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www.ahrq.gov/patient-safety/settings/labor-delivery/perinatal-care/modules/teamwork/board-checklist.html
July 01, 2023 - Board Checklist
AHRQ Safety Program for Perinatal Care
Who should use this tool: Senior leaders
Checklist Items
Leader Responsible
Date Initiated
1. Set an organization aim of annually assessing the safety and teamwork climate.
2. Improve the safety and teamwork c…
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psnet.ahrq.gov/node/37787/psn-pdf
May 28, 2008 - Adoption of health information technology for medication
safety in US hospitals, 2006.
May 28, 2008
Furukawa MF, Raghu TS, Spaulding TJ, et al. Adoption of health information technology for medication
safety in U.S. Hospitals, 2006. Health Aff (Millwood). 2008;27(3):865-75. doi:10.1377/hlthaff.27.3.865.
https://ps…
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psnet.ahrq.gov/node/836964/psn-pdf
April 20, 2022 - Occurrence of no-harm incidents and adverse events in
hospitalized patients with ischemic stroke or TIA: a
cohort study using trigger tool methodology.
April 20, 2022
Nowak B, Schwendimann R, Lyrer P, et al. Occurrence of no-harm incidents and adverse events in
hospitalized patients with ischemic stroke or TIA: a …
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www.ahrq.gov/sites/default/files/wysiwyg/policymakers/chipra/factsheets/fullreports/chipra-89-adhd-behavior-section-2-attach-3.pdf
June 02, 2025 - Section 2: Detailed Measure Specifications, Attachment 2: EHR Recommended Data Locations
SNAC Submission Form Measure 2: ADHD Behavior Therapy
Section 2: Detailed Measure Specifications
Attachment 2: EHR Recommended Data Locations
Th…
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psnet.ahrq.gov/node/47787/psn-pdf
February 20, 2019 - How to be a very safe maternity unit: an ethnographic
study.
February 20, 2019
Liberati EG, Tarrant C, Willars J, et al. How to be a very safe maternity unit: An ethnographic study. Soc
Sci Med. 2019;223:64-72. doi:10.1016/j.socscimed.2019.01.035.
https://psnet.ahrq.gov/issue/how-be-very-safe-maternity-unit-ethnog…
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psnet.ahrq.gov/node/36208/psn-pdf
January 05, 2017 - Implementing computerized provider order entry with an
existing clinical information system.
January 5, 2017
Barron WM, Reed L, Forsythe S, et al. Implementing computerized provider order entry with an existing
clinical information system. Jt Comm J Qual Patient Saf. 2006;32(9):506-16.
https://psnet.ahrq.gov/issue…
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psnet.ahrq.gov/node/38877/psn-pdf
April 08, 2011 - Computerized order entry with limited decision support to
prevent prescription errors in a PICU.
April 8, 2011
Kadmon G, Bron-Harlev E, Nahum E, et al. Computerized order entry with limited decision support to
prevent prescription errors in a PICU. Pediatrics. 2009;124(3):935-940. doi:10.1542/peds.2008-2737.
https…
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psnet.ahrq.gov/node/39670/psn-pdf
July 07, 2010 - The Power of Safety: State Reporting Provides Lessons in
Reducing Harm, Improving Care.
July 7, 2010
Washington DC: National Quality Forum; 2010.
https://psnet.ahrq.gov/issue/power-safety-state-reporting-provides-lessons-reducing-harm-improving-care
The landmark Institute of Medicine (IOM) report, To Err Is Human,…
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psnet.ahrq.gov/node/46416/psn-pdf
March 13, 2018 - Opioid prescribing for opioid-naive patients in emergency
departments and other settings: characteristics of
prescriptions and association with long-term use.
March 13, 2018
Jeffery MM, Hooten M, Hess EP, et al. Opioid Prescribing for Opioid-Naive Patients in Emergency
Departments and Other Settings: Characteristi…
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psnet.ahrq.gov/node/849319/psn-pdf
May 24, 2023 - Attitudes of clinicians and patient safety culture before
and after the ARRIVE trial.
May 24, 2023
White VanGompel E, Carlock F, Singh L, et al. Attitudes of clinicians and patient safety culture before and
after the ARRIVE trial. J Obstet Gynecol Neonatal Nurs. 2023;52(3):211-222.
doi:10.1016/j.jogn.2022.12.007.
…
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psnet.ahrq.gov/node/35927/psn-pdf
February 17, 2011 - Claims, errors, and compensation payments in medical
malpractice litigation.
February 17, 2011
Studdert DM, Mello MM, Gawande AA, et al. Claims, errors, and compensation payments in medical
malpractice litigation. N Engl J Med. 2006;354(19):2024-33.
https://psnet.ahrq.gov/issue/claims-errors-and-compensation-payme…
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psnet.ahrq.gov/node/37386/psn-pdf
January 06, 2017 - Medication reconciliation in ambulatory oncology.
January 6, 2017
Weingart SN, Cleary A, Seger AC, et al. Medication reconciliation in ambulatory oncology. Jt Comm J Qual
Patient Saf. 2007;33(12):750-7.
https://psnet.ahrq.gov/issue/medication-reconciliation-ambulatory-oncology
The Joint Commission mandates systems…
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psnet.ahrq.gov/node/44646/psn-pdf
November 11, 2015 - The hidden costs of reconciling surgical sponge counts.
November 11, 2015
Steelman VM, Schaapveld AG, Perkhounkova Y, et al. The Hidden Costs of Reconciling Surgical Sponge
Counts. AORN J. 2015;102(5):498-506. doi:10.1016/j.aorn.2015.09.002.
https://psnet.ahrq.gov/issue/hidden-costs-reconciling-surgical-sponge-coun…
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psnet.ahrq.gov/node/43567/psn-pdf
October 21, 2016 - National Action Plan for Adverse Drug Event Prevention.
October 21, 2016
Washington, DC: Office of Disease Prevention and Health Promotion, United States Department of Health
and Human Services; September 2014.
https://psnet.ahrq.gov/issue/national-action-plan-adverse-drug-event-prevention
This national action pla…
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psnet.ahrq.gov/node/45473/psn-pdf
April 24, 2018 - Navigating a ship with a broken compass: evaluating
standard algorithms to measure patient safety.
April 24, 2018
Hefner JL, Huerta T, McAlearney AS, et al. Navigating a ship with a broken compass: evaluating standard
algorithms to measure patient safety. J Am Med Inform Assoc. 2017;24(2):310-315.
doi:10.1093/jami…
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psnet.ahrq.gov/node/35737/psn-pdf
July 15, 2010 - Shepherding change: how the market, healthcare
providers, and public policy can deliver quality care for
the 21st century.
July 15, 2010
Kennedy P, Pronovost P. Shepherding change: how the market, healthcare providers, and public policy
can deliver quality care for the 21st century. Crit Care Med. 2006;34(3 Suppl)…
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www.uspreventiveservicestaskforce.org/uspstf/update-on-methods-insufficient-evidence---table-5
February 01, 2009 - Update on Methods: Insufficient Evidence - Table 5
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Table 5. Application of the 4 Domains: Lung Cancer Screening Using Computed Tomography (CT)
Domain
Information
…
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digital.ahrq.gov/program-overview
January 01, 2023 - Program Overview
AHRQ’s Digital Healthcare Research (DHR) program’s mission is to determine how the various components of the ever-evolving digital healthcare ecosystem can best come together to positively affect healthcare delivery and create value for patients and their families.
Our …
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www.ahrq.gov/sops/events/webinars/using-sops-tools-090925.html
August 01, 2025 - Patient Safety in Medical Offices: Using SOPS Tools to Drive Improvement
Date: Tuesday, September 9, 2025
Time: 1 to 2 PM ET
Register Description This 1-hour webcast will highlight how the University of Georgia Health Center used AHRQ’s Surveys on Patient Safety Culture® (SOPS®) Medical Office Survey and …
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www.uspreventiveservicestaskforce.org/home/getfilebytoken/dwyoU5ur5oQM69fH8GoaSc
Clinical Summary: Screening for Syphilis Infection in Pregnant Women
Clinical Summary: Screening for Syphilis Infection in Pregnant Women
Population Pregnant women
Recommendation
Screen early for syphilis infection in all pregnant women.
Grade: A
Risk Assessment
All pregnant w omen are at r…