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psnet.ahrq.gov/node/33611/psn-pdf
July 01, 2005 - In Conversation with…Christopher P. Landrigan, MD
April 1, 2005
In Conversation with…Christopher P. Landrigan, MD. PSNet [internet]. 2005.
https://psnet.ahrq.gov/perspective/conversation-withchristopher-p-landrigan-md
Editor's Note: In October 2004, in what immediately became a landmark paper in patient safety, Dr.…
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www.ahrq.gov/professionals/prevention-chronic-care/improve/coordination/webinar02/spcslides.html
July 01, 2013 - Advanced Methods in Delivery System Research - Planning, Executing, Analyzing, and Reporting Research on Delivery System Improvement
Webinar #2: Statistical Process Control (Slide Presentation)
This slide presentation was presented on May 14, 2013.
Presenter: Jill Marsteller, PhD, MPP Discussant: Stephen Al…
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psnet.ahrq.gov/node/49484/psn-pdf
June 01, 2005 - Two Pills, Same Drug
June 1, 2005
Horsky J, Patel VL. Two Pills, Same Drug. PSNet [internet]. 2005.
https://psnet.ahrq.gov/web-mm/two-pills-same-drug
The Case
A 34-year-old woman with AIDS developed a fever and hypotension due to suspected pneumonia. Her past
medical history included several AIDS-related complica…
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psnet.ahrq.gov/node/49492/psn-pdf
November 01, 2005 - Reconciling Doses
November 1, 2005
Federico F. Reconciling Doses. PSNet [internet]. 2005.
https://psnet.ahrq.gov/web-mm/reconciling-doses
Case Objectives
List the steps involved in medication reconciliation.
Describe the role of each of the stakeholders in medication reconciliation.
Discuss how medication reconc…
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/education/curriculum-tools/cusptoolkit/modules/spread/spreadnotes.docx
June 02, 2025 - SAY:
The Spread module of the Comprehensive Unit-based Safety Program (or CUSP) Toolkit helps all or part of an organization share, tailor, and use the components of a process that have worked well at the unit level. The other CUSP Toolkit modules focus on quality improvement projects at the unit level, where culture i…
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www.ahrq.gov/hai/cusp/clabsi-final-companion/clabsicomp4c.html
January 01, 2013 - Eliminating CLABSI, A National Patient Safety Imperative: Final Report Companion Guide
Infections Avoided, Excess Costs Averted, and Changes in Mortality Rate
Previous Page Next Page
Table of Contents
Eliminating CLABSI, A National Patient Safety Imperative: Final Report Companion Guide
Preface
…
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www.ahrq.gov/sites/default/files/wysiwyg/hai/tools/mrsa/099-cusp-guide-why-choose-cusp-approach.docx
October 01, 2024 - AHRQ Safety Program for MRSA Prevention
Why Choose a CUSP Approach?
ICU & Non-ICU
Slide Title and Commentary
Slide Number and Slide
Why Choose a CUSP Approach?
SAY:
Welcome to this presentation on the topic of “Why Choose a CUSP Approach?” The term CUSP is short for “the Comprehensive Unit-based Safety Program.” T…
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psnet.ahrq.gov/node/49710/psn-pdf
May 01, 2014 - Discontinued Medications: Are They Really
Discontinued?
May 1, 2014
Mankey CG, Varkey P. Discontinued Medications: Are They Really Discontinued? PSNet [internet]. 2014.
https://psnet.ahrq.gov/web-mm/discontinued-medications-are-they-really-discontinued
The Case
A 69-year-old man with a history of chronic atrial f…
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psnet.ahrq.gov/node/846125/psn-pdf
March 15, 2023 - The I-READI Quality and Safety Framework: Strong
Communications Channels and Effective Practices to
Rapidly Update and Implement Clinical Protocols During a
Time of Crisis
March 15, 2023
https://psnet.ahrq.gov/innovation/i-readi-quality-and-safety-framework-strong-communications-channels-
and-effective
Summary
…
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psnet.ahrq.gov/sites/default/files/2020-08/too_many_cooks_spotlight_pdf.pdf
January 01, 2020 - Spotlight
Too Many Cooks in the Kitchen
Source and Credits
• This presentation is based on the August 2020 AHRQ WebM&M
Spotlight Case
o See the full article at https://psnet.ahrq.gov/webmm
o CME credit is available
o Commentary by: Richard P. Dutton, MD, MBA
o AHRQ WebM&M Editors in Chief: Patrick Romano, MD…
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www.ahrq.gov/sites/default/files/2024-01/zimring-report.pdf
January 01, 2024 - AHRQ Final Progress Report: Impacts of the Physical Environment on Healthcare
FINAL PROGRESS/STATUS REPORT
18 December 2006
IMPACTS OF THE PHYSICAL ENVIRONMENT ON HEALTHCARE
AHRQ Grant Identification Number: #1R13HS015962-01
Dates of the project: 9/1/2005–8/31/2006
Total amount of the project: $25,000
Goal of…
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www.ahrq.gov/sites/default/files/2024-07/etchegaray2-report.pdf
January 01, 2024 - Final Progress Report: Parent Perceptions of NICU Safety Culture: Parent-Centered Safety Culture Tool
Parent Perceptions of NICU Safety Culture: Parent-Centered Safety Culture Tool
Project Team: Jason M. Etchegaray, PhD (PI; RAND Corporation); Madelene J. Ottosen, PhD (The
University of Texas Medical School at Hous…
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psnet.ahrq.gov/node/49670/psn-pdf
November 01, 2012 - Missed Pneumonia
November 1, 2012
Rohde JM, Flanders S. Missed Pneumonia. PSNet [internet]. 2012.
https://psnet.ahrq.gov/web-mm/missed-pneumonia
The Case
A 32-year-old man presented to the emergency department (ED) with 3 days of fever and right pleuritic
chest pain. Review of systems was negative for cough or dy…
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psnet.ahrq.gov/web-mm/or-peeping
May 01, 2015 - OR Peeping
Citation Text:
Mackenzie CF. OR Peeping. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2004.
Copy Citation
Format:
Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged PubMedId RIS
Dow…
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psnet.ahrq.gov/node/49397/psn-pdf
May 01, 2003 - The Dropped Lung
May 1, 2003
Heffner JR. The Dropped Lung. PSNet [internet]. 2003.
https://psnet.ahrq.gov/web-mm/dropped-lung
The Case
A 79-year-old woman was admitted for hypoxia and shortness of breath. Two weeks prior she had been
hospitalized for dyspnea and was found to have multiple bilateral pulmonary nodu…
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www.ahrq.gov/patient-safety/settings/long-term-care/resource/injuries/fallspx/manapc.html
December 01, 2017 - The Falls Management Program: A Quality Improvement Initiative for Nursing Facilities
Appendix C. Case Study and Program Examples
Previous Page Next Page
Table of Contents
The Falls Management Program: A Quality Improvement Initiative for Nursing Facilities
Chapter 1. Introduction and Program Over…
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/perinatal-care/modules/strategies/safe-electronic/e-fetal-monitoring_facguide.docx
May 01, 2017 - AHRQ Safety Program for Perinatal Care
Monitoring for Perinatal Safety: Electronic Fetal Monitoring
Monitoring for Perinatal Safety—Electronic Fetal Monitoring
SAY:
The Monitoring for Perinatal Safety bundle provides information on the use of electronic fetal monitoring (EFM). This bundle offers an approach to the us…
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www.ahrq.gov/patient-safety/settings/labor-delivery/perinatal-care/modules/strategies/safe-electronic-fac-guide.html
July 01, 2023 - Monitoring for Perinatal Safety: Electronic Fetal Monitoring: Facilitator Guide
AHRQ Safety Program for Perinatal Care
Slide 1: Monitoring for Perinatal Safety: Electronic Fetal Monitoring
Say:
The Monitoring for Perinatal Safety bundle provides information on the use of electronic fetal monitoring (EFM…
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psnet.ahrq.gov/node/860049/psn-pdf
January 04, 2024 - Myasthenia Crisis after a Delayed Diagnosis in a
Medically Complex Patient.
January 4, 2024
Chaffin Z. Myasthenia Crisis after a Delayed Diagnosis in a Medically Complex Patient. PSNet [internet].
2024.
https://psnet.ahrq.gov/web-mm/myasthenia-crisis-after-delayed-diagnosis-medically-complex-patient
The Case
A 9…
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psnet.ahrq.gov/node/49797/psn-pdf
June 01, 2017 - Diagnostic Overshadowing Dangers
June 1, 2017
Raven MC. Diagnostic Overshadowing Dangers. PSNet [internet]. 2017.
https://psnet.ahrq.gov/web-mm/diagnostic-overshadowing-dangers
The Case
A 72-year-old woman with history of opioid abuse was sent to the emergency department (ED) from a
methadone clinic because she a…