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psnet.ahrq.gov/issue/three-missed-critical-nursing-care-processes-labor-and-delivery-units-during-covid-19
October 29, 2017 - It happened to me, as a pregnant OB-GYN.
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psnet.ahrq.gov/issue/effect-visitation-restrictions-ed-error
July 01, 2016 - It happened to me, as a pregnant OB-GYN.
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psnet.ahrq.gov/issue/how-can-specialist-investigation-agencies-inform-system-wide-learning-patient-safety
January 29, 2014 - September 27, 2023
Events that inspired change: the importance of sharing what happened
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psnet.ahrq.gov/issue/national-analysis-ed-presentations-early-pregnancy-and-complications-implications-post-roe
September 07, 2016 - It happened to me, as a pregnant OB-GYN.
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psnet.ahrq.gov/issue/saying-it-without-words-qualitative-study-oncology-staffs-experiences-speaking-about-safety
November 05, 2014 - June 28, 2023
Deny, Dismiss, Dehumanise: What Happened When I Went to Hospital.
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psnet.ahrq.gov/issue/exploring-physician-perspectives-residency-holdover-handoffs-qualitative-study-understand
April 27, 2015 - July 2, 2014
What happened to my patient?
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psnet.ahrq.gov/issue/we-cant-get-along-without-each-other-qualitative-interviews-physicians-about-device-industry
March 07, 2018 - June 14, 2019
Deny, Dismiss, Dehumanise: What Happened When I Went to Hospital.
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psnet.ahrq.gov/issue/shifting-indirect-patient-care-duties-after-hours-era-work-hours-restrictions
February 18, 2011 - Patient Safety and the Evolution of WebM&M and PSNet
September 1, 2019
What happened
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psnet.ahrq.gov/issue/we-need-talk-primary-care-provider-communication-discharge-era-shared-electronic-medical
October 13, 2018 - Patient Safety and the Evolution of WebM&M and PSNet
September 1, 2019
What happened
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psnet.ahrq.gov/issue/development-and-evaluation-checklist-support-decision-making-cancer-multidisciplinary-team
September 25, 2011 - May 20, 2020
Deny, Dismiss, Dehumanise: What Happened When I Went to Hospital.
-
www.ahrq.gov/sites/default/files/publications/files/sustainability-guideapa.pdf
January 01, 2009 - Topic
AHRQ Safety Program for Reducing CAUTI in Hospitals
A Model for Sustaining and Spreading Safety Interventions
Appendix A. Action Plan Tool for Project Sustainability
The Purpose of This Tool
This tool is intended to support sustainability efforts for your catheter-associated urinary tract infect…
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/cauti-tools/guides/sustainability-guideapa.pdf
January 01, 2009 - Topic
A Model for Sustaining and Spreading Safety Interventions
Appendix A. Action Plan Tool for Project Sustainability
The Purpose of This Tool
This tool is intended to support sustainability efforts for your catheter-associated urinary tract infections (CAUTI) prevention project team. This
worksheet will help…
-
www.ahrq.gov/patient-safety/settings/hospital/candor/impguide/apd.html
February 01, 2017 - Implementation Guide for the CANDOR Process: Appendix D
Action Plan Template
Purpose: To provide leaders and staff a template Action Plan to work through project activities and tasks.
Who should use this tool? Leaders (administrators, director of nursing, medical director, etc.) and any staff who are wo…
-
psnet.ahrq.gov/node/861286/psn-pdf
January 24, 2024 - Surgical safety does not happen by accident: learning
from perioperative near miss case studies.
January 24, 2024
Stucky CH, Michael Hartmann J, Yauger YJ, et al. Surgical safety does not happen by accident: learning
from perioperative near miss case studies. J Perianesth Nurs. 2024;39(1):10-15.
doi:10.1016/j.jopa…
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psnet.ahrq.gov/issue/prescribing-errors-children-why-they-happen-and-how-prevent-them
December 13, 2017 - Newspaper/Magazine Article
Prescribing errors in children: why they happen and how to prevent them.
Citation Text:
Conn R, Fox A, Carrington A, et al. Prescribing errors in children: why they happen and how to prevent them. Pharmaceutical Journal. 2023;310:7973. doi:10.1211/pj.2023.1.184…
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psnet.ahrq.gov/node/33789/psn-pdf
August 01, 2015 - If an error happened on the floor in the old days, the nurse would have tapped the doctor on the shoulder … better for rheumatoid arthritis through a lengthy complex double blind
trial, we'll be looking at what happened
-
effectivehealthcare.ahrq.gov/sites/default/files/zikmund.pdf
October 08, 2025 - Zikmund
Slide
1: The
Right Tool is What They
Need, Not What We
Have: A Taxonomy
of Appropriate
Levels of Precision in Patient Risk Communication
Brian J. Zikmund-‐Fisher, Ph.D.
Assistant Professor, Health Behavior & Health Education
University of Michigan School of…
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psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.353_slideshow.ppt
August 01, 2015 - patient requiring the brain MRI had the same initials as another patient on the same unit who also happened … patients-the-x-factor-for-health-information-exchange
14
This Case
Greater outreach and education to providers is needed to ensure what happened
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psnet.ahrq.gov/node/33781/psn-pdf
March 01, 2015 - I think what has happened subsequently was an incredible change in the acceptance of HSMRs. … problems, there's a commitment to change and reorganize,
and yet, as you've pointed out, not much happened
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psnet.ahrq.gov/node/60844/psn-pdf
August 26, 2020 - Surgical errors happen, but are learners trained to
recover from them? A survey of North American surgical
residents and fellows.
August 26, 2020
Gabrysz-Forget F, Young M, Zahabi S, et al. Surgical errors happen, but are learners trained to recover
from them? A survey of North American surgical residents and fell…