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  1. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/35907/psn-pdf
    October 03, 2017 - Transparent and open discussion of errors does not increase malpractice risk in trauma patients. October 3, 2017 Stewart RM, Corneille MG, Johnston J, et al. Transparent and open discussion of errors does not increase malpractice risk in trauma patients. Ann Surg. 2006;243(5):645-9; discussion 649-51. https://psne…

  2. Understanding SOPS Surveys: A Primer for New Users - Brady (pdf file)

    www.ahrq.gov/sites/default/files/wysiwyg/sops/events/webinar/sops101-2-brady-2018.pdf
    January 01, 2018 - Understanding SOPS Surveys: A Primer for New Users - Brady 6 Overview of AHRQ’s Patient Safety Priorities and Programs Jeff Brady, MD, MPH Director, Center for Quality Improvement and Patient Safety, Agency for Healthcare Research and Quality (AHRQ) Rear Admiral, Assistant Surgeon General, U.S. Public Health Ser…

  3. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/37655/psn-pdf
    September 24, 2010 - Reducing anticoagulant medication adverse events and avoidable patient harm. September 24, 2010 Jennings HR, Miller EC, Williams TS, et al. Reducing anticoagulant medication adverse vents and avoidable patient harm. Jt Comm J Qual Patient Saf. 2008;34(4):196-200. https://psnet.ahrq.gov/issue/reducing-anticoagulant…

  4. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/42419/psn-pdf
    July 17, 2013 - Health IT Patient Safety Action and Surveillance Plan. July 17, 2013 Washington, DC: Office of the National Coordinator for Health Information Technology; July 2, 2013. https://psnet.ahrq.gov/issue/health-it-patient-safety-action-and-surveillance-plan This report from the Department of Health and Human Services (HH…

  5. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/44127/psn-pdf
    September 28, 2017 - Overkill: An avalanche of unnecessary medical care is harming patients physically and financially. What can we do about it? September 28, 2017 Gawande A. The New Yorker. May 2015 https://psnet.ahrq.gov/issue/overkill-avalanche-unnecessary-medical-care-harming-patients-physically-and- financially-what The overuse…

  6. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/37849/psn-pdf
    March 23, 2011 - The incidence and nature of in-hospital adverse events: a systematic review. March 23, 2011 de Vries EN, Ramrattan MA, Smorenburg SM, et al. The incidence and nature of in-hospital adverse events: a systematic review. Qual Saf Health Care. 2008;17(3):216-223. doi:10.1136/qshc.2007.023622. https://psnet.ahrq.gov/is…

  7. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/37091/psn-pdf
    March 02, 2016 - The tension between needing to improve care and knowing how to do it. March 2, 2016 Auerbach AD, Landefeld S, Shojania KG. The tension between needing to improve care and knowing how to do it. N Engl J Med. 2007;357(6):608-13. https://psnet.ahrq.gov/issue/tension-between-needing-improve-care-and-knowing-how-do-it …

  8. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/34087/psn-pdf
    June 16, 2011 - Evaluation of the culture of safety: survey of clinicians and managers in an academic medical center. June 16, 2011 Pronovost PJ, Weast B, Holzmueller CG, et al. Evaluation of the culture of safety: survey of clinicians and managers in an academic medical center. Qual Saf Health Care. 2003;12(6):405-10. https://ps…

  9. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/36455/psn-pdf
    December 22, 2010 - Changing the work environment in ICUs to achieve patient-focused care: the time has come. December 22, 2010 McCauley K, Irwin RS. Changing the work environment in ICUs to achieve patient-focused care: the time has come. Chest. 2006;130(5):1571-8. https://psnet.ahrq.gov/issue/changing-work-environment-icus-achieve-…

  10. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/866078/psn-pdf
    June 05, 2024 - Second victim experiences of health care learners and the influence of the training environment on postevent adaptation. June 5, 2024 Huang L, Riggan KA, Torbenson VE, et al. Second victim experiences of health care learners and the influence of the training environment on postevent adaptation. Mayo Clin Proc Inno…

  11. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/836824/psn-pdf
    March 30, 2022 - Collaborative case review: a systems-based approach to patient safety event investigation and analysis. March 30, 2022 Lacson R, Khorasani R, Fiumara K, et al. Collaborative case review: a systems-based approach to patient safety event investigation and analysis. J Patient Saf. 2022;18(2):e522-e527. doi:10.1097/pt…

  12. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/45651/psn-pdf
    November 16, 2016 - Improving patient safety through the involvement of patients: development and evaluation of novel interventions to engage patients in preventing patient safety incidents and protecting them against unintended harm. November 16, 2016 Wright J, Lawton R, O’Hara J, et al. Improving Patient Safety Through The Involve…

  13. Standards for Guideline Development | United States Preventive Services Taskforce

    www.uspreventiveservicestaskforce.org/uspstf/about-uspstf/methods-and-processes/standards-guideline-development
    June 01, 2018 - Standards for Guideline Development Share to Facebook Share to X Share to WhatsApp Share to Email Print The U.S. Preventive Services Task Force (Task Force) is committed to making its recommendation development process as clear and transparen…

  14. NAC Member Biography: Sinsi Hernández-Cancio | Agency for Healthcare Research and Quality

    www.ahrq.gov/cpi/about/organization/nac/hernandez-cancio.html
    February 01, 2025 - NAC Member Biography: Sinsi Hernández-Cancio Sinsi Hernández-Cancio, J.D.  Vice President for Health Justice  National Partnership for Women & Families Sinsi Hernández-Cancio, J.D. , is vice president for health justice, at the National Partnership for Women & Families. She is a national health and healthcare…

  15. NAC Member Biography: Michael L. Millenson | Agency for Healthcare Research and Quality

    www.ahrq.gov/cpi/about/organization/nac/millenson.html
    February 01, 2025 - NAC Member Biography: Michael L. Millenson Michael L. Millenson President Health Quality Advisors, LLC Michael L. Millenson , is president of Health Quality Advisors, LLC, and an internationally recognized expert on making healthcare better, safer, and more patient-centered. The author of the critically acclaim…

  16. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/35623/psn-pdf
    August 05, 2009 - Changing and sustaining medical students' knowledge, skills, and attitudes about patient safety and medical fallibility. August 5, 2009 Madigosky WS, Headrick LA, Nelson K, et al. Changing and sustaining medical students' knowledge, skills, and attitudes about patient safety and medical fallibility. Acad Med. 2006…

  17. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/35032/psn-pdf
    February 03, 2011 - Five years after 'To Err is Human': what have we learned? February 3, 2011 Leape L, Berwick DM. Five years after To Err Is Human: what have we learned? JAMA. 2005;293(19):2384-90. https://psnet.ahrq.gov/issue/five-years-after-err-human-what-have-we-learned Two of the leaders in the patient safety movement, Lucian …

  18. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/44321/psn-pdf
    July 08, 2015 - Move toward full use of metric dosing: eliminate dosage cups that measure liquids in fluid drams. Use cups that measure mL. July 8, 2015 National Alert Network. Horsham, PA: Institute for Safe Medication Practices; Bethesda, MD: American Society of Health-System Pharmacists. June 30, 2015. https://psnet.ahrq.gov/…

  19. 5 Tk2 P2T1-Sample Letter Of Agreement Phase 2 (doc file)

    www.ahrq.gov/sites/default/files/wysiwyg/nhguide/5_TK2_P2T1-Sample_Letter_of_Agreement_Phase_2.doc
    May 01, 2014 - Comprehensive Antibiogram Toolkit: Phase 2 Sample Letter of Agreement Date Name Address of Laboratory RE: Developing an Antibiogram for [NURSING HOME NAME] Dear [insert name]: For several years, antibiogram reports have been used in hospitals to address the issue of appropriate antibiotic use; nursing homes are …

  20. 5 Tk2 P3T1-Sample Policy Phase 3 (pdf file)

    www.ahrq.gov/sites/default/files/wysiwyg/nhguide/5_TK2_P3T1-Sample_Policy_Phase_3.pdf
    May 01, 2014 - Sample Vignettes Advancing Excellence in Health Care www.ahrq.gov Agency for Healthcare Research and Quality HAIs Healthcare- Associated Infections PREVENT Comprehensive Antibiogram Toolkit: Phase 3 Sample Policy [NAME OF NURSING HOME] RE: Antibiogram Program [DATE] Antibiotics are among the most commonly…
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