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psnet.ahrq.gov/primer/patient-safety-101
January 16, 2025 - Patient Safety 101
Citation Text:
Patient Safety 101. PSNet [internet]. … Background The History of the Patient Safety Movement The concept that patients could be harmed while … Definitions Used in Patient Safety The patient safety field uses the term adverse events to describe … Research in the field of patient safety began with studies of hospitalized patients. … Care and Patient Safety Primers.
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www.ahrq.gov/sites/default/files/wysiwyg/sops/surveys/hospital/hsops2-pilot-test-partii.pdf
September 01, 2019 - Reporting Patient Safety Events
1. … Reporting Patient Safety Events
1. … Survey 2.0
Pilot Test Hospitals
Interaction With Patients
Patient Safety Culture Composite Measures … Reporting Patient Safety Events
1. … Reporting Patient Safety Events
1.
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psnet.ahrq.gov/issue/trial-automated-decision-support-alerts-contraindicated-medications-using-computerized
May 20, 2019 - Effect of restriction of the number of concurrently open records in an electronic health record on wrong-patient … Related Resources
An empirical model to estimate the potential impact of medication safety … alerts on patient safety, health care utilization, and cost in ambulatory care. … September 1, 2016
Mixed results in the safety performance of computerized physician order … Computerised provider order entry combined with clinical decision support systems to improve medication safety
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www.ahrq.gov/sites/default/files/wysiwyg/ncepcr/tools/PCMH/using-health-it-to-support-qi.pdf
March 01, 2015 - in its strategic plan for health IT and proposed health IT as a tool to
improve patient safety, reduce … Building on this input, OCHIN has developed a set of
common quality indicators for the collaborative … OCHIN members also use EHR-based registries and dashboards to track quality indicators
for patients … For example, the EHR-based
diabetes dashboard displays a number of key indicators, including whether … Each indicator produces a score for the patient; patients with outdated tests and health indicators
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digital.ahrq.gov/ahrq-funded-projects/tools-optimizing-medication-safety-top-meds/citation/indication-based
January 01, 2023 - Indication-based prescribing prevents wrong-patient medication errors in computerized provider order … Indication-based prescribing prevents wrong-patient medication errors in computerized provider order … Principal Investigator
Lambert, Bruce
Project Name
Tools for Optimizing Medication Safety
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psnet.ahrq.gov/primer/radiation-safety
September 15, 2024 - This Patient Safety Primer will discuss the safety issues associated with the use of radiation, both … May 25, 2011
An international review of patient safety measures in radiotherapy practice. … July 8, 2009
National Voluntary Consensus Standards for Patient Safety Measures: A Consensus Report … October 18, 2023
Radiographers' experience of preventing patient safety incidents in … September 29, 2017
Society of Interventional Radiology IR Pre-Procedure Patient Safety
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www.ahrq.gov/hai/cauti-tools/phys-championsgd/section8.html
October 01, 2015 - Infections
Preamble and Summary
Epidemiology of Invasive Devices and Complications
Examples of Patient … Harm Related to Invasive Devices
Preventing Device-Associated Infections
Resident Physicians as Safety … perioperative use in selected surgeries, need for prolonged immobilization, monitoring fluids in critically ill patients … It builds the capacity to address safety issues by combining clinical best practices and the science … of safety.
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psnet.ahrq.gov/sites/default/files/2020-06/final_june-spotlight_case_slides_06.12.2020.pdf
January 01, 2020 - safety targets associated with this case … SAFETY TARGETS
12
Patient Safety Targets
The following were unmet in this case
1. … safety because of the difficulty in
monitoring for over-sedation; determining whether a patient is … Can nurses shift work jeopardize patient safety? A systematic review. … The impact of new graduate nurse transition programs on competency development and
patient safety:
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effectivehealthcare.ahrq.gov/sites/default/files/related_files/cer-205-predictors-trauma-care-evidence-summary.pdf
April 01, 2018 - and
Quality in conjunction with the sponsoring partner
agency, the National Highway Transportation Safety … If the indicators of high-risk patients were
consistent, cleaner comparisons could be made both across … Washington, DC:
National Highway Traffic Safety Administration; February 2013. … Prehospital triage in
the injured pediatric patient. … Decision tool for the
early diagnosis of trauma patient hypovolemia.
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psnet.ahrq.gov/node/49569/psn-pdf
September 01, 2008 - Because of decreasing oxygen levels and worsening mental status, the patient required transfer back to … Indicators of tubesite during feedings. J Neurosci Nurs.
2005;37:320-325. [go to PubMed]
7. … Indicators of postpyloric feeding tube placement in
children. Crit Care Med. 2000;28:2962-2966. … National Patient Safety Agency. … Jt Comm J Qual Patient Saf. 2008;34:285-292.
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www.ahrq.gov/hai/tools/surgery/tools/surgical-complication-prevention/normothermia-audit.html
December 01, 2017 - Normothermia Audit Tool
AHRQ Safety Program for Surgery
Introduction
Problem … Statement
Patients’ perioperative core temperatures should be maintained at normothermia to prevent … Purpose of This Tool
This tool will help your safety program team understand how consistently you maintain … A safety program team member may collect data retrospectively from patient charts. … patient moves through your perioperative area.
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psnet.ahrq.gov/node/838079/psn-pdf
September 14, 2022 - Exploring the impact of employee engagement and
patient safety. … Exploring the impact of employee engagement and patient safety. … https://psnet.ahrq.gov/issue/exploring-impact-employee-engagement-and-patient-safety
Healthcare worker … safety, but
research assessing the impact on patient safety outcomes is in its infancy. … https://psnet.ahrq.gov/issue/exploring-impact-employee-engagement-and-patient-safety
https://psnet.ahrq.gov
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psnet.ahrq.gov/issue/systematic-review-effectiveness-interruptive-medication-prescribing-alerts-hospital-cpoe
August 17, 2016 - An Annual Perspective discussed CPOE as it relates to patient safety. … October 10, 2012
The impact of drug shortages on patients with cardiovascular disease … July 10, 2024
Revealing and resolving patient safety defects: the impact of leadership … WalkRounds on frontline caregiver assessments of patient safety. … April 22, 2020
The prevalence of dose errors among paediatric patients in hospital wards
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www.ahrq.gov/sites/default/files/wysiwyg/research/findings/nhqrdr/2021qdr-intro-methods.pdf
December 01, 2021 - In
addition, the area of patient safety was expanded to include sections on healthcare-associated
infections … and patient safety culture. … Limitations With the Medicare Patient Safety Monitoring System Data
For these measures, “hospital patients … Hospital Conditions report (https://www.ahrq.gov/sites/default/
files/wysiwyg/professionals/quality-patient-safety … https://www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/pfp/Updated-hacreportFInal2017data.pdf
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psnet.ahrq.gov/issue/use-patient-pictures-and-verification-screens-reduce-computerized-provider-order-entry-errors
November 16, 2022 - safety collaborative. … August 10, 2022
Challenges in ethics, safety, best practices, and oversight regarding … HIT vendors, their customers, and patients: a report of an AMIA special task force. … June 12, 2019
Perspectives on anesthesia and perioperative patient safety: past, present … safety.
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effectivehealthcare.ahrq.gov/sites/default/files/pdf/angina-heart-attack-treatments_research-protocol.pdf
December 11, 2012 - effectiveness and safety differ? … and safety differ? … and safety differ? … acute coronary syndrome a
meta-analysis of individual patient data. … followed by an
infusion of 1.75
mg/kg/hr (if CrCl< 30
ml/min reduce
infusion to 1.0
mg/kg/hr, if patient
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/cauti-tools/archived-webinars/connecting-dots-100813.ppt
January 01, 2013 - the safety of patients. … safety indicators on the y axis. … Patients hear what we say and see what we do. … Exploring relationships between patient safety culture
and patients’ assessments of hospital care. … Exploring relationships between patient safety culture and patients’ assessments of hospital care.
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/cauti-tools/impl-guide/implementation-guide-appendix-h.docx
June 02, 2025 - Remove that Foley
AHRQ Safety Program for Reducing CAUTI in Hospitals
Appendix H. … Foley catheters can cause:
· Infections
· Length of Stay
· Cost
· Patient Discomfort
· Antibiotic … Use
Urinary catheters confine patients to bed, making them more immobile and thus increasing their … indwelling urinary catheter on admission
· Accurate measurement of urinary output in critically ill patients … Incontinence
· Prolonged postoperative use
· Morbid obesity
· Immobility
· Confusion or dementia
· Patient
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digital.ahrq.gov/ahrq-funded-projects/using-it-improve-quality-cardiovascular-disease-cvd-prevention-and-management/annual-summary/2010
January 01, 2010 - Kaiser Foundation Research Institute
Funding Mechanism
RFA: HS07-002: Ambulatory and Safety … related physicians’ prior index scores to subsequent disease incidence and to care utilization in their patients … scores would be associated with lower rates of incident CVD and health care utilization within each patient … addressed including organizational deficiencies, clinician failure to recommend appropriate services, and patient … In settings where EMR data are accessible to providers and patients, the PI and DMI evaluate care based
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psnet.ahrq.gov/node/34594/psn-pdf
January 04, 2017 - Eisenberg Patient Safety Awards. … Eisenberg Patient Safety Awards. … https://psnet.ahrq.gov/issue/john-m-eisenberg-patient-safety-awards-leapfrog-group-patient-safety-
rewarding-higher … https://psnet.ahrq.gov/issue/john-m-eisenberg-patient-safety-awards-leapfrog-group-patient-safety-rewarding-higher … https://psnet.ahrq.gov/issue/john-m-eisenberg-patient-safety-awards-leapfrog-group-patient-safety-rewarding-higher