- CEO/Senior Leader Checklist
Who should use this tool? Senior leaders.
Checklist Items
Leader Responsible
Date
Initiated
1. Ensure all current and new employees receive Science of Safety training.
2. Assign a senior executive (Chief Executive Officer or another leader) as an active member of each
psnet.ahrq.gov/node/47603/psn-pdf
March 20, 2019 - Electronic patient identification for sample labeling
reduces wrong blood in tube errors.
March 20, 2019
Kaufman RM, Dinh A, Cohn CS, et al. Electronic patient identification for sample labeling reduces wrong
blood in tube errors. Transfusion (Paris). 2019;59(3):972-980. doi:10.1111/trf.15102.
https://psnet.ahrq.g…
psnet.ahrq.gov/node/43486/psn-pdf
September 01, 2016 - Indication alerts intercept drug name confusion errors
during computerized entry of medication orders.
September 1, 2016
Galanter W, Bryson M, Falck S, et al. Indication alerts intercept drug name confusion errors during
computerized entry of medication orders. PLoS One. 2014;9(7):e101977.
doi:10.1371/journal.pone…
psnet.ahrq.gov/node/38076/psn-pdf
February 15, 2011 - Consequences of inadequate sign-out for patient care.
February 15, 2011
Horwitz LI, Moin T, Krumholz HM, et al. Consequences of inadequate sign-out for patient care. Arch Intern
Med. 2008;168(16):1755-60. doi:10.1001/archinte.168.16.1755.
https://psnet.ahrq.gov/issue/consequences-inadequate-sign-out-patient-care
W…
psnet.ahrq.gov/node/43617/psn-pdf
September 24, 2016 - Do telephone call interruptions have an impact on
radiology resident diagnostic accuracy?
September 24, 2016
Balint BJ, Steenburg SD, Lin H, et al. Do telephone call interruptions have an impact on radiology resident
diagnostic accuracy? Acad Radiol. 2014;21(12):1623-8. doi:10.1016/j.acra.2014.08.001.
https://psne…
psnet.ahrq.gov/node/844790/psn-pdf
January 01, 2020 - Effectiveness of double checking to reduce medication
administration errors: a systematic review.
September 18, 2019
Koyama AK, Maddox C-SS, Li L, et al. Effectiveness of double checking to reduce medication
administration errors: a systematic review. BMJ Qual Saf. 2020;29(7):595-603. doi:10.1136/bmjqs-2019-
00955…
psnet.ahrq.gov/node/43969/psn-pdf
November 17, 2017 - Transparency when things go wrong: physician attitudes
about reporting medical errors to patients, peers, and
institutions.
November 17, 2017
Bell SK, White AA, Yi JC, et al. Transparency When Things Go Wrong. J Patient Saf. 2015;13(4):243-248.
doi:10.1097/pts.0000000000000153.
https://psnet.ahrq.gov/issue/transp…
www.ahrq.gov/patient-safety/settings/long-term-care/resource/injuries/fallspx/fax.html
February 01, 2023 - The Falls Management Program: A Quality Improvement Initiative for Nursing Facilities
Appendix B3: Fax Alert
Previous Page Next Page
Table of Contents
The Falls Management Program: A Quality Improvement Initiative for Nursing Facilities
Chapter 1. Introduction and Program Overview
Chapter 2. Fal…
psnet.ahrq.gov/node/45882/psn-pdf
June 28, 2017 - Early death after discharge from emergency departments:
analysis of national US insurance claims data.
June 28, 2017
Obermeyer Z, Cohn B, Wilson M, et al. Early death after discharge from emergency departments: analysis
of national US insurance claims data. BMJ. 2017;356:j239. doi:10.1136/bmj.j239.
https://psnet.a…
psnet.ahrq.gov/node/46856/psn-pdf
June 20, 2018 - Visual acuity, literacy, and unintentional misuse of
nonprescription medications.
June 20, 2018
Mullen RJ, Curtis LM, O'Conor R, et al. Visual acuity, literacy, and unintentional misuse of nonprescription
medications. Am J Health-Syst Pharm. 2018;75(9):e213-e220. doi:10.2146/ajhp170303.
https://psnet.ahrq.gov/issu…
psnet.ahrq.gov/node/45319/psn-pdf
September 01, 2018 - Special Issue: Progress at the Intersection of Patient
Safety and Medical Liability.
September 1, 2018
Ridgely MS, Greenberg MD, Clancy CM, eds. Health Serv Res. 2016;51(suppl 3):2395-2648.
https://psnet.ahrq.gov/issue/special-issue-progress-intersection-patient-safety-and-medical-liability
Medical liability refor…
psnet.ahrq.gov/node/47916/psn-pdf
May 29, 2019 - Incivility and patient safety: a longitudinal study of
rudeness, protocol compliance, and adverse events.
May 29, 2019
Riskin A, Bamberger P, Erez A, et al. Incivility and Patient Safety: A Longitudinal Study of Rudeness,
Protocol Compliance, and Adverse Events. Jt Comm J Qual Patient Saf. 2019;45(5):358-367.
doi:…
psnet.ahrq.gov/node/46337/psn-pdf
August 30, 2017 - Nurses' response to parents' 'speaking-up' efforts to
ensure their hospitalized child's safety: an attribution
theory perspective.
August 30, 2017
Bsharat S, Drach-Zahavy A. Nurses' response to parents' 'speaking-up' efforts to ensure their hospitalized
child's safety: an attribution theory perspective. J Adv Nurs…
www.ahrq.gov/sites/default/files/wysiwyg/hai/abate/introduction/scientific-rationale.pdf
March 01, 2022 - Although ICUs have the highest incidence rate of HAIs, the vast majority of HAIs, in absolute
numbers … Selective use of intranasal mupirocin and
chlorhexidine bathing and the incidence of methicillin-resistant … Reduction in incidence of nosocomial
methicillin-resistant Staphylococcus aureus (MRSA) infection in … Impact of a prevention strategy targeted
at vascular-access care on incidence of infections acquired
www.ahrq.gov/sites/default/files/2024-01/strom-report.pdf
January 01, 2024 - Muscle toxicity analyses: number of events (events), person-years (p-y), incidence rates per 1000 person … Renal dysfunction analyses: number of events (events), person-years (p-y), incidence rates per 1000 … Hepatic dysfunction analyses: number of events (events), person-years (p-y), incidence rates per 1000 … Incidence of hospitalized rhabdomyolysis in
patients treated with lipid-lowering drugs. JAMA.
effectivehealthcare.ahrq.gov/sites/default/files/product/pdf/ems-911-workforce-protocol.pdf
January 01, 2015 - What are the characteristics, incidence, prevalence, and severity of
occupationally-acquired exposures … How do the incidence, prevalence, and severity of exposures vary by
demographic characteristics (e.g … How do the incidence, prevalence, and severity of exposures vary by
workforce characteristics (e.g., … (Outcomes
of interest include but are not limited to, incidence, prevalence, duration,
severity, missed … (Outcomes of interest include but are not limited to, incidence, prevalence,
duration, severity, missed