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  1. www.ahrq.gov/sites/default/files/wysiwyg/research/findings/final-reports/25702-Lipsitz-report.pdf
    August 31, 2022 - characteristics, and we performed separate analyses of outcomes before the pandemic and while it was still occurring
  2. www.ahrq.gov/sites/default/files/2024-01/savage-report.pdf
    January 01, 2024 - Second, we documented the extent to which medication administration workarounds occurring in intensive … [probe to expand on impact or clarify – e.g., do they notice when problems are occurring?]
  3. www.ahrq.gov/sites/default/files/wysiwyg/professionals/education/curriculum-tools/teamstepps/instructor/fundamentals/module4/exbriefing.pdf
    March 20, 2014 - TeamSTEPPS 2.0 Briefing Exercise Sheet TeamSTEPPS 2.0 Briefing Exercise Sheet – B-4-33 Leading Teams Briefing Exercise Sheet INSTRUCTIONS: 1. Convene in a group of 3-7 individuals. 2. As a Master Trainer, you have decided to implement briefings to improve coordination of care in your unit. Answer the…
  4. www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/mvp/modules/cusp/learn-from-defects-slides.pptx
    January 01, 2017 - Presentation: Program Overview Learn From Defects in Care of Mechanically Ventilated Patients AHRQ Safety Program for Mechanically Ventilated Patients AHRQ Pub. No. 16(17)-0018-34-EF January 2017 Learn From Defects ‹#› AHRQ Safety Program for Mechanically Ventilated Patients 1 Learning Objectives After this ses…
  5. www.ahrq.gov/sites/default/files/wysiwyg/teamstepps/longtermcare/module4/ts2-0ltc_module4_briefing_exsheet.pdf
    April 24, 2017 - Briefing Exercise Sheet TeamSTEPPS 2.0 for Long-Term Care Briefing Exercise Sheet – B-4-33 Leading Teams Briefing Exercise Sheet INSTRUCTIONS: 1. Convene in a group of 3-7 individuals. 2. As a Master Trainer, you have decided to implement briefings to improve coordination of care in your unit, depa…
  6. www.ahrq.gov/hai/cusp/modules/understand/science-safety-notes.html
    July 01, 2018 - increase their ability to learn from mistakes and implement procedures to help prevent serious errors from occurring
  7. www.ahrq.gov/patient-safety/settings/hospital/candor/impguide.html
    August 01, 2022 - Implementation Guide for the CANDOR Process Communication and Optimal Resolution Toolkit Purpose: The Toolkit Implementation Guide is a reference for organizational leaders who are committed to improving their response to unexpected patient harm events. The guide describes the CANDOR process, implementatio…
  8. www.ahrq.gov/sites/default/files/wysiwyg/hai/tools/mrsa-2/111-ss-cusp-lfd-worksheet-a3.docx
    April 01, 2025 - AHRQ Safety Program for MRSA Prevention: Targeting SSI Investigating a Defect Worksheet Surgical Services For: Cardiac, Hip and Knee Joint Replacement, and Spinal Fusion SurgeriesOwner: ____________________________ Date Defect Occurred: ________________ Date Investigation Initiated: ___________ Use the Learning From …
  9. www.ahrq.gov/sites/default/files/wysiwyg/hai/tools/mrsa-surgery/111-cusp-learning-from-defects-worksheet.docx
    April 01, 2025 - AHRQ Safety Program for MRSA Prevention: Targeting SSI Investigating a Defect Worksheet Surgical Services For: Cardiac, Hip and Knee Joint Replacement, and Spinal Fusion SurgeriesOwner: ____________________________ Date Defect Occurred: ________________ Date Investigation Initiated: ___________ Use the Learning From …
  10. www.ahrq.gov/sites/default/files/wysiwyg/teamstepps/webinars/2013-materials/teamstepps-monthly-webinar-dec2013.pptx
    January 01, 2013 - =  person  was  not  engaged  in   other  tasks  while  the  briefing  was  occurring
  11. www.ahrq.gov/teamstepps/officebasedcare/module6/office_support.html
    September 01, 2015 - Directed toward improvement Helps prevent the same problem from occurring in the future.
  12. www.ahrq.gov/practiceimprovement/delivery-initiative/ihs/chapter7.html
    December 01, 2017 - The AI/AN rate is nearly 2.5 times that for Whites, with 36.0 percent of deaths from heart disease occurring
  13. www.ahrq.gov/policymakers/chipra/demoeval/what-we-learned/implementation-guides/implementation-guide2/implguide2pt1.html
    September 01, 2014 - the highest-need, highest-cost youth with complex behavioral health concerns, such as severe or co-occurring
  14. www.ahrq.gov/hai/cusp/modules/identify/identify.html
    December 01, 2012 - CUSP and Sensemaking tools help teams identify defects and identify ways to deter them from occurring
  15. www.ahrq.gov/sites/default/files/2024-01/cohen-report.pdf
    January 01, 2024 - The fault tree is structured with data entry verification occurring after the data entry process and
  16. www.ahrq.gov/sites/default/files/wysiwyg/professionals/education/curriculum-tools/cusptoolkit/modules/patfamilyengagement/CUSP_Patient_Family_Engagement_Facilitator_Notes.docx
    September 13, 2013 - SAY: The Patient and Family Engagement module of the Comprehensive Unit-based Safety Program (or CUSP) Toolkit focuses on an important topic: Making sure patients and their family members understand what is happening during the patient’s hospital stay, are active participants in the patient’s care, and are prepared for…
  17. www.ahrq.gov/sites/default/files/wysiwyg/antibiotic-use/ambulatory-care/allergies-guide.docx
    September 01, 2022 - Best Practices in the Management of Patients With Antibiotic Allergies – Facilitator Guide AHRQ Safety Program for Improving Antibiotic Use 1 Best Practices in the Management of Patients with Antibiotic Allergies Ambulatory Care Slide Title and Commentary Slide Number and Slide Best Practices in the Managemen…
  18. www.ahrq.gov/patient-safety/settings/hospital/candor/modules/notes6.html
    August 01, 2022 - Module 6: Care for the Caregiver AHRQ Communication and Optimal Resolution Toolkit Facilitator Notes Say: Module 6 includes information on the Care for the Caregiver component of the CANDOR process, which focuses on providing emotional support to caregivers following a CANDOR event. This module …
  19. www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/pfp/2014finalhacreport-cx.pdf
    December 01, 2016 - from 2011 to 2014 as a result of the reduction in HACs, with nearly $16 billion of those cost savings occurring
  20. www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/pfp/2014FinalHACreport4Web-13Dec2016.pdf
    December 01, 2016 - from 2011 to 2014 as a result of the reduction in HACs, with nearly $16 billion of those cost savings occurring

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