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441. Wisconsin Critical Access Hospital Sees Big Results with AHRQ’s CUSP, RED and TeamSTEPPS® | Agency for Healthcare Research and Quality
     www.ahrq.gov/news/newsroom/case-studies/201520.html
     July 01, 2015 - Cut medication error rates from 1 in 2,100 doses in January 2010 to a 12-month average of 1 in 20,400

442. Final Progress Report: EHR-Based Medication Complete Communication Strategy to Promote Safe Opioid Use (pdf file)
     www.ahrq.gov/sites/default/files/2024-01/mccarthy-report.pdf
     January 01, 2024 - Final Progress Report: EHR-Based Medication Complete Communication Strategy to Promote Safe Opioid Use Title Page EHR-Based Medication Complete Communication Strategy to Promote Safe Opioid Use Principal Investigator: Danielle M. McCarthy, MD, MS Co-Investigators: Mike S. Wolf, PhD, MPH, Kenzie A. Cameron, PhD, MP…

443. Diagnostic Safety Across Transitions of Care Throughout the Healthcare System: Current State and a Call to Action (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/patient-safety/reports/issue-briefs/diagnostic-safety-transitions-care.pdf
     June 01, 2023 - Diagnostic Safety Across Transitions of Care Throughout the Healthcare System: Current State and a Call to Action PATIENT SAFETY e Issue Brief 11 Diagnostic Safety Across Transitions of Care Throughout the Healthcare System: Current State and a Call to Action This page intentionally left blank. e Issue …

444. Final Progress Report: Implementation of a Medication Reconciliation Toolkit to Improve Patient Safety (MARQUIS2) (pdf file)
     www.ahrq.gov/sites/default/files/2024-02/schnipper2-report.pdf
     January 01, 2024 - Final Progress Report: Implementation of a Medication Reconciliation Toolkit to Improve Patient Safety (MARQUIS2) 1 | P a g e Implementation of a Medication Reconciliation Toolkit to Improve Patient Safety (MARQUIS2) Principal Investigator: Jeffrey L. Schnipper, MD, MPH Team Members: Harry Reyes Nieva, MAS; Me…

445. Silence A Commentary | Agency for Healthcare Research and Quality
     www.ahrq.gov/patient-safety/reports/liability/silence.html
     August 01, 2017 - Advances in Patient Safety and Medical Liability Silence A Commentary Previous Page Next Page Table of Contents Advances in Patient Safety and Medical Liability Preface Acknowledgments Prologue Silence A Commentary Reforming the Medical Liability System in Massachusetts: Communication, Apo…

446. Chapter 6. Measure Maps and Profiles (continued, 20) | Agency for Healthcare Research and Quality
     www.ahrq.gov/ncepcr/care/coordination/atlas/chapter6s.html
     June 01, 2014 - or Health System Characteristics: In a Swedish study, the risk of negative clinical outcomes due to medication … errors was significantly reduced for elderly individuals who were given comprehensive and structured

447. Information to Help Hospitals Get Started (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/engagingfamilies/howtogetstarted/Ways_To_Learn_More_508.pdf
     October 28, 2009 - Information to Help Hospitals Get Started Information to Help Hospitals Get Started Guide to Patient and Family Engagement :: 1 Ways to Learn More This document contains links to resources on the following topics: • General resources • Getting started with patient- and family-centered care and patient and …

448. I. Introduction | Agency for Healthcare Research and Quality
     www.ahrq.gov/patient-safety/reports/hotline/intro1.html
     May 01, 2016 - Developing and Testing the Health Care Safety Hotline: A Prototype Consumer Reporting System for Patient Safety Events I. Introduction Previous Page Next Page Table of Contents Developing and Testing the Health Care Safety Hotline: A Prototype Consumer Reporting System for Patient Safety Events Pr…

449. Advancing Patient Safety: A Decade of Evidence, Design, and Implementation (pdf file)
     www.ahrq.gov/sites/default/files/publications/files/advancing-patient-safety.pdf
     January 01, 2010 - Advancing Patient Safety: A Decade of Evidence, Design, and Implementation Evidence Design and Implementation Advancing Excellence in Health Care •www.ahrq.gov Agency for Healthcare Research and Quality Advancing Patient Safety: A Decade of 1999 1 Introduction Patient safety was a fairly new field when the …

450. Advancing Patient Safety | Agency for Healthcare Research and Quality
     www.ahrq.gov/patient-safety/reports/advancing/index.html
     July 01, 2022 - Advancing Patient Safety A Decade of Evidence, Design, and Implementation After the Institute of Medicine released its sentinel report, To Err is Human: Building a Safer Health System , the Agency for Healthcare Research and Quality (AHRQ), in conjunction with its Federal partners and non-Federal…

451. Table 5.A.1. Evidence Table (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/acute/chipra-143-section-5a-evidence-table.pdf
     January 01, 2014 - The incidence of category F-I harms as defined by the National Coordinating Council for Medication … Error Reporting and Prevention (NCC MERP) declined eightfold from the baseline to post-intervention

452. Guide to Improving Patient Safety in Primary Care Settings by Engaging Patients and Families | Agency for Healthcare Research and Quality
     www.ahrq.gov/patient-safety/reports/engage.html
     October 01, 2021 - Guide to Improving Patient Safety in Primary Care Settings by Engaging Patients and Families Research shows that when patients are engaged in their healthcare, it can lead to measurable improvements in safety and quality. To promote stronger engagement, the Agency for Healthcare Research and Quality (AHRQ) has …

453. Mapping a Large Patient Safety Database to the 2005 Patient Safety Event Taxonomy (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol1/Advances-Clarke_8.pdf
     January 25, 2008 - “Other,” and 20 of the subcategories within primary categories are described as “other” (e.g., A, medication … error; 9, other). … Medication error B. Adverse drug reaction (not a medication error) C. … information 7.6 Skin integrity: Type-specific information 5.0 Equipment: Type-specific information 4.0 Medication … error: Type-specific information 0.2 7 For the remaining seven PSET classifications,

454. Tool 5: How To Conduct a Postdischarge Followup Phone Call | Agency for Healthcare Research and Quality
     www.ahrq.gov/es/patient-safety/settings/hospital/red/toolkit/redtool5.html
     March 01, 2025 - Re-Engineered Discharge (RED) Toolkit Tool 5: How To Conduct a Postdischarge Followup Phone Call Previous Page Next Page Table of Contents Re-Engineered Discharge (RED) Toolkit Tool 1: Overview Tool 2: How To Begin the Re-engineered Discharge Implementation at Your Hospital How CMS Measures th…

455. Tool 5: How To Conduct a Postdischarge Followup Phone Call | Agency for Healthcare Research and Quality
     www.ahrq.gov/patient-safety/settings/hospital/red/toolkit/redtool5.html
     March 01, 2025 - Re-Engineered Discharge (RED) Toolkit Tool 5: How To Conduct a Postdischarge Followup Phone Call Previous Page Next Page Table of Contents Re-Engineered Discharge (RED) Toolkit Tool 1: Overview Tool 2: How To Begin the Re-engineered Discharge Implementation at Your Hospital How CMS Measures th…

456. Findings | Agency for Healthcare Research and Quality
     www.ahrq.gov/research/findings/final-reports/ptfamilyscan/ptfamily3.html
     July 01, 2018 - Guide to Patient and Family Engagement Findings Previous Page Next Page Table of Contents Guide to Patient and Family Engagement Executive Summary Introduction Methods Findings Implications for the Guide Summary and Discussion Next Steps References Appendix A: Draft Key Informant I…

457. Identify Defects Module Alternate Text | Agency for Healthcare Research and Quality
     www.ahrq.gov/hai/cusp/modules/identify/alt-text.html
     March 01, 2013 - Identify Defects Module Alternate Text Slide Number and Title Slide Content Content for Alternative Text (Illustration) Slide 1 Cover Slide (CUSP Toolkit logo) The "Identify Defects Through Sensemaking" module of the Comprehensive Unit-Based Safety Program (CUSP) Toolkit. The CUSP Toolk…

458. Final Progress Report: Verbal Order Policies, Occurrence, and Perceptions (pdf file)
     www.ahrq.gov/sites/default/files/2024-11/wakefield2-report.pdf
     January 01, 2024 - Final Progress Report: Verbal Order Policies, Occurrence, and Perceptions Verbal Order Policies, Occurrence, and Perceptions Douglas S. Wakefield, PhD Principal Investigator Center for Health Care Quality University of Missouri Bonnie Wakefield, RN, PhD Co-Investigator Associate Research Professor Sinclair…

459. Blood Thinner Pills: Your Guide to Using Them Safely | Agency for Healthcare Research and Quality
     www.ahrq.gov/patients-consumers/diagnosis-treatment/treatments/btpills/btpills.html
     March 01, 2023 - Many medication errors are found by patients.

460. Making Healthcare Safer Practices: 11. Patient Identification Errors in the Operating Room (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/research/findings/making-healthcare-safer/mhs3/patient-id-errors-1.pdf
     March 01, 2020 - Making Healthcare Safer Practices: 11. Patient Identification Errors in the Operating Room Patient Identification Errors in the Operating Room 11-1 11. Patient Identification Errors in the Operating Room Authors: Cori Sheedy, Ph.D., and Sonja Richard, M.P.H. Introduction In the first Making Health Care Safer …