamSTEPPS Primary Care Version Participant Handouts Directions: Form … If your medical team members are present, form a group of your medical office team members and develop