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psnet.ahrq.gov/node/42854/psn-pdf
March 20, 2014 - Medication event huddles: a tool for reducing adverse
drug events.
March 20, 2014
Morvay S, Lewe D, Stewart B, et al. Medication event huddles: a tool for reducing adverse drug events. Jt
Comm J Qual Patient Saf. 2014;40(1):39-45.
https://psnet.ahrq.gov/issue/medication-event-huddles-tool-reducing-adverse-drug-eve…
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psnet.ahrq.gov/node/39525/psn-pdf
March 13, 2019 - Effect of bar-code technology on the safety of medication
administration.
March 13, 2019
Poon EG, Keohane C, Yoon CS, et al. Effect of bar-code technology on the safety of medication
administration. New Engl J Med. 2010;362(18):1698-1707. doi:10.1056/NEJMsa0907115.
https://psnet.ahrq.gov/issue/effect-bar-code-tech…
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psnet.ahrq.gov/node/866846/psn-pdf
September 24, 2024 - Zero Harm: Striving to Reduce Preventable Harms – Point,
Counterpoint, and Areas of Agreement
September 24, 2024
Stockmeier CA, Thomas E, Mossburg S, et al. Zero Harm: Striving to Reduce Preventable Harms – Point,
Counterpoint, and Areas of Agreement. PSNet [internet]. 2023.
https://psnet.ahrq.gov/perspective/zero…
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www.ahrq.gov/sites/default/files/wysiwyg/patient-safety/highlights/ps-project-highlights-hit-hie-2025.pdf
January 01, 2025 - Consistency in navigation elements such as buttons for submission and going
back reduces errors due … importation into major EHR
systems, particularly for vital signs and laboratory data, which significantly
reduces
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www.uspreventiveservicestaskforce.org/home/getfilebytoken/ERYP-oE5C6JuSVZogm3Nyj
September 02, 2025 - Summary of USPSTF Draft Recommendation: Screening and Behavioral Counseling Interventions to Reduce Unhealthy Alcohol Use in Adolescents and Adults
1
The Task Force is a scientifically independent, volunteer panel of national experts in
prevention and evidence-based medicine that w…
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www.ahrq.gov/sites/default/files/wysiwyg/hai/tools/mrsa-2/129-ss-blank-lfd.docx
April 01, 2025 - AHRQ Safety Program for MRSA Prevention: Targeting SSI
Learning From Defects Tool
Surgical Services
For: Cardiac, Hip and Knee Joint Replacement, and Spinal Fusion Surgeries
What Is a Defect?
A defect is any clinical or operational event or situation that you would not want to happen again. This could include incidents…
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www.ahrq.gov/patient-safety/settings/hospital/resource/guide/web3.html
December 01, 2017 - Webinar 3: Review & Update Readmission Reduction Efforts: Slide Presentation
Designing & Delivering Whole-Person Transitional Care: The Hospital Guide to Reducing Medicaid Readmissions
Text version of Webinar slide presentation.
Slide 1: Designing & Delivering Whole-Person Transitional Care
Designing & …
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www.uspreventiveservicestaskforce.org/home/getfilebytoken/c97uqjXbUHjNuoNDkvChZu
August 01, 2013 - specificity, 73% to 94%) are used; use of higher
cutoff points increases specificity to an extent but reduces
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www.ahrq.gov/sites/default/files/wysiwyg/hai/tools/clabsi-cauti-icu/urinary-retention.pdf
April 01, 2022 - Making It Work Tip Sheet: Managing Urinary Retention and Catheterization in Intensive Care Unit Patients With Primary Neurologic Disorders
AHRQ Safety Program for Intensive Care Units:
Preventing CLABSI and CAUTI
Making It Work Tip Sheet
Managing Urinary Retention and Catheterization in Intensive
Care …
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psnet.ahrq.gov/issue/hamilton-acute-pain-service-safety-study-using-root-cause-analysis-reduce-incidence-adverse
January 12, 2011 - Study
Hamilton Acute Pain Service Safety Study: using root cause analysis to reduce the incidence of adverse events.
Citation Text:
Paul JE, Buckley N, McLean RF, et al. Hamilton acute pain service safety study: using root cause analysis to reduce the incidence of adverse events. Anesth…
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digital.ahrq.gov/ahrq-funded-projects/ai-directed-cds-tool-reduce-iron-deficiency-anemia-pregnancy-randomized
August 01, 2024 - An AI-Directed CDS Tool to Reduce Iron Deficiency Anemia in Pregnancy: A Randomized Controlled Trial (AID-IDA Trial)
Project Description
Integrating a predictive model into the electronic health record (EHR) via a clinical decision support (CDS) tool provides a scalable, resour…
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psnet.ahrq.gov/issue/executivesenior-leader-checklist-improve-culture-and-reduce-central-line-associated
August 25, 2010 - Commentary
Executive/senior leader checklist to improve culture and reduce central line–associated bloodstream infections.
Citation Text:
Goeschel CA, Holzmueller CG, Berenholtz SM, et al. Executive/Senior Leader Checklist to improve culture and reduce central line-associated bloodstream…
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psnet.ahrq.gov/issue/prescription-opioids-medicare-needs-expand-oversight-efforts-reduce-risk-harm
December 06, 2017 - Book/Report
Prescription Opioids: Medicare Needs to Expand Oversight Efforts to Reduce the Risk of Harm.
Citation Text:
Prescription Opioids: Medicare Needs to Expand Oversight Efforts to Reduce the Risk of Harm. Washington, DC: United States Government Accountability Office; October 201…
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psnet.ahrq.gov/issue/how-informatics-nurses-use-bar-code-technology-reduce-medication-errors
August 04, 2021 - Commentary
How informatics nurses use bar code technology to reduce medication errors.
Citation Text:
Gann M. How informatics nurses use bar code technology to reduce medication errors. Nursing (Brux). 2015;45(3):60-6. doi:10.1097/01.NURSE.0000458923.18468.37.
Copy Citation
Format:…
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psnet.ahrq.gov/issue/prescription-opioid-crisis-role-anaesthesiologist-reducing-opioid-use-and-misuse
November 16, 2022 - Review
Emerging Classic
The prescription opioid crisis: role of the anaesthesiologist in reducing opioid use and misuse.
Citation Text:
Soffin EM, Lee BH, Kumar KK, et al. The prescription opioid crisis: role of the anaesthesiologist in reducing opioid use and m…
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psnet.ahrq.gov/issue/interventions-reduce-medication-prescribing-errors-paediatric-cardiac-intensive-care-unit
November 16, 2022 - Study
Interventions to reduce medication prescribing errors in a paediatric cardiac intensive care unit.
Citation Text:
Burmester MK, Dionne R, Thiagarajan RR, et al. Interventions to reduce medication prescribing errors in a paediatric cardiac intensive care unit. Intensive Care Med. …
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psnet.ahrq.gov/issue/new-infusion-syringe-label-system-designed-reduce-task-complexity-during-drug-preparation
February 13, 2019 - Study
A new infusion syringe label system designed to reduce task complexity during drug preparation.
Citation Text:
Merry AF, Webster CS, Connell H. A new infusion syringe label system designed to reduce task complexity during drug preparation. Anaesthesia. 2007;62(5). doi:10.1111/j.1…
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psnet.ahrq.gov/node/37627/psn-pdf
March 19, 2008 - Patient Safety in Obstetrics and Gynecology: Improving
Outcomes, Reducing Risks.
March 19, 2008
Gluck PA, ed. Obstet Gynecol Clin. 2008;35(1):1-168.
https://psnet.ahrq.gov/issue/patient-safety-obstetrics-and-gynecology-improving-outcomes-reducing-risks
This special issue comprehensively addresses the topics of med…
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psnet.ahrq.gov/node/37829/psn-pdf
April 23, 2014 - Hospitals move to reduce risk of night shift.
April 23, 2014
Landro L.
https://psnet.ahrq.gov/issue/hospitals-move-reduce-risk-night-shift
This article reports how hospitals are aiming to boost the safety of care delivered on nights and weekends
by employing "nocturnists" (a hospitalist subspecialty)—physicians wh…
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psnet.ahrq.gov/node/35937/psn-pdf
June 19, 2007 - Ounce of prevention: to reduce errors, hospitals
prescribe innovative designs.
June 19, 2007
Naik G. Wall Street Journal. May 8, 2006; A1.
https://psnet.ahrq.gov/issue/ounce-prevention-reduce-errors-hospitals-prescribe-innovative-designs
This article reports on innovations implemented at a Wisconsin hospital to im…