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5081. Final Progress Report: Reducing Adverse Drug Events From Anticoagulants, Diabetes Agents and Opioids in Primary Care (pdf file)
      www.ahrq.gov/sites/default/files/2024-01/wessell2-report.pdf
      January 01, 2024 - Final Progress Report: Reducing Adverse Drug Events From Anticoagulants, Diabetes Agents and Opioids in Primary Care Final Progress Report Reducing Adverse Drug Events from Anticoagulants, Diabetes Agents and Opioids in Primary Care Principal Investigator: Andrea M. Wessell, PharmD Team Members: Steven M. Orns…

5082. Final Progress Report: Creating Safe Ambulatory Care: The Path to Resilience (pdf file)
      www.ahrq.gov/sites/default/files/2025-04/nemeth-report.pdf
      January 01, 2025 - Final Progress Report: Creating Safe Ambulatory Care: The Path to Resilience 28 November 2009 Title of Project Creating Safe Ambulatory Care: The Path to Resilience Principal Investigator Christopher Nemeth, PhD Team Members James Walter, MD Robert Wears, MD, MS Richard Cook, MD Organization The University of Ch…

5083. Final Progress Report: Validation of an Innovative Approach to Error Reduction (pdf file)
      www.ahrq.gov/sites/default/files/2024-11/blumenthal-report.pdf
      January 01, 2024 - Final Progress Report: Validation of an Innovative Approach to Error Reduction Final Progress Report Validation of an Innovative Approach To Error Reduction Principal Investigator: David Blumenthal, MD, MPP Team Members: Carlos A. Camargo, Jr., MD, DrPH (Massachusetts General Hospital) Paul D. Cleary, PhD (Yale…

5084. The New York Model: Root Cause Analysis Driving Patient Safety Initiative to Ensure Correct Surgical and Invasive Procedures (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol1/Advances-Faltz_56.pdf
      March 27, 2008 - The New York Model: Root Cause Analysis Driving Patient Safety Initiative to Ensure Correct Surgical and Invasive Procedures 1 The New York Model: Root Cause Analysis Driving Patient Safety Initiative to Ensure Correct Surgical and Invasive Procedures Lawrence L. Faltz, MD, FACP; John N. Morley, MD, FACP…

5085. Puh-Electronic-Reports (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/long-term-care/resources/ontime/pruhealing/puh-electronic-reports.pdf
      February 10, 2014 - AHRQ’s Safety Program for Nursing Homes: On-Time Pressure Ulcer Healing Electronic Reports On-Time Existing Pressure Ulcers Report Table 1: Sample On-Time Existing Pressure Ulcers Report On-Time Existing Pressure Ulcers Report Unit: A Date: 02/10/14 Resident Name (last, first) Room Number Days …

5086. Medication Discrepancies and Potential Adverse Drug Events During Transfer of Care from Hospital to Home | Agency for Healthcare Research and Quality
      www.ahrq.gov/patient-safety/reports/liability/neumiller.html
      August 01, 2017 - Advances in Patient Safety and Medical Liability Medication Discrepancies and Potential Adverse Drug Events During Transfer of Care from Hospital to Home Previous Page   Table of Contents Advances in Patient Safety and Medical Liability Preface Acknowledgments Prologue Silence A Commentary …

5087. Observing Nurse Interaction with Infusion Pump Technologies (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol2/Carayon.pdf
      January 01, 2004 - Observing Nurse Interaction with Infusion Pump Technologies 349 Observing Nurse Interaction with Infusion Pump Technologies Pascale Carayon, Tosha B. Wetterneck, Ann Schoofs Hundt, Mustafa Ozkaynak, Prashant Ram, Joshua DeSilvey, Brian Hicks, Tanita L. Robert, Myra Enloe, Rupa Sheth, Sade Sobande Abstract…

5088. Work System Analysis: The Key to Understanding Health Care Systems (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol2/Karsh.pdf
      April 22, 2004 - Work System Analysis: The Key to Understanding Health Care Systems 337 Work System Analysis: The Key to Understanding Health Care Systems Ben-Tzion Karsh, Samuel J. Alper Abstract Many articles in the medical literature state that medical errors are the result of systems problems, require systems analyses, a…

5089. Barcode Medication Administration: Lessons Learned from an Intensive Care Unit Implementation (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol3/Wideman.pdf
      April 20, 2004 - Barcode Medication Administration: Lessons Learned from an Intensive Care Unit Implementation 437 Barcode Medication Administration: Lessons Learned from an Intensive Care Unit Implementation Mary V. Wideman, Michael E. Whittler, Timothy M. Anderson Abstract An electronic barcode medication administration sy…

5090. Final Progress Report: Do Safety Warnings Change Prescribing Among the US Dialysis Population? (pdf file)
      www.ahrq.gov/sites/default/files/2024-01/thamer-report.pdf
      January 01, 2024 - Final Progress Report: Do Safety Warnings Change Prescribing Among the US Dialysis Population? Principal Investigator: Thamer, Mae FINAL REPORT TITLE PAGE Title: Do Safety Warnings Change Prescribing among the US Dialysis Population? Principal Investigator and Team Members: M Thamer, PI, and other team members (…

5091. Compendium of U.S. Health Systems, 2016, Hospital Linkage File, Technical Documentation (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/chsp/compendium/chsp_linkage_file_tech_doc.pdf
      October 01, 2018 - Compendium of U.S. Health Systems, 2016, Hospital Linkage File, Technical Documentation Comparative Health System Performance Initiative: Compendium of U.S. Health Systems, 2016, Hospital Linkage File, Technical Documentation Prepared for: Agency for Healthcare Research and Quality U.S. Department of …

5092. Pennsylvania Psychiatric Institute Slashes Readmission Rates with AHRQ-based Discharge Program | Agency for Healthcare Research and Quality
      www.ahrq.gov/news/newsroom/case-studies/201706.html
      May 01, 2017 - Pennsylvania Psychiatric Institute Slashes Readmission Rates with AHRQ-based Discharge Program Search All Impact Case Studies May 2017 The Pennsylvania Psychiatric Institute in Harrisburg reduced its 30-day readmission rate from 20 percent in 2013 to 10.4 percent in 2015 after implementing a discharge progr…

5093. Tools & Resources for Decolonization | Agency for Healthcare Research and Quality
      www.ahrq.gov/hai/tools/mrsa-prevention/toolkit/tools-resources-decolonization.html
      October 01, 2024 - MRSA Prevention Toolkit: ICUs & Non-ICUs Tools & Resources for Decolonization Previous Page Next Page Table of Contents MRSA Prevention Toolkit: ICUs & Non-ICUs The Four Key Strategies of MRSA Prevention The Importance of MRSA Prevention Decolonization Tools & Resources for Decolonization …

5094. Checklist: Creating a Medicine List When Patient Brings Medicines (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-family-engagement/pfeprimarycare/medicinelist-checklist-meds-final508.pdf
      June 02, 2025 - Checklist: Creating a Medicine List When Patient Brings Medicines The Guide to Improving Patient Safety in Primary Care Settings by Engaging Patients and Families Checklist: Creating a Medicine List When patient brings medicines Starting the Process � Thank the patient for bringing in his or her medicines. � Us…

5095. Medication Management: Common Barriers to Medication Adherence (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-family-engagement/pfeprimarycare/medication-mgmt-common-barriers-card-4x6.pdf
      June 02, 2025 - Medication Management: Common Barriers to Medication Adherence Common Barriers to Medication Adherence What Patients Might Say Possible Solutions My medicine makes me feel sick. Prescribe a substitute medication; change the dose. I feel fine. Explain how the patient’s disease affects the body. I forget. F…

5096. New AHRQ SOPS® Workplace Safety Supplemental Items for Hospitals - McGaffigan (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/sops/events/webinar/03-new-sops-workplace-safety-mcgaffigan.pdf
      December 01, 2020 - New AHRQ SOPS® Workplace Safety Supplemental Items for Hospitals - McGaffigan Workforce Safety Patricia McGaffigan, RN, MS, CPPS pmcgaffigan@ihi.org; @Pmcgaffigan_IHI mailto:pmcgaffigan@ihi.org Why Workforce Safety Matters Workforce safety is essential for safe, high- quality care and is preconditional to …

5097. Sustainability-Tool (doc file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/ambulatory-surgery/sections/sustainability/training-tools/sustainability-tool.docx
      May 01, 2017 - AHRQ Safety Program for Ambulatory Surgery Module 4: Sustainability Sustainability Tool Background: This tool can be used to identify sustainability issues in planning and implementing your improvement efforts. How to use this tool: The Implementation Team leader (or individual designated by the leader) should comple…

5098. Please bring ALL your medicines to your next appointment. (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-family-engagement/pfeprimarycare/medmanage-ptfactsheet.pdf
      June 02, 2025 - Please bring ALL your medicines to your next appointment. Please Bring ALL Your Medicines to Your Next Appointment You will work with your health care team to make a medicine list. Please make sure you bring (in the original container)... � Prescription medicines. � Medicines you buy without a prescription (…

5099. Module 6: Laying the Groundwork for Care Coordination | Agency for Healthcare Research and Quality
      www.ahrq.gov/takeheart/training/module-6/index.html
      December 01, 2022 - Module 6: Laying the Groundwork for Care Coordination   YouTube embedded video: https://www.youtube-nocookie.com/embed/Zvp6SFaH-8g Video: Laying the Groundwork for Care Coordination (1:00:12) Slides: Laying the Groundwork for Effective Care Coordination (PDF, 1.4 MB) Implementation Guide:  Laying th…

5100. Term of Award: Pilot for Enhancement of Contractor Employee Whistleblower Protections | Agency for Healthcare Research and Quality
      www.ahrq.gov/funding/grant-mgmt/whistleblowers.html
      December 01, 2013 - Term of Award: Pilot for Enhancement of Contractor Employee Whistleblower Protections As of July 2013, a new Term of Award, Pilot for Enhancement of Contractor Employee Whistleblower Protections, applies to all grants of AHRQ. General Term and Condition Grantees are hereby given notice that the 48 CFR secti…