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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol1/Advances-Kline_32.pdf
March 03, 2008 - Specific institutional case studies—a 58-year-old woman and a 72-year-old man who fell and
sustained
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effectivehealthcare.ahrq.gov/sites/default/files/pdf/methods-balancing-harms-benefits_research.pdf
February 01, 2014 - Protocol for Quantitative Assessment of Benefit and Harm analysis of Aspirin for primary prevention
Methods Research Report
Evaluation of the Benefits and Harms of Aspirin for
Primary Prevention of Cardiovascular Events: A
Comparison of Quantitative Approaches
…
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psnet.ahrq.gov/node/35379/psn-pdf
June 15, 2011 - Report 6: Managing Risk and Minimising Mistakes in
Services to Children and Families.
June 15, 2011
Bostock L, Bairstow S, Fish S, et al. London, UK: Social Care Institute for Excellence; September 2005.
https://psnet.ahrq.gov/issue/report-6-managing-risk-and-minimising-mistakes-services-children-and-families
This…
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psnet.ahrq.gov/node/38248/psn-pdf
December 27, 2008 - AHRQ presses on: no rule yet, but agency taps 10 safety
organizations.
December 27, 2008
DerGurahian J. AHRQ presses on. No rule yet, but agency taps 10 safety organizations. Modern
healthcare. 2008;38(45):8-9.
https://psnet.ahrq.gov/issue/ahrq-presses-no-rule-yet-agency-taps-10-safety-organizations
This article …
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psnet.ahrq.gov/node/38518/psn-pdf
October 27, 2015 - Hospital Report Card: Ontario 2009.
October 27, 2015
Esmail N, Hazel M. Studies in Health Care Policy. Fraser Institute. Calgary, Alberta, Canada; March 2009.
ISSN: 1918-2082.
https://psnet.ahrq.gov/issue/hospital-report-card-ontario-2009
Designed to help patients choose hospitals, this report utilized AHRQ qualit…
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www.ahrq.gov/nursing-home/resources/crisis-staff.html
February 01, 2021 - Advance Care Planning During a Crisis: Key Information for Nursing Facility Staff
Resource: Advance Care Planning During a Crisis: Key Information for Nursing Facility Staff
This educational webinar provides information about advance care planning during the COVID-19 pandemic for nursing facility staff. Thi…
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psnet.ahrq.gov/node/37806/psn-pdf
July 14, 2010 - Impact of patient safety mandates on medical education
in the United States.
July 14, 2010
Kane JM, Brannen ML, Kern E. Impact of Patient Safety Mandates on Medical Education in the United
States. J Patient Saf. 2008;4(2):93-97. doi:10.1097/pts.0b013e318173f7b5.
https://psnet.ahrq.gov/issue/impact-patient-safety-m…
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psnet.ahrq.gov/node/39191/psn-pdf
February 08, 2011 - Leadership in Healthcare Organizations: A Guide to Joint
Commission Leadership Standards.
February 8, 2011
Schyve PM. San Diego, CA: Governance Institute; 2009.
https://psnet.ahrq.gov/issue/leadership-healthcare-organizations-guide-joint-commission-leadership-
standards
This white paper provides comprehensive inf…
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/cauti-tools/impl-guide/implementation-guide-appendix-d.pdf
June 02, 2025 - Appendix D. Poster on Indications for Urinary Catheters
AHRQ Safety Program for Reducing CAUTI in Hospitals
Appendix D. Poster on Indications for Urinary Catheters
In lower right, use Adobe Acrobat Pro to insert contact information for your institution.
Does your patient
really nee…
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psnet.ahrq.gov/node/40696/psn-pdf
December 01, 2011 - Rapid response systems: a prospective study of
response times.
December 1, 2011
Adelstein B-A, Piza MA, Nayyar V, et al. Rapid response systems: a prospective study of response times. J
Crit Care. 2011;26(6):635.e11-8. doi:10.1016/j.jcrc.2011.03.013.
https://psnet.ahrq.gov/issue/rapid-response-systems-prospective-…
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psnet.ahrq.gov/node/47977/psn-pdf
August 14, 2019 - Reducing Diagnostic Error: Measurement Considerations.
August 14, 2019
National Quality Forum
https://psnet.ahrq.gov/issue/reducing-diagnostic-error-measurement-considerations
This website tracks the progress of a project focused on the development and review of measures to
enhance viability, reporting, accountabi…
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psnet.ahrq.gov/node/39969/psn-pdf
October 27, 2010 - The Preventable Harm Index: an effective motivator to
facilitate the drive to zero.
October 27, 2010
Brilli RJ, McClead RE, Davis T, et al. The Preventable Harm Index: an effective motivator to facilitate the
drive to zero. J Pediatr. 2010;157(4):681-3. doi:10.1016/j.jpeds.2010.05.046.
https://psnet.ahrq.gov/issue…
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psnet.ahrq.gov/node/37450/psn-pdf
June 13, 2011 - Technical patient safety solutions for medicines
reconciliation on admission of adults to hospital.
June 13, 2011
Manchester, UK: National Institute for Health and Clinical Excellence; 2015.
https://psnet.ahrq.gov/issue/technical-patient-safety-solutions-medicines-reconciliation-admission-adults-
hospital
This gu…
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psnet.ahrq.gov/node/34718/psn-pdf
August 05, 2008 - How can we save the next victim?
August 5, 2008
Belkin L
https://psnet.ahrq.gov/issue/how-can-we-save-next-victim
In this article, Belkin examines how the medical field has recently shifted away from blaming individuals for
medical error toward a model that searches for systems problems and solutions for preventio…
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psnet.ahrq.gov/node/36883/psn-pdf
August 31, 2011 - Voluntary review of quality of care peer review for patient
safety.
August 31, 2011
Stumpf PG. Voluntary review of quality of care peer review for patient safety. Best Pract Res Clin Obstet
Gynaecol. 2007;21(4):557-64.
https://psnet.ahrq.gov/issue/voluntary-review-quality-care-peer-review-patient-safety
The autho…
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digital.ahrq.gov/ahrq-funded-projects/quantifying-efficiencies-gained-through-shareable-clinical-decision-support/final-report
January 01, 2023 - Quantifying Efficiencies Gained Through Shareable Clinical Decision Support Resources - Final Report
Citation
MedStar Health Research Institute. Quantifying Efficiencies Gained Through Shareable Clinical Decision Support Resources - Final Report. (Prepared under Contract 233-20-1500022I.) AHRQ Publica…
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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/37247/psn-pdf
December 15, 2011 - Perinatal clinical decision support system: a
documentation tool for patient safety.
December 15, 2011
Provost C, Gray M. Perinatal clinical decision support system: a documentation tool for patient safety. Nurs
Womens Health. 2007;11(4):407-10.
https://psnet.ahrq.gov/issue/perinatal-clinical-decision-support-syst…
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www.ahrq.gov/evidencenow/heart-health/smoking/uspstf-rec.html
August 01, 2018 - USPSTF Recommendation: Tobacco Smoking Cessation in Adults
Resource title: Behavioral Counseling and Pharmacotherapy Interventions for Tobacco Cessation in Adults: A Review of Reviews for the U.S. Preventive Services Task Force
Resource description: This comprehensive report synthesizes evidence on the use…
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www.ahrq.gov/sites/default/files/2024-01/bates-report.pdf
January 01, 2024 - errors in warfarin use in nursing home patients.
6) Development and validation of a tool to assess institutional … Safe medication practice depends on institutional (systems) factors, such as
standardization of medication