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81. MHA Keystone Center for Patient Safety and Quality. | PSNet
    psnet.ahrq.gov/issue/mha-keystone-center-patient-safety-and-quality
    May 01, 2023 - Keystone Center has directed some of the most successful patient safety projects of the past decade, including

82. Safer Hospital Care: Strategies for Continuous Innovation, Second Edition. | PSNet
    psnet.ahrq.gov/issue/safer-hospital-care-strategies-continuous-innovation
    October 05, 2022 - This publication provides various strategies to drive innovation in patient safety, including how to

83. Using Human Factors Engineering and the SEIPS Model to Advance Patient Safety in Care Transitions | PSNet
    psnet.ahrq.gov/perspective/using-human-factors-engineering-and-seips-model-advance-patient-safety-care-transitions
    November 16, 2022 - The data required to create improvements is collected through multiple methods, including observation … With an understanding of how interactions among all work system elements (including people) can go right … Technology now has a prominent role in many aspects of healthcare delivery including admissions, discharge … Pascale Carayon: The decision was made based on including a lot of stakeholders, and we had a lot of … We brought in key stakeholders, including skilled nursing facility practitioners, health IT folks from

84. In Conversation With...Stephen Hines, PhD and Monika Haugstetter, MHA, MSN, RN, CPHQ about TeamSTEPPS 3.0 | PSNet
    psnet.ahrq.gov/perspective/conversation-withstephen-hines-phd-and-monika-haugstetter-mha-msn-rn-cphq-about
    February 28, 2024 - Stephen Hines: I have been involved with TeamSTEPPS since the early 2000s, including the initial TeamSTEPPS … With a need to engage every member of the health care team, including patients and caregivers, it became … Including the patient as a part of the team changes a lot within the curriculum. … The website has resources , including training slides, for people who teach TeamSTEPPS. … There were challenges, including the amount of content to be revised and coordination of revisions across

85. Revising TeamSTEPPS: The Evolution of Patient Safety Teamwork Training | PSNet
    psnet.ahrq.gov/perspective/revising-teamstepps-evolution-patient-safety-teamwork-training
    February 28, 2024 - inception, TeamSTEPPS training has been widely implemented across a variety of healthcare settings, including … AHRQ sought input from several sources to inform the updates, including a technical expert panel composed … With a need to engage every member of the health care team, including patients and caregivers, it became … Including the patient as a part of the team changes a lot within the curriculum. … The website has resources , including training slides, for people who teach TeamSTEPPS.

86. Maternal Safety and Perinatal Mental Health | PSNet
    psnet.ahrq.gov/perspective/maternal-safety-and-perinatal-mental-health
    March 28, 2023 - It is essential to address patient safety challenges across the different healthcare settings, including … Healthcare providers should routinely screen for perinatal mental health problems, including depression … A variety of mental health screening tools is available, including the Edinburgh Postnatal Depression … Could tell us about how the AIM Program aligns with AHRQ’s maternal health initiatives, including the … The bundle is focused on best practices, including transitions of care, screening, and referral.

87. Medication administration in aged care facilities: a mixed-methods systematic review. | PSNet
    psnet.ahrq.gov/issue/medication-administration-aged-care-facilities-mixed-methods-systematic-review
    March 05, 2025 - Five overarching themes were identified, including staffing and resident rights.

88. AHRQ PSNet Annual Webinar: Evidence on Advancing Rapid Response Systems and Opioid Stewardship. | PSNet
    psnet.ahrq.gov/issue/ahrq-psnet-annual-webinar-evidence-advancing-rapid-response-systems-and-opioid-stewardship
    December 10, 2024 - Making Healthcare Safer IV: Opioid Stewardship explores the use of prescribed and ordered opioids, including

89. The problem with incident reporting. | PSNet
    psnet.ahrq.gov/issue/problem-incident-reporting
    February 28, 2024 - health care incident reporting systems that limit their ability to contribute to improvements, including

90. Effects of work shift or shift length on radiation safety perception. | PSNet
    psnet.ahrq.gov/issue/effects-work-shift-or-shift-length-radiation-safety-perception
    August 23, 2023 - Fostering a culture of safety is a key objective across all clinical areas, including radiology .

91. Psn-Pdf (pdf file)
    psnet.ahrq.gov/node/847934/psn-pdf
    April 26, 2023 - inform healthcare providers in efforts to develop systems and processes to prevent harm to patients, including … Outcome measures of patient safety, including hospital acquired infections, hospital acquired conditions … College of Surgeons provides risk-adjusted surgical outcome measures for participating hospitals, including … hospitals “that could have been potentially prevented by implementing evidence-informed practice,” including … reporting, the Organization for Economic Cooperation and Development has adapted 6 of AHRQ’s PSIs, including

92. Health Literacy Toolkit. | PSNet
    psnet.ahrq.gov/issue/health-literacy-toolkit
    February 22, 2023 - This toolkit provides resources related to health literacy including a business case for interventions

93. Quality Special Issue. | PSNet
    psnet.ahrq.gov/issue/quality-special-issue
    April 13, 2022 - This special issue explores themes related to radiology and radiation oncology, including monitoring

94. Government Response to the Investigation into the Death of Elizabeth Dixon. | PSNet
    psnet.ahrq.gov/issue/government-response-investigation-death-elizabeth-dixon
    February 19, 2020 - This report sets out the government’s response to each recommendation, including the agency responsible

95. Be an Active Member of Your Health Care Team. | PSNet
    psnet.ahrq.gov/issue/be-active-member-your-health-care-team
    April 08, 2020 - This fact sheet describes five ways patients can contribute to and ensure safe medication use, including

96. Patient safety and quality improvement. | PSNet
    psnet.ahrq.gov/issue/patient-safety-and-quality-improvement
    December 21, 2022 - support the implementation of portions of the Patient Safety and Quality Improvement Act of 2005  including

97. Periodic Issue | PSNet
    psnet.ahrq.gov/periodic-issue/periodic-issue-471
    December 31, 2024 - PSNet highlights the latest patient safety literature, news, and expert commentary, including … Making Healthcare Safer IV: Opioid Stewardship explores the use of prescribed and ordered opioids, including … This call for public comment seeks to understand the impacts of ageism on healthcare quality, including … Despite treatment including heparin, amiodarone, and metoprolol for atrial fibrillation, and interventions … PSNet highlights the latest patient safety literature, news, and expert commentary, including Weekly

98. Continuing Education | PSNet
    psnet.ahrq.gov/continuing-education
    February 26, 2025 - was initially stable upon arrival, though with signs of fluid overload and electrolyte abnormalities including … Despite treatment including heparin, amiodarone, and metoprolol for atrial fibrillation, and interventions … Copy URL A 38-year-old man sustained multiple injuries in a motorcycle crash, including … Three weeks later, he presented with ongoing symptoms including worsening cognition and increased headache … was discharged with antibiotic prescriptions, but returned three days later with worsening symptoms, including

99. Breakage of a PICC Line | PSNet
    psnet.ahrq.gov/web-mm/breakage-picc-line
    June 21, 2023 - A chest roentgenogram, including a view of the arm with the insertion site, should be performed initially … ) Take-Home Points For a variety of reasons, use of PICCs has become increasingly prevalent, including … catheters.( 5 ) Use strict aseptic precautions for insertion and maintenance of the catheter, including

100. A Stable Airway? Fatal Airway Occlusion After Inadequate Post-Tracheostomy Care | PSNet
     psnet.ahrq.gov/web-mm/stable-airway-fatal-airway-occlusion-after-inadequate-post-tracheostomy-care
     June 28, 2023 - This commentary will discuss tracheostomy function, proper care, risks and complications, including how … adequate body temperature and minute ventilation. 3 HMEs have additional limitations, including added … the patients with tracheostomies who may be at increased risk for greater morbidity and mortality, including … during transitions of care between ICU and lower levels of care, and especially between institutions including … for tracheostomies should be trained in the emergency management of patients with tracheostomies, including