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psnet.ahrq.gov/issue/patient-led-training-patient-safety-pilot-study-test-feasibility-and-acceptability
April 24, 2017 - Study
Patient-led training on patient safety: a pilot study to test the feasibility and acceptability of an educational intervention.
Citation Text:
Jha V, Winterbottom A, Symons J, et al. Patient-led training on patient safety: a pilot study to test the feasibility and acceptability …
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psnet.ahrq.gov/issue/enteral-nutrition-underappreciated-source-patient-safety-events
February 01, 2023 - Study
Enteral nutrition: an underappreciated source of patient safety events.
Citation Text:
Citty SW, Chew M, Hiller LD, et al. Enteral nutrition: an underappreciated source of patient safety events. Nutr Clin Prac. 2024;39(4):784-799. doi:10.1002/ncp.11153.
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psnet.ahrq.gov/issue/development-and-implementation-suicide-prevention-checklist-create-safe-environment
August 04, 2021 - Study
Development and implementation of a suicide prevention checklist to create a safe environment.
Citation Text:
Frost DA, Snydeman CK, Lantieri MJ, et al. Development and Implementation of a Suicide Prevention Checklist to Create a Safe Environment. Psychosomatics. 2019;61(2):154-160…
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psnet.ahrq.gov/issue/achieving-national-quality-forums-never-events-prevention-wrong-site-wrong-procedure-and
September 28, 2010 - Review
Achieving the National Quality Forum's "Never Events": prevention of wrong site, wrong procedure, and wrong patient operations.
Citation Text:
Michaels RK, Makary MA, Dahab Y, et al. Achieving the National Quality Forum's "Never Events": prevention of wrong site, wrong procedure…
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psnet.ahrq.gov/issue/approval-and-perceived-impact-duty-hour-regulations-survey-pediatric-program-directors
February 27, 2013 - Study
Approval and perceived impact of duty hour regulations: survey of pediatric program directors.
Citation Text:
Drolet BC, Whittle SB, Khokhar MT, et al. Approval and perceived impact of duty hour regulations: survey of pediatric program directors. Pediatrics. 2013;132(5):819-24. doi…
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psnet.ahrq.gov/issue/large-scale-deployment-global-trigger-tool-across-large-hospital-system-refinements
November 23, 2014 - Study
Large-scale deployment of the Global Trigger Tool across a large hospital system: refinements for the characterisation of adverse events to support patient safety learning opportunities.
Citation Text:
Good VS, Saldaña M, Gilder R, et al. Large-scale deployment of the Global Trig…
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psnet.ahrq.gov/issue/tallman-lettering-strategy-differentiation-look-alike-sound-alike-drug-names-role-familiarity
May 27, 2020 - Study
Tallman lettering as a strategy for differentiation in look-alike, sound-alike drug names: the role of familiarity in differentiating drug doppelgangers.
Citation Text:
DeHenau C, Becker MW, Bello NM, et al. Tallman lettering as a strategy for differentiation in look-alike, sound-a…
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psnet.ahrq.gov/issue/standardized-multidisciplinary-protocol-improves-handover-cardiac-surgery-patients-intensive
July 14, 2010 - Study
Standardized multidisciplinary protocol improves handover of cardiac surgery patients to the intensive care unit.
Citation Text:
Joy BF, Elliott E, Hardy C, et al. Standardized multidisciplinary protocol improves handover of cardiac surgery patients to the intensive care unit*. P…
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digital.ahrq.gov/sites/default/files/docs/page/peds_templates_weight_counsel_final.pdf
June 16, 2021 - Clinical Decision Support Toolkit: Pediatric Documentation Templates
Pediatric Documentation Templates
Weight & Nutritional Counseling Template
Executive Summary
The Partners Pediatric Weight & Nutritional Counseling Template was designed to aid
clinicians in documenting delivery of exerci…
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psnet.ahrq.gov/issue/patterns-communication-breakdowns-resulting-injury-surgical-patients
March 03, 2011 - Study
Classic
Patterns of communication breakdowns resulting in injury to surgical patients.
Citation Text:
Greenberg CC, Regenbogen SE, Studdert DM, et al. Patterns of communication breakdowns resulting in injury to surgical patients. J Am Coll Surg. 2007;204…
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meps.ahrq.gov/mepsweb/survey_comp/survey_spanish.jsp
January 01, 2002 - Medical Expenditure Panel Survey Cuestionarios
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psnet.ahrq.gov/issue/applying-human-factors-engineering-address-telemetry-alarm-problem-large-medical-center
February 10, 2021 - Study
Applying human factors engineering to address the telemetry alarm problem in a large medical center.
Citation Text:
Patterson ES, Rayo MF, Edworthy JR, et al. Applying human factors engineering to address the telemetry alarm problem in a large medical center. Hum Factors. 2022;64(1…
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digital.ahrq.gov/funding-mechanism/national-resource-center-health-it-nrc
January 01, 2023 - National Resource Center for Health IT (NRC)
Children's EHR Format Enhancement - Final Report
Citation
Wald JS, Rizk S, Webb JR., Haque S, et al. Children’s EHR Format Enhancement - Final Report. (Prepared by RTI International under Contract No. HHSA 290-2009-00021I). AHRQ Pub…
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psnet.ahrq.gov/issue/improving-safety-evaluating-impact-supply-chain-and-drug-shortages-health-systems
November 04, 2020 - Commentary
Improving safety by evaluating the impact of the supply chain and drug shortages on health-systems.
Citation Text:
Patel V, Cieslak K, Hertig JB. Improving safety by evaluating the impact of the supply chain and drug shortages on health-systems. Hosp Pharm. 2023;58(2):120-124.…
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psnet.ahrq.gov/issue/reducing-rate-catheter-associated-bloodstream-infections-surgical-intensive-care-unit-using
November 16, 2022 - Study
Reducing the rate of catheter-associated bloodstream infections in a surgical intensive care unit using the Institute for Healthcare Improvement Central Line Bundle.
Citation Text:
Sacks GD, Diggs BS, Hadjizacharia P, et al. Reducing the rate of catheter-associated bloodstream infe…
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qualityindicators.ahrq.gov/Downloads/Modules/PQI/V50/PQI_Brochure.pdf
April 01, 2022 - AHRQ Quality Indicators™ Prevention Quality Indicators
AHRQ Quality Indicators™
Prevention Quality Indicators
Measures to help assess quality and access to health care in the community
Prevention Quality Indicators—
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psnet.ahrq.gov/issue/effects-efforts-optimise-morbidity-and-mortality-rounds-serve-contemporary-quality
July 19, 2019 - Review
Effects of efforts to optimise morbidity and mortality rounds to serve contemporary quality improvement and educational goals: a systematic review.
Citation Text:
Smaggus A, Mrkobrada M, Marson A, et al. Effects of efforts to optimise morbidity and mortality rounds to serve contem…
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psnet.ahrq.gov/issue/recent-two-fold-increase-medical-adverse-event-deaths-among-us-inpatients
April 06, 2022 - Study
A recent two-fold increase in medical adverse event deaths among US inpatients.
Citation Text:
Oura P, Sajantila A. A recent two-fold increase in medical adverse event deaths among US inpatients. J Public Health Res. 2022;11(4):227990362211399. doi:10.1177/22799036221139935.
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psnet.ahrq.gov/issue/medication-safety-neonatal-care-review-medication-errors-among-neonates
August 15, 2016 - Review
Medication safety in neonatal care: a review of medication errors among neonates.
Citation Text:
Krzyzaniak N, Bajorek B. Medication safety in neonatal care: a review of medication errors among neonates. Ther Adv Drug Saf. 2016;7(3):102-119. doi:10.1177/2042098616642231.
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digital.ahrq.gov/health-it-tools-and-resources/implementation-toolsets-e-prescribing/toolset-e-prescribing/tool-72-oregon-community-health-information-network-electronic-medical-record-emr-implementation-and
January 01, 2023 - Tool 7.2: Oregon Community Health Information Network Electronic Medical Record (EMR) Implementation and Planning Tool
6 Months Prior Leadership & CIT (Clinic Implementation Team) Engagement
6 Months Prior Engagement: Work Processes CIT Meets Monthly
4 Months Prior Communic…