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psnet.ahrq.gov/node/47053/psn-pdf
May 23, 2018 - TeamSTEPPS Canada.
May 23, 2018
Canadian Patient Safety Institute.
https://psnet.ahrq.gov/issue/teamstepps-canada
The TeamSTEPPS program was developed to support effective communication and teamwork skills in
various health care settings. This site supports the Canadian TeamSTEPPS initiative. The program will
pre…
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psnet.ahrq.gov/node/35382/psn-pdf
October 05, 2005 - Rx for a better prescription. Hospital bans doctors from
using confusing medical abbreviations.
October 5, 2005
Hall J. Fredericksburg Times. September 25, 2005
https://psnet.ahrq.gov/issue/rx-better-prescription-hospital-bans-doctors-using-confusing-medical-
abbreviations
This article presents one hospital’s pro…
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psnet.ahrq.gov/node/37238/psn-pdf
September 04, 2018 - Guide for Developing a Community-Based Patient Safety
Advisory Council.
September 4, 2018
Leonhardt, K, Bonin D, Pagel P. Rockville, MD: Agency for Healthcare Research and Quality; April 2008.
AHRQ Publication No. 08-0048
https://psnet.ahrq.gov/issue/guide-developing-community-based-patient-safety-advisory-council…
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psnet.ahrq.gov/node/37428/psn-pdf
March 28, 2012 - A team training program using human factors to enhance
patient safety.
March 28, 2012
Marshall DA, Manus DA. A Team Training Program Using Human Factors to Enhance Patient Safety.
AORN J. 2007;86(6). doi:10.1016/j.aorn.2007.11.026.
https://psnet.ahrq.gov/issue/team-training-program-using-human-factors-enhance-pati…
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psnet.ahrq.gov/node/42332/psn-pdf
June 12, 2013 - Quality improvement through implementation of
discharge order reconciliation.
June 12, 2013
Lu Y, Clifford P, Bjorneby A, et al. Quality improvement through implementation of discharge order
reconciliation. Am J Health Syst Pharm. 2013;70(9):815-20. doi:10.2146/ajhp120050.
https://psnet.ahrq.gov/issue/quality-impr…
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psnet.ahrq.gov/node/42493/psn-pdf
August 14, 2013 - Partnering to prevent falls: using a multimodal
multidisciplinary team.
August 14, 2013
Volz TM, Swaim J. Partnering to prevent falls: using a multimodal multidisciplinary team. J Nurs Adm.
2013;43(6):336-41. doi:10.1097/NNA.0b013e3182942c5a.
https://psnet.ahrq.gov/issue/partnering-prevent-falls-using-multimodal-m…
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psnet.ahrq.gov/web-mm/when-meds-dont-reach-bed
May 16, 2022 - These types of “intervention bundles” that combine M2B programs with existing initiatives to improve
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digital.ahrq.gov/sites/default/files/docs/citation/ahrq_cedar_outreach_report_final.pdf
September 01, 2023 - In this way, the CEDAR UI could be used to identify and support
initiatives that potentially enhance … , research award grantees) or external
(e.g., user-group representatives named by Congress in PCOR initiatives … A streamlined plan incorporates three components: 1) clear goals, 2) key initiatives and
responsibilities
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effectivehealthcare.ahrq.gov/sites/default/files/related_files/ahrq-healthcare-horizon-scan-protocol-operations-manual-151001.pdf
September 01, 2015 - diagnostic intervention is within the areas of interest that AHRQ is not addressing
through other agency initiatives … (Rationale: AHRQ has other
initiatives examining LDTs and thus LDTs are outside the scope of the Healthcare
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effectivehealthcare.ahrq.gov/sites/default/files/ahrq-healthcare-horizon-scan-protocol-operations-manual-151001.pdf
September 01, 2015 - diagnostic intervention is within the areas of interest that AHRQ is not addressing
through other agency initiatives … (Rationale: AHRQ has other
initiatives examining LDTs and thus LDTs are outside the scope of the Healthcare
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www.ahrq.gov/evidencenow/projects/heart-health/research-results/research/implementation-faq.html
March 01, 2021 - EvidenceNOW: popHealth Implementation FAQ
Northwestern University Cooperative
Resource: EvidenceNOW: popHealth Implementation FAQ, Healthy Hearts in the Heartland (Word, 29 KB, 5 pages)
This FAQ was provided to an EvidenceNOW Cooperative's participating practice that were considering enrolling in popHealth…
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www.ahrq.gov/ncepcr/tools/transform-qi/facilitation/heart-health-toolkit.html
April 01, 2021 - Primary Care Quality Improvement (QI) Toolkit for Heart Health
Resource: Implementing Heart Health Practice Self-Assessment
This toolkit is for facilitators to help primary care practices implement the ABCS of heart health and create a supportive practice environment for quality improvement. It contains 1…
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psnet.ahrq.gov/node/39076/psn-pdf
March 26, 2014 - Still hard to share. PSOs making progress but still face
tech hurdles.
March 26, 2014
DerGurahian J. Still hard to share. PSOs making progress but still face tech hurdles. Modern healthcare.
2009;39(41):30, 32.
https://psnet.ahrq.gov/issue/still-hard-share-psos-making-progress-still-face-tech-hurdles
This article…
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psnet.ahrq.gov/node/40850/psn-pdf
October 19, 2011 - Reporting of hazards and near-misses in the ambulatory
care setting.
October 19, 2011
Schnall R, Bakken S. Reporting of hazards and near-misses in the ambulatory care setting. J Nurs Care
Qual. 2011;26(4):328-334. doi:10.1097/NCQ.0b013e3182109204.
https://psnet.ahrq.gov/issue/reporting-hazards-and-near-misses-ambu…
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psnet.ahrq.gov/node/837708/psn-pdf
July 20, 2022 - Without question.
July 20, 2022
Liebowitz J. Without Question. N Engl J Med. 2022;386(26):2456-2457. doi:10.1056/nejmp2204361.
https://psnet.ahrq.gov/issue/without-question
Diagnostic errors caused by premature closure and anchoring bias occur when clinicians rely on initial
diagnosis despite receiving subsequent …
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psnet.ahrq.gov/node/38264/psn-pdf
January 02, 2017 - Using an advanced practice nursing model for a rapid
response team.
January 2, 2017
Benson L, Mitchell C, Link M, et al. Using an advanced practice nursing model for a rapid response team.
Jt Comm J Qual Patient Saf. 2008;34(12):743-7.
https://psnet.ahrq.gov/issue/using-advanced-practice-nursing-model-rapid-respon…
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psnet.ahrq.gov/node/841489/psn-pdf
December 14, 2022 - Rise to Health Coalition.
December 14, 2022
Boston, MA; Institute for Healthcare Improvement: December 2022.
https://psnet.ahrq.gov/issue/rise-health-coalition
Systemic efforts to improve health equity support patient safety. This announcement highlights an initiative
for collective work to address four areas of e…
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psnet.ahrq.gov/node/39982/psn-pdf
January 17, 2012 - Hand-off Communications.
January 17, 2012
DeRosier JM, Stalhandske E, Bagian JP, et al. Using health care Failure Mode and Effect Analysis: the VA
National Center for Patient Safety's prospective risk analysis system.
https://psnet.ahrq.gov/issue/hand-communications
The Joint Commission Center for Transforming Hea…
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psnet.ahrq.gov/node/35587/psn-pdf
May 12, 2009 - Canadian Patient Safety Institute announces recipients of
first research funding competition.
May 12, 2009
Canadian Patient Safety Institute; CPSI.
https://psnet.ahrq.gov/issue/canadian-patient-safety-institute-announces-recipients-first-research-funding-
competition
This news release announces the selection of 2…
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psnet.ahrq.gov/node/40153/psn-pdf
November 26, 2014 - The effect of workload reduction on the quality of
residents' discharge summaries.
November 26, 2014
Coit MH, Katz JT, McMahon GT. The effect of workload reduction on the quality of residents' discharge
summaries. J Gen Intern Med. 2011;26(1):28-32. doi:10.1007/s11606-010-1465-z.
https://psnet.ahrq.gov/issue/effec…