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psnet.ahrq.gov/node/46496/psn-pdf
October 11, 2017 - Lessons learned for reducing the negative impact of
adverse events on patients, health professionals and
healthcare organizations.
October 11, 2017
Mira JJ, Lorenzo S, Carrillo I, et al. Lessons learned for reducing the negative impact of adverse events on
patients, health professionals and healthcare organization…
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psnet.ahrq.gov/node/35762/psn-pdf
January 02, 2017 - Using Failure Mode and Effects Analysis for safe
administration of chemotherapy to hospitalized children
with cancer.
January 2, 2017
Robinson DL, Heigham M, Clark J. Using Failure Mode and Effects Analysis for safe administration of
chemotherapy to hospitalized children with cancer. Jt Comm J Qual Patient Saf. 20…
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psnet.ahrq.gov/node/44156/psn-pdf
November 10, 2015 - Exploring the role of communications in quality
improvement: a case study of the 1000 Lives Campaign in
NHS Wales.
November 10, 2015
Cooper A, Gray J, Willson A, et al. Exploring the role of communications in quality improvement: A case
study of the 1000 Lives Campaign in NHS Wales. J Commun Healthc. 2015;8(1):76-…
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psnet.ahrq.gov/node/43127/psn-pdf
April 23, 2014 - An interprofessional qualitative study of barriers and
potential solutions for the safe use of insulin in the
hospital setting.
April 23, 2014
Rousseau M-P, Beauchesne M-F, Naud A-S, et al. An interprofessional qualitative study of barriers and
potential solutions for the safe use of insulin in the hospital settin…
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psnet.ahrq.gov/node/43345/psn-pdf
July 16, 2014 - Avoiding potential harm by improving appropriateness of
urinary catheter use in 18 emergency departments.
July 16, 2014
Fakih MG, Heavens M, Grotemeyer J, et al. Avoiding potential harm by improving appropriateness of
urinary catheter use in 18 emergency departments. Ann Emerg Med. 2014;63(6):761-8.e1.
doi:10.1016…
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psnet.ahrq.gov/node/44181/psn-pdf
June 03, 2015 - Preventing device-associated infections in US hospitals:
national surveys from 2005 to 2013.
June 3, 2015
Krein SL, Fowler KE, Ratz D, et al. Preventing device-associated infections in US hospitals: national
surveys from 2005 to 2013. BMJ Qual Saf. 2015;24(6):385-92. doi:10.1136/bmjqs-2014-003870.
https://psnet.ah…
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psnet.ahrq.gov/node/38098/psn-pdf
March 03, 2011 - Quality of clinical aspects of call handling at Dutch out of
hours centres: cross sectional national study.
March 3, 2011
Derkx HP, Rethans J-JE, Muijtjens AM, et al. Quality of clinical aspects of call handling at Dutch out of
hours centres: cross sectional national study. BMJ. 2008;337:a1264. doi:10.1136/bmj.a126…
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psnet.ahrq.gov/node/837037/psn-pdf
May 04, 2022 - Humanizing harm: using a restorative approach to heal
and learn from adverse events.
May 4, 2022
Wailling J, Kooijman A, Hughes J, et al. Humanizing harm: Using a restorative approach to heal and learn
from adverse events. Health Expect. 2022;25(4):1192-1199. doi:10.1111/hex.13478.
https://psnet.ahrq.gov/issue/hum…
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psnet.ahrq.gov/node/60973/psn-pdf
September 30, 2020 - During the pandemic, aspire to identify and prevent
medication errors and to avoid blaming attitudes.
September 30, 2020
ISMP Medication Safety Alert! Acute care edition. August 27, 2020;25(17).
https://psnet.ahrq.gov/issue/during-pandemic-aspire-identify-and-prevent-medication-errors-and-avoid-
blaming-attitudes
…
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effectivehealthcare.ahrq.gov/sites/default/files/cf_deliberativemethodswebinar_synthesizingoutputs.pdf
May 29, 2025 - Slide 1
Synthesizing the Outputs of
Deliberative Forum
Julia Abelson, PhD
Department of Clinical Epidemiology & Biostatistics
McMaster University
Hamilton, Ontario CANADA
1
Linking deliberation objectives to outputs
• What is the expected deliverable of the
deliberation?
-To elicit val…
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psnet.ahrq.gov/node/45128/psn-pdf
June 15, 2016 - Society of Interventional Radiology IR Pre-Procedure
Patient Safety Checklist by the Safety and Health
Committee.
June 15, 2016
Rafiei P, Walser EM, Duncan JR, et al. Society of Interventional Radiology IR Pre-Procedure Patient Safety
Checklist by the Safety and Health Committee. J Vasc Interv Radiol. 2016;27(5):6…
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digital.ahrq.gov/organization/group-health-cooperative
January 01, 2023 - Group Health Cooperative
Understanding and Honoring Patients with Multiple Chronic Conditions
Description
This project determined care priorities for patients with multiple chronic conditions based on patient needs, preferences, and capabilities and developed a set of recommen…
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psnet.ahrq.gov/node/838641/psn-pdf
October 19, 2022 - Optimizing Pediatric Patient Safety in the Emergency Care
Setting.
October 19, 2022
Joseph MM, Mahajan P, Snow SK, et al. Optimizing Pediatric Patient Safety in the Emergency Care
Setting. Pediatrics. 2022;150(5):e2022059673. doi:10.1542/peds.2022-059673.
https://psnet.ahrq.gov/issue/optimizing-pediatric-patient-s…
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psnet.ahrq.gov/node/852698/psn-pdf
August 30, 2023 - The e-Autopsy/e-Biopsy: A Systematic Chart Review to
Increase Safety and Diagnostic Accuracy Innovation
August 30, 2023
https://psnet.ahrq.gov/innovation/e-autopsye-biopsy-systematic-chart-review-increase-safety-and-
diagnostic-accuracy
Summary
Addressing diagnostic errors to improve outcomes and patient safety h…
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hcup-us.ahrq.gov/datainnovations/clinicalcontentenhancementtoolkit/ny10.pdf
July 31, 2012 - Instructions for Extracting and Submitting
Data Submission Instructions 2/22/2012 Page 1
Instructions for Extracting and Submitting
Laboratory Data for the Study Using Clinically-
Enhanced Claims Data to Guide the Selection of
Coronary Procedures
A Summary of the Steps…
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/esrd/patfamengagement/patientandfamilyengagement_slides.pptx
September 03, 2014 - PowerPoint Presentation
Patient Engagement in Hemodialysis Facilities
1
Objectives
Understand what patient and family engagement is in the context of end-stage renal disease (ESRD)
Learn how to recognize and overcome obstacles to engaging patients and their families
Equip your facility to engage patients in each …
-
psnet.ahrq.gov/node/73642/psn-pdf
August 25, 2021 - Sudden Collapse During Upper Gastrointestinal
Endoscopy: Expect the Unexpected
August 25, 2021
Wieck M. Sudden Collapse During Upper Gastrointestinal Endoscopy: Expect the Unexpected. PSNet
[internet]. 2021.
https://psnet.ahrq.gov/web-mm/sudden-collapse-during-upper-gastrointestinal-endoscopy-expect-
unexpected
…
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www.ahrq.gov/sites/default/files/wysiwyg/hai/tools/mrsa/008-antibiotic-stewardship-slides.pptx
October 01, 2022 - AHRQ Safety Program for MRSA Prevention
AHRQ Safety Program for MRSA Prevention
Antibiotic Stewardship and MRSA Reduction
ICU & Non-ICU
AHRQ Pub. No. 25-0007
October 2024
AHRQ Safety Program for MRSA Prevention | ICU & Non-ICU
Antibiotic Stewardship
1
Educational Objectives
Understand the goals of antibiotic ste…
-
www.ahrq.gov/sites/default/files/2024-10/landrigan3-report.pdf
January 01, 2024 - Final Progress Report: Developing a Risk Index of Healthcare Provider Alertness To Improve Safety
Developing a Risk Index of Healthcare Provider
Alertness to Improve Safety
Final Progress Report – May 31, 2011
Principal Investigator: Christopher P. Landrigan, M.D., M.P.H.
Team Members: Dennis A. Dean, Scott A. …
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www.ahrq.gov/sites/default/files/wysiwyg/cahps/surveys-guidance/cg/about/measures-cg30-2309.pdf
June 01, 2017 - Patient Experience Measures from the CAHPS Clinician & Group Survey
Patient Experience Measures from the CAHPS Clinician & Group Survey
CAHPS® Clinician & Group Survey and Instructions
Patient Experience Measures from the
CAHPS® Clinician & Group Survey
Introduction ...................................…