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3481. Meeting Minutes, November 2017 | Agency for Healthcare Research and Quality
      www.ahrq.gov/news/events/nac/2017-11-nac/nacmtg1117-minutes.html
      February 01, 2018 - Meeting Minutes, November 2017 National Advisory Council Minutes from the November 3, 2017, meeting of the Agency for Healthcare Research and Quality's National Advisory Council. Contents Summary Call to Order and Approval of July 26, 2017, Summary Report Director's Update The Healthcare Cost and Ut…

3482. Identifying, Understanding, and Communicating Medical Device Use Errors: Observations from an FDA Pilot Program (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol3/Flack.pdf
      January 01, 2005 - Identifying, Understanding, and Communicating Medical Device Use Errors: Observations from an FDA Pilot Program 223 Identifying, Understanding, and Communicating Medical Device Use Errors: Observations from an FDA Pilot Program Marilyn Flack, Terrie Reed, Jay Crowley, Susan Gardner Abstract The U.S. Food an…

3483. Presentation: Implementing Your SSI Prevention Bundle
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/surgery/modules/implementation/imp_ssibundle.pptx
      December 01, 2017 - Presentation: Implementing Your SSI Prevention Bundle Implementing Your Surgical Site Infection Prevention Bundle AHRQ Safety Program for Surgery Implementation AHRQ Pub. No. 16(18)-0004-15-EF December 2017 AHRQ Safety Program for Surgery – Implementation This module is about implementing your surgical site infe…

3484. 2015 CAHPS Clinician & Group Survey Database Chartbook (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/cahps/cahps-database/2015_cg_cahps_chartbook.pdf
      January 01, 2015 - 2015 CAHPS Clinician & Group Survey Database Chartbook THE CAHPS DATABASE 2015 CAHPS Clinician & Group Survey Database 2015 Chartbook: What Patients Say About Their Health Care Providers and Medical Practices AHRQ Contract No.: HHSA290201300003C Managed and prepared by: Westat, Rockville, MD D…

3485. Issue Brief 26: Exploration of Foundational Terminology and Paradigms for Improving Diagnosis (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/diagnostic/resources/issue-briefs/dxsafety-terminology.pdf
      April 01, 2025 - Issue Brief 26: Exploration of Foundational Terminology and Paradigms for Improving Diagnosis Issue Brief #26 Exploration of Foundational Terminology and Paradigms for Improving Diagnosis Prepared for: Monika Haugstetter, M.H.A., M.S.N., R.N., CPHQ Contract Officer Representative Agency for Healthc…

3486. AHRQ-Funded Patient Safety Project Highlights: Improving Healthcare Safety by Enhancing Teamwork and Leadership (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/patient-safety/highlights/ps-project-highlights-teamwork-leadership-2025.pdf
      January 01, 2025 - In addition, most hospitals had not implemented recommended practices. … Based on the findings, researchers recommended that AHRQ continue the National Implementation of TeamSTEPPS

3487. Final Progress Report: Engineering Safe Care Journeys for Vulnerable Older Adults (pdf file)
      www.ahrq.gov/sites/default/files/2025-03/smith-werner-carayon-report.pdf
      January 01, 2025 - clinical or community resources, notifications sent to the primary care physician regarding the risk and recommended … passport to each subsequent healthcare setting, which in turn will review the passport and implement the recommended

3488. Making Healthcare Safer Practices: 12. Infusion Pumps (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/research/findings/making-healthcare-safer/mhs3/infusion-pumps-1.pdf
      March 01, 2020 - harms averted (defined as high risk drugs being programmed by the nurse 2.5 times or greater than recommended … Ferguson et al., 20104 Hospital was following all the patient-controlled analgesia (PCA) guidelines recommended

3489. Final Progress Report: Risk-Informed Interventions in Community Pharmacy: Implementation and Evaluation (pdf file)
      www.ahrq.gov/sites/default/files/2024-02/cohen2-report.pdf
      January 01, 2024 - ensure the output of each Scorecard focused on the most crucial vulnerabilities to be addressed and recommended … because they can appreciate the causes of errors and perceive the utility, in quantifiable terms, of the recommended

3490. Pocket Guide: TeamSTEPPS: Strategies & Tools to Enhance Performance and Patient Safety (pdf file)
      www.ahrq.gov/sites/default/files/publications/files/pocketguide.pdf
      January 01, 2020 - Pocket Guide: TeamSTEPPS: Strategies & Tools to Enhance Performance and Patient Safety Pocket Guide Team Strategies & Tools to Enhance Performance and Patient Safety 2 Table of Contents TeamSTEPPS® • Framework and Competencies ....4 • Key Principles ...............................5 Team Structure • Multi-T…

3491. Advanced Methods in Delivery System Research - Planning, Executing, Analyzing, and Reporting Research on Delivery System Improvement | Agency for Healthcare Research and Quality
      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…

3492. Section 2: Explanation and Value of the TeamSTEPPS Curriculum  | Agency for Healthcare Research and Quality
      www.ahrq.gov/teamstepps-program/curriculum/intro/explain.html
      July 01, 2023 - Section 2: Explanation and Value of the TeamSTEPPS Curriculum  This section contains explanations and illustrations to help you better understand and appreciate the structure and importance of the TeamSTEPPS curriculum and its key concepts. If you teach this content or want additional insights into how the mate…

3493. AHRQ New Models of Primary Care Workforce and Financing - Executive Summary (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/primary-care/workforce-financing/workforce-executive-summary.pdf
      October 01, 2016 - AHRQ New Models of Primary Care Workforce and Financing - Executive Summary New Models of Primary Care Workforce and Financing Executive Summary AHRQ New Models of Primary Care Workforce and Financing Executive Summary Prepared for: Agency for Healthcare Research and …

3494. Turning Data Into Action—Using HSOPS and SSI Data as Part of a Meaningful Change: Facilitator Notes | Agency for Healthcare Research and Quality
      www.ahrq.gov/hai/tools/surgery/modules/on-boarding/data-into-action-fac-notes.html
      December 01, 2017 - Turning Data Into Action—Using HSOPS and SSI Data as Part of a Meaningful Change: Facilitator Notes AHRQ Safety Program for Surgery Slide 1: Turning Data Into Action: Using HSOPS and SSI Data as Part of a Meaningful Change Say: In this module, you’ll learn about using data as part of your team’s improve…

3495. Facilitator Guide for Hospital AIM Team Leads (doc file)
      www.ahrq.gov/sites/default/files/wysiwyg/hai/tools/perinatal-care-2/sppcii-facilitator-guide.docx
      July 01, 2023 - Facilitator Guide for Hospital AIM Team Leads Facilitator Guide for Hospital AIM Team Leads What Is This Guide? This guide is intended as a complement to the online training modules of the Safety Program for Perinatal Care II (SPPC-II) Teamwork Toolkit. It provides helpful information about scheduling and conducting …

3496. Appendix C. Case Study and Program Examples | Agency for Healthcare Research and Quality
      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…

3497. AHRQ Safety Program for Perinatal Care: Monitoring for Perinatal Safety: Assemble the Team and Engage Leadership
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/perinatal-care/modules/teamwork/assemble/assemble-the-team.pptx
      May 01, 2017 - AHRQ Safety Program for Perinatal Care: Monitoring for Perinatal Safety: Assemble the Team and Engage Leadership AHRQ Safety Program for Perinatal Care Assemble the Team and Engage Leadership for Perinatal Safety AHRQ Publication No. 17-0003-2-EF May 2017 1 Learning Objectives 2 AHRQ Safety Program for Perinata…

3498. AHRQ Safety Program for Perinatal Care: Sample Scenario for Postoperative Cesarean Section Complication In Site Simulation (doc file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/perinatal-care/modules/situ/simulation_postop-csection.docx
      May 01, 2017 - AHRQ Safety Program for Perinatal Care: Sample Scenario for Postoperative Cesarean Section Complication In Site Simulation AHRQ Safety Program for Perinatal Care Sample Scenario for Postoperative Cesarean Section Complication In Situ Simulation Sample Scenario for Postoperative Cesarean Section Complication In Situ …

3499. E-Fetal-Monitoring Facguide (doc file)
      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…

3500. AHRQ Safety Program for Perinatal Care: Sample Scenario for Umbilical Cord Prolapse In Situ Simulation (doc file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/perinatal-care/modules/situ/simulation_cord-prolapse.docx
      May 01, 2017 - AHRQ Safety Program for Perinatal Care: Sample Scenario for Umbilical Cord Prolapse In Situ Simulation AHRQ Safety Program for Perinatal Care Sample Scenario for Umbilical Cord Prolapse In Situ Simulation Sample Scenario for Umbilical Cord Prolapse In Situ Simulation Purpose of the tool: The Umbilical Cord Prolapse …