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3181. Meeting Minutes, July 2017 | Agency for Healthcare Research and Quality
      www.ahrq.gov/news/events/nac/2017-07-nac/nacmtg0717-minutes.html
      November 01, 2017 - Meeting Minutes, July 2017 National Advisory Council Minutes from the July 26, 2017, meeting of the Agency for Healthcare Research and Quality's National Advisory Council. Contents Summary Call to Order and Approval of November 2, 2016, Summary Report Director's Update Update on Learning Health Care…

3182. 105-What-Are-The-4-Es-Notes (doc file)
      www.ahrq.gov/sites/default/files/wysiwyg/hai/tools/mrsa-surgery/105-what-are-the-4-es-notes.docx
      April 01, 2025 - AHRQ Safety Program for MRSA Prevention: Targeting SSI What Are the 4 Es? Surgical Services For: Cardiac, Hip and Knee Joint Replacement, and Spinal Fusion Surgeries Slide Title and Commentary Slide Number and Slide What Are the 4 Es? SAY: This presentation reviews the 4 Es, a framework to guide the implementation…

3183. Improving the Value of Patient Safety Reporting Systems (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol1/Advances-Pronovost_95.pdf
      June 12, 2008 - Improving the Value of Patient Safety Reporting Systems Improving the Value of Patient Safety Reporting Systems Peter J. Pronovost, MD, PhD; Laura L. Morlock, PhD; J. Bryan Sexton, PhD; Marlene R. Miller, MD, MSc; Christine G. Holzmueller, BLA; David A. Thompson, DNSc, MS; Lisa H. Lubomski, PhD; Albert W. Wu, M…

3184. Technology for Improving Medication Monitoring in Nursing Homes (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol4/Lapane.pdf
      March 09, 2005 - Technology for Improving Medication Monitoring in Nursing Homes 401 Technology for Improving Medication Monitoring in Nursing Homes Kate L. Lapane, Kathleen Cameron, Janice Feinberg Abstract A 1997 report entitled Prescription Drug Use in Nursing Homes, by the Department of Health and Human Services’ Office…

3185. The Incident Decision Tree: Guidelines for Action Following Patient Safety Incidents (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol4/Meadows.pdf
      December 01, 2003 - The Incident Decision Tree: Guidelines for Action Following Patient Safety Incidents 387 The Incident Decision Tree: Guidelines for Action Following Patient Safety Incidents Sandra Meadows, Karen Baker, Jeremy Butler Abstract The National Patient Safety Agency has developed the Incident Decision Tree to hel…

3186. Systems-Based Practice: Improving the Safety and Quality of Patient Care by Recognizing and Improving the Systems in Which We Work (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol2/Advances-Johnson_90.pdf
      June 10, 2008 - Systems-Based Practice: Improving the Safety and Quality of Patient Care by Recognizing and Improving the Systems in Which We Work Systems-Based Practice: Improving the Safety and Quality of Patient Care by Recognizing and Improving the Systems in Which We Work Julie K. Johnson, MSPH, PhD; Stephen H. Miller, M…

3187. AHRQ’s Safety Program for Nursing Homes: On-Time Preventable Hospital and Emergency Department Visits Training | Agency for Healthcare Research and Quality
      www.ahrq.gov/patient-safety/settings/long-term-care/resource/ontime/prevhosp/ereportguide.html
      September 01, 2017 - AHRQ’s Safety Program for Nursing Homes: On-Time Preventable Hospital and Emergency Department Visits Training Facilitator Training Instructor Guide Slide 1: Introduction to Preventable Hospital and ED Visits Reports Say: In this session we will introduce you to the Preventable Hospital and ED Visits el…

3188. Final progress Report: Improving Over-the-Counter Medication Safety for Older Adults (pdf file)
      www.ahrq.gov/sites/default/files/2024-03/chui-report.pdf
      January 01, 2024 - Final progress Report: Improving Over-the-Counter Medication Safety for Older Adults Improving Over-the-Counter Medication Safety for Older Adults Project Dates: 04/01/2016 – 01/31/2020 R18HS024490 Institution: University of Wisconsin - Madison PI: Michelle Chui Team Members: Pascale Carayon, Roger Brown, Nora Jac…

3189. Transitioning Newborns from NICU to Home: Family Information Packet, Appendix B (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/nicu_toolkit/nicupacket-apb.pdf
      June 02, 2025 - Transitioning Newborns from NICU to Home: Family Information Packet, Appendix B Appendix B: Clinical Materials to Share With Primary Care Providers Diagnoses and Conditions ■ Anemia of Prematurity ■ Apnea of Prematurity ■ Bronchopulmonary Dysplasia ■ Gastroesophageal Reflux ■ Nephrocalcinosis ■ Patent D…

3190. Introducing a Protocol To Obtain Patient Comments Using the CAHPS® Clinician & Group Survey (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/cahps/news-and-events/events/webinars/cahps-webinar-jan-2017-transcript.pdf
      January 01, 2017 - Introducing a Protocol To Obtain Patient Comments Using the CAHPS® Clinician & Group Survey Introducing a Protocol To Obtain Patient Comments Using the CAHPS® Clinician & Group Survey January 2017  Webcast Speakers Mark Schlesinger, PhD, Professor of Health Policy, Yale School of Public Health Lise Rybo…

3191. Primary Care Practice Facilitation Curriculum Module 2: Practice Facilitation as a Resource for Practice Improvement (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/ncepcr/tools/PCMH/pcpf-module-2-pf-as-a-resource.pdf
      September 01, 2015 - Primary Care Practice Facilitation Curriculum Module 2: Practice Facilitation as a Resource for Practice Improvement Primary Care Practice Facilitation Curriculum Module 2: Practice Facilitation as a Resource for Practice Improvement Agency for Healthcare Research and Quality Advancing Excellence in Healt…

3192. Seamless Care: Safe Patient Transitions from Hospital to Home (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol1/Spehar.pdf
      April 18, 2004 - Seamless Care: Safe Patient Transitions from Hospital to Home 79 Seamless Care: Safe Patient Transitions from Hospital to Home Andrea M. Spehar, Robert R. Campbell, Carron Cherrie, Polly Palacios, Donna Scott, Jacquelyn L. Baker, Brad Bjornstad, Jay Wolfson Abstract Background: “Seamless care” is a smooth a…

3193. Diagnostic error in mental health: a review (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/topics/dx-safety-mental-health-bmjqs.pdf
      April 15, 2024 - Diagnostic error in mental health: a review Diagnostic error in mental health: a review Andrea Bradford , 1,2 Ashley N D Meyer , 1,2 Sundas Khan,2 Traber D Giardina , 1,2 Hardeep Singh 1,2 Bradford A, et al. BMJ Qual Saf 2024;0:1–10. doi:10.1136/bmjqs-2023-016996 1 REVIEW 1Department of Medicine, Baylor…

3194. Final Progress Report: Patient-Centric Risk Model for Medication Safety During Care Transitions (pdf file)
      www.ahrq.gov/sites/default/files/2024-02/gurses-report.pdf
      January 01, 2024 - medications with nonsustainable cost, especially with large price differences among choices, was the leading

3195. On-Time Pressure Ulcer Prevention: Facilitator Training Instructor Guide - Electronic Reports (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/long-term-care/resources/ontime/pruprev/erepguide.pdf
      March 22, 2014 - may want to access trended information to gain insight into the status of a resident in the 4 weeks leading

3196. Final Progress Report: Engaging Families in Bedside Rounds To Promote Pediatric Patient Safety (pdf file)
      www.ahrq.gov/sites/default/files/2024-07/cox-carayon-report.pdf
      January 01, 2024 - exam findings, minimizing distractions and interruptions, attending and/or senior resident physicians leading

3197. Nutritional Research Series, Volume 2 (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/research/findings/evidence-based-reports/nutrtp2.pdf
      March 01, 2009 - By leading a workgroup through the systematic review process to formulate questions that a nutrient

3198. Final Progress Report: Engineering Safe Care Journeys for Vulnerable Older Adults (pdf file)
      www.ahrq.gov/sites/default/files/2025-03/smith-werner-carayon-report.pdf
      January 01, 2025 - Final Progress Report: Engineering Safe Care Journeys for Vulnerable Older Adults AHRQ Grant Final Progress Report Grant Award Number: R18 HS026624 Project Title: Engineering Safe Care Journeys for Vulnerable Older Adults Grantee Organization: University of Wisconsin – Madison Project Period: September 30, 2018 –…

3199. Network of Patient Safety Databases Chartbook, 2023 (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/npsd/data/npsd-chartbook-2023-rev.pdf
      January 01, 2023 - Communication was the leading contributor for Surgery or Anesthesia events (42.0%; 2,125 / 5,063),

3200. Introducing the CAHPS Cancer Care Survey" Transcript (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/cahps/news-and-events/events/webinars/cahps-cancer-care-transcript.pdf
      June 01, 2017 - It's possible that there could be an error in those data leading to an individual who has not actually