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1221. Blood Thinner Pills: Your Guide to Using Them Safely (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/patients-consumers/diagnosis-treatment/treatments/btpills/btpills.pdf
      September 01, 2015 - Many medication errors are found by patients. 3 Using Other Medicines Tell your doctor about every

1222. New AHRQ SOPS™ Health Information Technology Patient Safety Supplemental Items for Hospitals - (Yount) (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/sops/quality-patient-safety/patientsafetyculture/hospital/healthitwebinar/sops-hit-webcast4-yount.pdf
      June 02, 2025 - New AHRQ SOPS™ Health Information Technology Patient Safety Supplemental Items for Hospitals - (Yount) Introducing the AHRQ SOPS Health IT Patient Safety Supplemental Items Naomi Yount, PhD Westat Health IT Patient Safety Supplemental Items • Supplemental item set that can be added to the end of the Hospit…

1223. Final Progress Report: Patient Safety: Physician Assistant Responsibilities and Opportunities (pdf file)
      www.ahrq.gov/sites/default/files/2024-02/crane-report.pdf
      January 01, 2024 - Final Progress Report: Patient Safety: Physician Assistant Responsibilities and Opportunities Final Report Patient Safety: Physician Assistant Responsibilities and Opportunities An educational conference program of the American Academy of Physician Assistants This program was funded by a grant from the Agency fo…

1224. Implement-Facilitator-Guide (doc file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/perinatal-care/modules/teamwork/implement/implement-facilitator-guide.docx
      May 01, 2017 - AHRQ Safety Program for Perinatal Care Implement Teamwork and Communication for Perinatal Safety Implement Teamwork and Communication for Perinatal Safety SAY: The Implement Teamwork and Communication module of the AHRQ Safety Program for Perinatal Care will help you understand the importance of effective communicatio…

1225. Implement Teamwork and Communication for Perinatal Safety: Facilitator Guide | Agency for Healthcare Research and Quality
      www.ahrq.gov/patient-safety/settings/labor-delivery/perinatal-care/modules/teamwork/implement-fac-guide.html
      July 01, 2023 - Implement Teamwork and Communication for Perinatal Safety: Facilitator Guide AHRQ Safety Program for Perinatal Care Slide 1: Implement Teamwork and Communication for Perinatal Safety Say: The Implement Teamwork and Communication module of the AHRQ Safety Program for Perinatal Care will help you understa…

1226. 130-Ss-Swiss-Cheese-Fg (doc file)
      www.ahrq.gov/sites/default/files/wysiwyg/hai/tools/mrsa-2/130-ss-swiss-cheese-fg.docx
      April 01, 2025 - prevents infusions from running too fast is an example of a latent defect that could contribute to medication … errors.

1227. “Safeware”: Safety-Critical Computing and Health Care Information Technology (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol4/Advances-Wears_75.pdf
      May 27, 2008 - Role of computerized physician order entry systems in facilitating medication errors.

1228. “Near-miss” Reporting System Development and Implications for Human Subjects Protection (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol3/Murff.pdf
      January 01, 2004 - Outside the VHA, after studying aggregate data on adverse drug events, it was determined that many medication … errors occur during the ordering and administration stage of “Near-miss” Reporting: Implications … This medication error was detected by a staff nurse prior to drug administration. … Effect of computerized physician order entry and a team intervention on prevention of serious medication … errors.

1229. Prescribers-Facilitator-Guide (doc file)
      www.ahrq.gov/sites/default/files/wysiwyg/antibiotic-use/long-term-care/prescribers-facilitator-guide.docx
      June 01, 2021 - In a survey of 2,000 health care professionals, intimidation was found to be the root cause of medication … error. … improve communication and alleviate this feeling of intimidation can reduce unnecessary prescriptions or medication … errors.

1230. Teamworknotes (doc file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/education/curriculum-tools/cusptoolkit/modules/implement/teamworknotes.docx
      June 02, 2025 - SAY: The “Implement Teamwork and Communication” module of the Comprehensive Unit-based Safety Program (or CUSP) Toolkit will help you understand the importance of effective communication and transparency, identify barriers to communication, and apply the effective teamwork and communication tools from CUSP and TeamSTEP…

1231. Improving the Safety and Quality of Health Care: The Impact of the National Academy of Medicine on Research and Collaboration (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/news/events/ahrq-research-summit/dzau-summit2016.pdf
      September 28, 2016 - improved educational and training materials for clinical staff • information technology that reduced medication … errors and improved data collection AHRQ AHRQ's reauthorizing legislation specified that the

1232. References | Agency for Healthcare Research and Quality
      www.ahrq.gov/diagnostic-safety/resources/issue-briefs/distributed-cognition-er-nurses6.html
      August 01, 2022 - Distributed Cognition and the Role of Nurses in Diagnostic Safety in the Emergency Department References Previous Page   Table of Contents Distributed Cognition and the Role of Nurses in Diagnostic Safety in the Emergency Department Introduction The Theory of Distributed Cognition Nurses' Role…

1233. References | Agency for Healthcare Research and Quality
      www.ahrq.gov/diagnostic-safety/resources/issue-briefs/state-of-science-5.html
      June 01, 2020 - Operational Measurement of Diagnostic Safety: State of the Science References Previous Page   Table of Contents Operational Measurement of Diagnostic Safety: State of the Science Introduction Special Considerations for Measurement of Diagnostic Safety Getting Ready for Measurement: Overcoming …

1234. Maine Groups Improve Care for Patients with Intellectual/Developmental Disabilities | Agency for Healthcare Research and Quality
      www.ahrq.gov/news/newsroom/case-studies/202201.html
      January 01, 2022 - Maine Groups Improve Care for Patients with Intellectual/Developmental Disabilities Search All Impact Case Studies January 2022 A partnership between the Maine Developmental Disabilities Council (MDDC) and two AHRQ-listed patient safety organizations (PSOs) is helping improve care for patients with intell…

1235. Information to Help Hospitals Get Started
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/engagingfamilies/howtogetstarted/How_to_Use_Guide_Ldr_Slide_508.pptx
      July 23, 2010 - engage patients and family members in the transition from hospital to home, with the goal of reducing medication … errors and preventable readmissions. 11 Guide to Patient and Family Engagement Why work with patients

1236. The Science of Improving Patient Safety
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/education/curriculum-tools/cusptoolkit/modules/understand/scisafety.pptx
      March 01, 2009 - The Science of Improving Patient Safety 1 2 Describe the historical and contemporary context of the Science of Safety Explain how system design affects system results List the principles of safe design and identify how they apply to technical work and teamwork Indicate how teams make wise decisions when the…

1237. Final Progress Report: Pharmacist Technology for Nursing Home Resident Safety (pdf file)
      www.ahrq.gov/sites/default/files/2024-01/lapane-report.pdf
      January 01, 2024 - Assessment Med Guide™ (GRAM™), in nursing facilities to improve medication safety Scope: Efforts to reduce medication … errors have focused on prescribing, dispensing, or medication administration; GRAM™ targets the monitoring … Many clinical informatics systems focus on the reduction of medication errors at the point of prescribing

1238. Federal Interagency Workgroup: Improving Diagnostic Safety and Quality in Healthcare (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/topics/dx-safety-workgroup-meeting-notes-mar2023.pdf
      July 14, 2023 - • Preventable Harm From Pediatric Outpatient Medication Errors: Measure Development o Project

1239. Mobile Text Messaging | Agency for Healthcare Research and Quality
      www.ahrq.gov/diagnostic-safety/resources/issue-briefs/healthit-ed-3.html
      February 01, 2021 - Health Information Technology for Engaging Patients in Diagnostic Decision Making in Emergency Departments Mobile Text Messaging Previous Page Next Page Table of Contents Health Information Technology for Engaging Patients in Diagnostic Decision Making in Emergency Departments Introduction Elect…

1240. Producing Accurate Clinical Quality Reports for Population Health: A Delivery System-Oriented Approach to Report Validation (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/evidencenow/tools-and-materials/ehr-reports.pdf
      March 01, 2016 - Producing Accurate Clinical Quality Reports for Population Health: A Delivery System-Oriented Approach to Report Validation Producing Accurate Clinical Quality Reports for Population Health: A Delivery System-Oriented Approach to Report Validation March 2016 Authored by: Jeff Hummel, MD, MPH Peggy C. Evans, Ph…