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psnet.ahrq.gov/node/47193/psn-pdf
September 05, 2018 - Situation, background, assessment, recommendation
(SBAR) communication tool for handoff in health care- a
narrative review.
September 5, 2018
Shahid S, Thomas S. Situation, background, assessment, recommendation (SBAR) communication tool for
handoff in health care; a narrative review. Saf Health. 2018;4(7). doi:10…
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psnet.ahrq.gov/node/847543/psn-pdf
April 12, 2023 - What works in medication reconciliation: an on-treatment
and site analysis of the MARQUIS2 study.
April 12, 2023
Schnipper JL, Reyes Nieva H, Yoon CS, et al. What works in medication reconciliation: an on-treatment
and site analysis of the MARQUIS2 study. BMJ Qual Saf. 2023;32(8):457-469. doi:10.1136/bmjqs-2022-
0…
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psnet.ahrq.gov/node/862131/psn-pdf
February 07, 2024 - Prospective study of the multisite spread of a medication
safety intervention: factors common to hospitals with
improved outcomes.
February 7, 2024
Kaplan HC, Goldstein SL, Rubinson C, et al. Prospective study of the multisite spread of a medication
safety intervention: factors common to hospitals with improved ou…
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www.ahrq.gov/hai/tools/mvp/modules.html
January 01, 2017 - Toolkit Modules
The toolkit consists of four modules and other resources that will help ICUs uncover local defects, implement interventions to prevent ventilator-associated events, and build a sustainable safety culture.
Module on How To Apply CUSP for Mechanically Ventilated Patients
The Comprehensive Unit…
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psnet.ahrq.gov/node/837735/psn-pdf
July 27, 2022 - A quality improvement initiative using peer audit and
feedback to improve compliance with the surgical safety
checklist.
July 27, 2022
Fridrich A, Imhof A, Staender S, et al. A quality improvement initiative using peer audit and feedback to
improve compliance. Int J Qual Health Care. 2022;34(3). doi:10.1093/intqhc…
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psnet.ahrq.gov/node/45247/psn-pdf
August 15, 2016 - Physician transition of care: benefits of I-PASS and an
electronic handoff system in a community pediatric
residency program.
August 15, 2016
Walia J, Qayumi Z, Khawar N, et al. Physician Transition of Care: Benefits of I-PASS and an Electronic
Handoff System in a Community Pediatric Residency Program. Acad Pediat…
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psnet.ahrq.gov/node/36843/psn-pdf
January 05, 2017 - Improving medication reconciliation in the outpatient
setting.
January 5, 2017
Varkey P, Cunningham J, Bisping S. Improving medication reconciliation in the outpatient setting. Jt Comm
J Qual Patient Saf. 2007;33(5):286-92.
https://psnet.ahrq.gov/issue/improving-medication-reconciliation-outpatient-setting
The Jo…
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psnet.ahrq.gov/node/45706/psn-pdf
September 01, 2018 - Improving communication and resolution following
adverse events using a patient-created simulation
exercise.
September 1, 2018
Gallagher TH, Etchegaray J, Bergstedt B, et al. Improving Communication and Resolution Following
Adverse Events Using a Patient-Created Simulation Exercise. Health Serv Res. 2016;51 Suppl …
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psnet.ahrq.gov/node/38517/psn-pdf
February 17, 2011 - Use of electronic health records in US hospitals.
February 17, 2011
Jha AK, DesRoches CM, Campbell EG, et al. Use of electronic health records in U.S. hospitals.
doi:10.1056/NEJMsa0900592.
https://psnet.ahrq.gov/issue/use-electronic-health-records-us-hospitals
Increasing the use of electronic health records (EHRs)…
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www.ahrq.gov/hai/quality/tools/cauti-ltc/infection-prevention.html
March 01, 2017 - Implement an Infection Prevention Quality Improvement Project
Start with the Implementation Guide , and then consult the Sustainability Guide
Long -Term Care Safety Toolkit Modules
Comprises six modules (available in English and Spanish) that describe how to apply CUSP for long-term care resident safety…
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psnet.ahrq.gov/node/72526/psn-pdf
January 01, 2021 - How effective are electronic medication systems in
reducing medication error rates and associated harm
among hospital inpatients? A systematic review and
meta-analysis.
December 2, 2020
Gates PJ, Hardie R-A, Raban MZ, et al. How effective are electronic medication systems in reducing
medication error rates and as…
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www.ahrq.gov/practiceimprovement/systemdesign/leancasestudies/lean-exhibit1-19.html
November 01, 2014 - Improving Care Delivery Through Lean: Implementation Case Studies
Exhibit 1.19. Major Factors that Inhibit Lean Success at LHC
Previous Page Next Page
Table of Contents
Improving Care Delivery Through Lean: Implementation Case Studies
Introduction to the Case Studies
Case 1. Lakeview Healthcare …
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psnet.ahrq.gov/node/48019/psn-pdf
June 26, 2019 - Please reconcile, not wait a while.
June 26, 2019
Trivedi A, Sharma S, Ajitsaria R, et al. Please reconcile, not wait a while. Arch Dis Child Educ Pract Ed.
2019;105(2):122-126. doi:10.1136/archdischild-2018-316356.
https://psnet.ahrq.gov/issue/please-reconcile-not-wait-while
Medication reconciliation to ensure ac…
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psnet.ahrq.gov/node/37454/psn-pdf
January 09, 2008 - Quantifying nursing workflow in medication
administration.
January 9, 2008
Keohane CA, Bane AD, Featherstone E, et al. Quantifying nursing workflow in medication administration. J
Nurs Adm. 2007;38(1):19-26. doi:10.1097/01.nna.0000295628.87968.bc.
https://psnet.ahrq.gov/issue/quantifying-nursing-workflow-medicatio…
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www.ahrq.gov/practiceimprovement/systemdesign/leancasestudies/lean-exhibit2-14.html
November 01, 2014 - Improving Care Delivery Through Lean: Implementation Case Studies
Exhibit 2.14. Major Factors that Facilitated Lean Success at Central
Previous Page Next Page
Table of Contents
Improving Care Delivery Through Lean: Implementation Case Studies
Introduction to the Case Studies
Case 1. Lakeview Hea…
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psnet.ahrq.gov/node/852285/psn-pdf
August 09, 2023 - Risk Evaluation and Mitigation Strategy (REMS) Programs
and Medication Safety: Parts I and II.
August 9, 2023
ISMP Medication Safety Alert! Acute care edition. July 13, 2023;(4):1-3;July 27, 2023;(5):1-5.
https://psnet.ahrq.gov/issue/risk-evaluation-and-mitigation-strategy-rems-programs-and-medication-safety-
part…
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psnet.ahrq.gov/node/855421/psn-pdf
November 15, 2023 - Informatics tools in deprescribing and medication
optimization in older adults: development and
dissemination of VIONE methodology in a high reliability
organization.
November 15, 2023
Winter SG, Sedgwick C, Wallace-Lacey A, et al. Informatics tools in deprescribing and medication
optimization in older adults: de…
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psnet.ahrq.gov/node/35802/psn-pdf
January 02, 2017 - Reconciliation failures lead to medication errors.
January 2, 2017
Santell JP. Reconciliation failures lead to medication errors. Jt Comm J Qual Patient Saf. 2006;32(4):225-9.
https://psnet.ahrq.gov/issue/reconciliation-failures-lead-medication-errors
Medication reconciliation represents an active effort of hospita…
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psnet.ahrq.gov/node/35404/psn-pdf
March 11, 2011 - Improving patient safety by identifying side effects from
introducing bar coding in medication administration.
March 11, 2011
Patterson ES, Cook RI, Render ML. Improving patient safety by identifying side effects from introducing bar
coding in medication administration. J Am Med Inform Assoc. 2002;9(5):540-53.
htt…
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digital.ahrq.gov/sitemap
January 01, 2023 - Sitemap
Program Overview
Director's Corner
Strategic Priorities
Research Reports
2023 Year in Review
Executive Summary
Research Spotlight
Research Themes and Findings
DHR Impact and Reach
2022 Year in Review
Executive Summary
Rese…