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www.ahrq.gov/sites/default/files/wysiwyg/hai/tools/mrsa-surgery/105-what-are-the-4-es-notes.docx
April 01, 2025 - Lessons learned should be shared.
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www.ahrq.gov/action-alliance/webinars/high-reliability.html
November 01, 2023 - Webinar: Journey To Becoming a High-Reliability Organization
The fifth webinar, held on September 26, highlighted the journey toward becoming a high-reliability organization. YouTube embedded video: https://www.youtube-nocookie.com/embed/bfk177p9-Mc VHA's Journey to High Reliability: Advancing Toward Zero Harm …
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www.ahrq.gov/patients-consumers/diagnosis-treatment/treatments/index.html
December 01, 2017 - Taking Medicines
Learn about taking medicine
Read
Blood Thinner Pills: Your Guide to Using Them Safely
How To Create a Pill Card
Your Medicine: Be Smart. Be Safe.
Watch
Staying Active and Healthy With Blood Thinners (Video, 8 minutes, 29 seconds; Transcript )
Manténgase activo y saludable con lo…
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www.ahrq.gov/antibiotic-use/acute-care/safety/changes.html
November 01, 2019 - Making Effective Changes in Antibiotic Decision Making
After viewing or presenting this presentation viewers will be able to—
Identify relevant factors that could improve antibiotic use
Identify interventions to reduce future harm associated with unnecessary antibiotic use
Apply interventions to effe…
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psnet.ahrq.gov/node/40135/psn-pdf
October 03, 2017 - A pinpoint beam strays invisibly, harming instead of
healing.
October 3, 2017
Bogdanich W; Rebelo K.
https://psnet.ahrq.gov/issue/pinpoint-beam-strays-invisibly-harming-instead-healing
This article explores inaccuracy of dosage, lack of protocol adherence, and absence of transparency as
trends that hinder learnin…
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psnet.ahrq.gov/node/36356/psn-pdf
June 16, 2019 - ISMP medication error report analysis.
June 16, 2019
Cohen MR.
https://psnet.ahrq.gov/issue/ismp-medication-error-report-analysis-8
This monthly column discusses the value of learning from rare yet severe events, shares successes with
read backs, and reports on errors involving non-formulary medications and vincri…
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www.ahrq.gov/patient-safety/patients-families/consumer-exp/reporting/summary.html
August 01, 2022 - Publish information on what was learned.
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www.ahrq.gov/news/events/nac/2022-11-nac/nacmtg111722-minutes.html
July 01, 2023 - agreed that the experience has been an honor and privilege and expressed gratitude, noting that she has learned
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psnet.ahrq.gov/perspective/conversation-richard-platt-md-msc
October 01, 2016 - With… Erik Hollnagel, PhD
June 1, 2019
Changing smart pump vendors: lessons learned
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psnet.ahrq.gov/web-mm/difficult-encounters-cmo-and-cno-respond
March 01, 2018 - I also learned that this work depended on having strong collaboration with physician leaders and so I
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www.ahrq.gov/funding/training-grants/institutional.html
December 01, 2022 - Institutional Research Training and Career Development Programs
AHRQ supports institutions to recruit individuals support predoctoral and postdoctoral research training programs in health services research along with institutions to provide mentored career development to newly trained clinician and research sci…
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www.ahrq.gov/nursing-home/resources/supporting-nursing-home.html
August 01, 2022 - Supporting Nursing Home Residents' Emotional Health
Resource: Supporting Nursing Home Residents' Emotional Health
This learning module will help you recognize when a resident may need support to resume normal activities.
Source: AHRQ
Topic(s): Staff and Resident Well-being
Audience(s): Managers, Cli…
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www.ahrq.gov/teamstepps-program/resources/additional/sbar.html
July 01, 2023 - TeamSTEPPS Additional Video: SBAR in Inpatient Medical Teams
YouTube embedded video: https://www.youtube-nocookie.com/embed/nbJPAumzJrc
TeamSTEPPS: SBAR in Inpatient Medical Teams (1:36)
SBAR stands for situation, background, assessment and recommendation. It’s a proven tool to quickly summarize and com…
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psnet.ahrq.gov/node/38916/psn-pdf
July 03, 2013 - Patient Safety Papers 4.
July 3, 2013
Baker GR, ed. Healthc Q. 2009;12(Spec No Patient):1-198.
https://psnet.ahrq.gov/issue/patient-safety-papers-4
This special issue discusses Canadian patient safety efforts in identifying risks, designing safe systems,
implementing solutions, developing learning systems, …
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psnet.ahrq.gov/node/42162/psn-pdf
December 06, 2016 - The robot will see you now.
December 6, 2016
Cohn J. The Atlantic. March 2013;311:59–67.
https://psnet.ahrq.gov/issue/robot-will-see-you-now
This magazine article reports how technology, such as IBM's Watson, can improve the efficiency and
accuracy of health care decision making.
https://psnet.ahrq.gov/issue/robo…
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digital.ahrq.gov/location/usa-me-augusta
January 01, 2023 - USA, ME, Augusta
Improving Health Information Technology Implementation in a Rural Health System
Description
Implemented an outpatient EMR in a rural health system using distinct phases to match the expected learning curve and to reduce the potential loss of practice productiv…
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psnet.ahrq.gov/node/42549/psn-pdf
August 28, 2013 - Patient safety: threats and solutions.
August 28, 2013
McCaughan D, Kaufman G. Patient safety: threats and solutions. Nurs Stand. 2013;27(44):48-55; quiz 56,
58.
https://psnet.ahrq.gov/issue/patient-safety-threats-and-solutions
This commentary provides an overview of patient safety, including types of adverse even…
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integrationacademy.ahrq.gov/products/playbooks/opioid-use-disorder/implement-mat-for-oud/engaging-and-educating-families-and-caregivers
January 01, 2019 - An official website of the Department of Health & Human Services
Search All AHRQ Sites
Careers
Contact Us
Español
FAQs
Email Updates
The Academy
Integrating Behavioral Health & Primary Care
Expand Navi…
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www.ahrq.gov/patient-safety/quality-resources/tools/chtoolbx/measures/measure-6.html
November 01, 2017 - Established Child Health Care Quality Measures--Child and Adolescent Health Measurement Initiative (CAHMI): Promoting Healthy Development Survey (PHDS)
Child Health Care Quality Toolbox
The Child Health Toolbox contains concepts, tips, and tools for evaluating the quality of health care for children.
Conten…
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www.ahrq.gov/patient-safety/settings/labor-delivery/perinatal-care/modules/teamwork/implement-slides.html
July 01, 2023 - Implement Teamwork and Communication for Perinatal Safety
AHRQ Safety Program for Perinatal Care
Slide 1: AHRQ Safety Program for Perinatal Care
Implement Teamwork and Communication for Perinatal Safety
Slide 2: Learning Objectives
Image: Four ascending steps show the learning objectives:
Recogn…