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digital.ahrq.gov/sites/default/files/docs/workflowtoolkit/PrescriptionRenewalRequest-PaperSystem.pdf
January 01, 2010 - Prescription Renewal Request - Paper System
Prescription Renewal Request – Paper system
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Retrieve patient
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Give renewal
request and chart
to provider for
approval/
proc…
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digital.ahrq.gov/health-it-tools-and-resources/evaluation-resources/workflow-assessment-health-it-toolkit/all-workflow-tools/heuristic-evaluation
January 01, 2023 - Heuristic Evaluation
Also Known As
Heuristic Analysis
Description
Heuristic evaluations are a form of usability evaluation in which various accepted principles of design are applied to the system being assessed.
Uses
Prior to system procurement.
In the early stages (especial…
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psnet.ahrq.gov/node/46175/psn-pdf
September 24, 2017 - Applying lessons from social psychology to transform the
culture of error disclosure.
September 24, 2017
Han J, LaMarra D, Vapiwala N. Applying lessons from social psychology to transform the culture of error
disclosure. Med Educ. 2017;51(10):996-1001. doi:10.1111/medu.13345.
https://psnet.ahrq.gov/issue/applying-…
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psnet.ahrq.gov/node/45457/psn-pdf
September 01, 2016 - Patient safety implications of electronic alerts and alarms
of maternal–fetal status during labor.
September 1, 2016
Simpson KR, Lyndon A, Davidson LA. Patient Safety Implications of Electronic Alerts and Alarms of
Maternal - Fetal Status During Labor. Nurs Womens Health. 2016;20(4):358-66.
doi:10.1016/j.nwh.2016.…
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psnet.ahrq.gov/node/47581/psn-pdf
January 09, 2019 - Patient safety in inpatient psychiatry: a remaining frontier
for health policy.
January 9, 2019
Shields MC, Stewart MT, Delaney KR. Patient Safety In Inpatient Psychiatry: A Remaining Frontier For
Health Policy. Health Aff (Millwood). 2018;37(11):1853-1861. doi:10.1377/hlthaff.2018.0718.
https://psnet.ahrq.gov/iss…
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psnet.ahrq.gov/node/43480/psn-pdf
January 01, 2015 - Speaking up: factors and issues in nurses advocating for
patients when patients are in jeopardy.
December 15, 2014
Rainer J. Speaking up: factors and issues in nurses advocating for patients when patients are in jeopardy.
J Nurs Care Qual. 2015;30(1):53-62. doi:10.1097/NCQ.0000000000000081.
https://psnet.ahrq.gov/…
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psnet.ahrq.gov/node/73403/psn-pdf
June 16, 2021 - Pathology Oversight Failures at the Veterans Health Care
System of the Ozarks in Fayetteville, Arkansas VA.
June 16, 2021
Office of Inspector General. June 2, 2021. Report No. 18-02496-157.
https://psnet.ahrq.gov/issue/pathology-oversight-failures-veterans-health-care-system-ozarks-fayetteville-
arkansas-va
…
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www.ahrq.gov/patient-safety/quality-resources/tools/chtoolbx/measures/measure-6.html
November 01, 2017 - Established Child Health Care Quality Measures--Child and Adolescent Health Measurement Initiative (CAHMI): Promoting Healthy Development Survey (PHDS)
Child Health Care Quality Toolbox
The Child Health Toolbox contains concepts, tips, and tools for evaluating the quality of health care for children.
Conten…
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/ambulatory-surgery/sections/sustainability/management/huddles/huddles-component-kit.docx
May 01, 2017 - Module 2: Component Kit
AHRQ Safety Program for Ambulatory Surgery
Management Practices for Sustainability
Module 2: Daily Huddles
AHRQ’s Safety Program for Ambulatory
Daily Huddle Component Kit
Contents
1. Why a Daily Huddle? 2
2. “Know What, Know How, Know Why” for Daily Huddle 4
3. Plan-Do-Study-Act “Ramp”: …
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psnet.ahrq.gov/node/49836/psn-pdf
July 01, 2018 - Primary Workaround, Secondary Complication
July 1, 2018
Debono D, Levett-Jones T. Primary Workaround, Secondary Complication. PSNet [internet]. 2018.
https://psnet.ahrq.gov/web-mm/primary-workaround-secondary-complication
The Case
A young adult with a progressive neurological disorder presented to a hospital emerg…
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psnet.ahrq.gov/node/33629/psn-pdf
March 01, 2006 - What Does Simulation Add to Teamwork Training?
March 1, 2006
Gaba DM. What Does Simulation Add to Teamwork Training? PSNet [internet]. 2006.
https://psnet.ahrq.gov/perspective/what-does-simulation-add-teamwork-training
Editor's Note: In these point–counterpoint articles, Drs. Pratt and Sachs of Beth Israel Deacones…
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psnet.ahrq.gov/web-mm/near-miss-neonate
August 15, 2018 - Near Miss With Neonate
Citation Text:
Malana J, Lyndon A. Near Miss With Neonate. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2016.
Copy Citation
Format:
Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endnote tag…
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psnet.ahrq.gov/web-mm/magnetic-deflection
November 18, 2016 - The Magnetic Deflection
Citation Text:
Kanal E. The Magnetic Deflection. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2019.
Copy Citation
Format:
Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged PubMe…
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psnet.ahrq.gov/web-mm/dnr-or-and-afterwards
July 01, 2003 - DNR in the OR and Afterwards
Citation Text:
Lo B. DNR in the OR and Afterwards. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2006.
Copy Citation
Format:
Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endnote tagge…
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psnet.ahrq.gov/node/33634/psn-pdf
May 04, 2006 - The Wild West: Patient Safety in Office-Based Anesthesia
May 1, 2006
Kaushal R, Upadhyayula S, Gaba DM, et al. The Wild West: Patient Safety in Office-Based Anesthesia.
PSNet [internet]. 2006.
https://psnet.ahrq.gov/perspective/wild-west-patient-safety-office-based-anesthesia
Perspective
Over the last decade, sur…
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psnet.ahrq.gov/node/49570/psn-pdf
October 01, 2008 - Recurrent Hypoglycemia: A Care Transition Failure?
October 1, 2008
Eytan T. Recurrent Hypoglycemia: A Care Transition Failure? PSNet [internet]. 2008.
https://psnet.ahrq.gov/web-mm/recurrent-hypoglycemia-care-transition-failure
Case Objectives
Understand the complementary abilities of an electronic health record a…
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psnet.ahrq.gov/web-mm/case-mistaken-intubation
July 01, 2016 - SPOTLIGHT CASE
The Case of Mistaken Intubation
Citation Text:
Silveira MJ. The Case of Mistaken Intubation. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2016.
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Format:
Google Scholar BibTeX End…
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psnet.ahrq.gov/web-mm/medication-mix-bad-worse
March 01, 2018 - Medication Mix-Up: From Bad to Worse
Citation Text:
Wollitz A, O'Connor MF. Medication Mix-Up: From Bad to Worse. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2015.
Copy Citation
Format:
Google Scholar BibTeX EndNote …
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psnet.ahrq.gov/node/49584/psn-pdf
April 01, 2009 - EMR Entry Error: Not So Benign
April 1, 2009
Koppel R. EMR Entry Error: Not So Benign. PSNet [internet]. 2009.
https://psnet.ahrq.gov/web-mm/emr-entry-error-not-so-benign
The Case
A 47-year-old man with advanced AIDS was admitted to an academic medical center with a chief complaint
of shortness of breath. He was …
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psnet.ahrq.gov/node/33663/psn-pdf
September 15, 2008 - Implementing a Patient Safety Program at a Large
National Health System
January 1, 2008
Hauck LD, Jacob J. Implementing a Patient Safety Program at a Large National Health System. PSNet
[internet]. 2008.
https://psnet.ahrq.gov/perspective/implementing-patient-safety-program-large-national-health-system
Perspectiv…