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psnet.ahrq.gov/web-mm/two-wrongs-dont-make-right-kidney
April 01, 2010 - operating room—implementation of the Universal Protocol could have been effective, but only if completely implemented … It is up to the health care administrators, providers, and surgeons to ensure that the protocol is implemented
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psnet.ahrq.gov/node/33563/psn-pdf
September 16, 2024 - methods (e.g., rapid response teams, structured communication methods such as SBAR) are being
widely implemented
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psnet.ahrq.gov/node/33567/psn-pdf
June 15, 2024 - implementing-situation-background-assessment-recommendation-anaesthetic-clinic-and-subsequent
https://psnet.ahrq.gov/issue/can-sbar-be-implemented-high-fidelity-and-does-it-improve-communication-between-healthcare
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psnet.ahrq.gov/primer/disclosure-errors
September 15, 2024 - criticized for its lack of patient-centeredness, and in response, a growing number of institutions have implemented
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psnet.ahrq.gov/print/pdf/node/865308
January 01, 2024 - encouraged to learn from their failures, but evidence shows that changes after errors
are not always implemented … encouraged to learn from their failures, but evidence shows that changes after errors
are not always implemented
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psnet.ahrq.gov/curated-library/organizational-learning
May 19, 2025 - encouraged to learn from their failures, but evidence shows that changes after errors are not always implemented … encouraged to learn from their failures, but evidence shows that changes after errors are not always implemented
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psnet.ahrq.gov/perspective/maternal-safety-and-perinatal-mental-health
March 28, 2023 - Christie Allen: The bundle is a tool and could be implemented by any AIM team. … These programs are implemented at the state level to provide resources to support OB/GYNs and other clinicians … Our goal is that all elements of the bundle are implemented. … The bundles are valuable tools, but they are piece of paper until they are implemented by a team with
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psnet.ahrq.gov/web-mm/framework-assessing-reasoning-about-controversial-end-life-clinical-decisions
November 30, 2023 - possible to do so, must be reconciled with reasons at this level – meaning that no care plan ought to be implemented … It must therefore be part of all clinicians’ discretionary responsibility to observe how care is implemented … ethical duty to ensure that appropriate personnel are assigned so that a patient’s care plan can be implemented
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psnet.ahrq.gov/perspective/annual-perspective-psychological-safety-healthcare-staff
November 16, 2022 - The way these learning approaches are implemented is important for their efficacy. … Edmondson. 7 It is of interest to see if the interventions developed in these studies are successfully implemented
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psnet.ahrq.gov/print/pdf/node/73848
July 01, 2022 - Building on the success of the Keystone ICU project model, this study also implemented a
comprehensive … Building on the success of the Keystone ICU project model, this study also implemented a
comprehensive
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psnet.ahrq.gov/web-mm/signout-fallout
November 16, 2022 - Drawing on the lessons from major patient safety successes that had implemented a bundle of complementary … the I-PASS Study Group was formed and led a multicenter project in which a refined handoff bundle was implemented
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psnet.ahrq.gov/perspective/antibiotic-and-opioid-stewardship-dentistry
December 07, 2020 - When I was a resident, I implemented a stewardship program at a typical academic medical center and also … We’ve implemented stewardship in academic clinics, academic primary care medical clinics, in the emergency … At my prior institution, the University of Illinois at Chicago (UIC), we implemented an antibiotic stewardship
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psnet.ahrq.gov/web-mm/delay-initiating-antibiotics-results-fatal-error
August 02, 2015 - additional 6 hours for education and transfer of care.( 10 ) To meet these requirements, many programs have implemented … In addition to reporting within these and other conferences (eg, M&M conferences), we have also implemented
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psnet.ahrq.gov/perspective/integrating-multiple-medication-decision-support-systems-how-will-we-make-it-all-work
May 01, 2008 - In 1977, Indiana University's Regenstrief Institute implemented a new system in which laboratory and … Just because a hospital has implemented CPOE does not mean that they necessarily have the decision support … Still, only about 15% of the nation's hospitals have implemented it.
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psnet.ahrq.gov/perspective/what-can-rest-health-care-system-learn-vas-quality-and-safety-transformation
September 01, 2006 - Over the past decade, VA has implemented an impressive array of programs to improve safety, focusing … Many of these same programs are now being implemented in the private sector. … safety folks from more than 100 non-VA hospital systems in the US have come to us to be trained and have implemented
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psnet.ahrq.gov/perspective/conversation-katie-j-suda-pharmd-ms
December 07, 2020 - When I was a resident, I implemented a stewardship program at a typical academic medical center and also … We’ve implemented stewardship in academic clinics, academic primary care medical clinics, in the emergency … At my prior institution, the University of Illinois at Chicago (UIC), we implemented an antibiotic stewardship
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psnet.ahrq.gov/web-mm/bad-writing-wrong-medication
March 01, 2015 - greater use of information technology to improve medication safety.( 12 ) CPOE systems, when correctly implemented … Electronic medical records with computerized provider order entry systems, when implemented correctly
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psnet.ahrq.gov/perspective/conversation-withbarbara-blakeney-ms-rn
August 01, 2005 - The National Quality Forum developed quality indictors that, if implemented in hospitals nationally, … If mandates can be implemented without major unintended consequences that adversely affect access and
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psnet.ahrq.gov/perspective/role-bar-coding-and-smart-pumps-safety
September 01, 2008 - And the places in the academic hospitals that have implemented this technology are naturally places where … some early evidence from the VA Hospital showing that, over the years as barcode technology has been implemented … any direct patient safety impact but definitely could increase the efficiency of the hospital if it's implemented
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psnet.ahrq.gov/perspective/conversation-witheric-g-poon-md-mph
September 01, 2008 - And the places in the academic hospitals that have implemented this technology are naturally places where … some early evidence from the VA Hospital showing that, over the years as barcode technology has been implemented … any direct patient safety impact but definitely could increase the efficiency of the hospital if it's implemented