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psnet.ahrq.gov/node/39962/psn-pdf
September 24, 2016 - Interruptions and medication errors: part I.
September 24, 2016
Flanders S, Clark AP. Interruptions and medication errors: part I. Clin Nurse Spec. 2010;24(6):281-5.
doi:10.1097/NUR.0b013e3181faf78b.
https://psnet.ahrq.gov/issue/interruptions-and-medication-errors-part-i
This commentary discusses preventable medic…
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psnet.ahrq.gov/node/39081/psn-pdf
September 27, 2016 - Medication room madness: calming the chaos.
September 27, 2016
Conrad C, Fields W, McNamara T, et al. Medication room madness: calming the chaos. J Nurs Care Qual.
2010;25(2):137-144. doi:10.1097/NCQ.0b013e3181c3695d.
https://psnet.ahrq.gov/issue/medication-room-madness-calming-chaos
Through space and process desi…
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psnet.ahrq.gov/node/35353/psn-pdf
July 16, 2009 - Best-practice protocols: preventing adverse drug events.
July 16, 2009
Weir VL. Best-practice protocols: preventing adverse drug events. Nurs Manage. 2005;36(9):24-30.
https://psnet.ahrq.gov/issue/best-practice-protocols-preventing-adverse-drug-events
This article reports on one hospital's use of failure modes and …
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psnet.ahrq.gov/node/39652/psn-pdf
June 30, 2010 - Aftercare tips for patients checking out of the hospital.
June 30, 2010
Alderman L. New York Times. June 18, 2010;B6.
https://psnet.ahrq.gov/issue/aftercare-tips-patients-checking-out-hospital
This news piece highlights efforts to improve discharge planning, enhance the safety of care transitions,
and reduce readm…
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psnet.ahrq.gov/node/34001/psn-pdf
April 16, 2018 - Patient Safety Authority.
April 16, 2018
Commonwealth of Pennsylvania
https://psnet.ahrq.gov/issue/patient-safety-authority
The Patient Safety Authority is an independent state agency charged with taking steps to reduce and
eliminate medical errors by identifying problems and recommending solutions. The site inclu…
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psnet.ahrq.gov/node/40761/psn-pdf
September 12, 2016 - Failure to rescue in neonatal care.
September 12, 2016
Gephart SM, McGrath JM, Effken JA. Failure to rescue in neonatal care. J Perinat Neonatal Nurs.
2011;25(3):275-282. doi:10.1097/JPN.0b013e318227cc03.
https://psnet.ahrq.gov/issue/failure-rescue-neonatal-care
This commentary suggests numerous strategies to redu…
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digital.ahrq.gov/organization/university-california-san-diego
January 01, 2023 - University of California, San Diego
Web-Based Intervention for Alcohol Use in Women of Childbearing Potential - 2010
Principal Investigator
Delrahim-Howlett, Katia
Project Name
Web-Based Intervention for Alcohol Use in Women of Childbearing Potential
…
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psnet.ahrq.gov/node/43268/psn-pdf
June 11, 2014 - Medication Safety Program.
June 11, 2014
Atlanta, GA: Centers for Disease Control and Prevention.
https://psnet.ahrq.gov/issue/medication-safety-program
This Web site provides information for providers and patients to reduce risks related to adverse drug
events, including links to fact sheets, research, and govern…
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psnet.ahrq.gov/node/38957/psn-pdf
January 16, 2013 - Diagnostic Error in Medicine.
January 16, 2013
Berner ES, Graber ML, eds. Adv Health Sci Educ Theory Pract. 2009;14(suppl 1):1-112.
https://psnet.ahrq.gov/issue/diagnostic-error-medicine
This supplement consists of 12 articles drawn from a 2008 conference on diagnostic error, covering topics
such as medical proble…
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psnet.ahrq.gov/node/36674/psn-pdf
January 18, 2011 - An intervention to enhance nursing staff teamwork and
engagement.
January 18, 2011
Kalisch BJ, Curley M, Stefanov S. An intervention to enhance nursing staff teamwork and engagement. J
Nurs Adm. 2007;37(2):77-84.
https://psnet.ahrq.gov/issue/intervention-enhance-nursing-staff-teamwork-and-engagement
The authors d…
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psnet.ahrq.gov/node/34135/psn-pdf
February 28, 2024 - Hand Hygiene in Healthcare Settings.
February 28, 2024
Centers for Disease Control and Prevention
https://psnet.ahrq.gov/issue/hand-hygiene-healthcare-settings
The hand hygiene guidelines represent part of a U.S. Centers for Disease Control and Prevention (CDC)
strategy to promote patient safety by reducing infect…
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psnet.ahrq.gov/node/34009/psn-pdf
November 12, 2014 - Consumer Safe Medicine.
November 12, 2014
Plymouth Meeting, PA; Institute for Safe Medication Practices.
https://psnet.ahrq.gov/issue/ismps-safe-medicine
ISMP's electronic consumer medication safety newsletter is published six times a year and its content aims
to engage patients and families in reducing medication…
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psnet.ahrq.gov/node/38368/psn-pdf
July 30, 2015 - Childrens' Hospitals' Solutions for Patient Safety.
July 30, 2015
https://psnet.ahrq.gov/issue/childrens-hospitals-solutions-patient-safety
This Web site provides resources related to a collaborative effort involving more than 80 hospitals with a
goal of reducing health care–associated conditions, readmissions, and…
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/perinatal-care/modules/strategies/medication/tool_safe-oxytocin.docx
May 01, 2017 - The use of standard NICHD nomenclature17,18,19 reduces confusion and risk of error.
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digital.ahrq.gov/sites/default/files/docs/citation/r01hs024713-adelman-final-report-2023.pdf
January 01, 2023 - Providing Evidence and Developing a Toolkit to Accelerate the Adoption of Patient Photographs in Electronic Health Records - Final Report
1
Final Progress Report to Agency for Healthcare Research and Quality
Title of Project
Providing Evidence and Developing a Toolkit to Accelerate the Adoption of Patient Ph…
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www.ahrq.gov/sites/default/files/wysiwyg/antibiotic-use/ambulatory-care/influenza-rsv-guide.docx
September 01, 2022 - The Never Antibiotics Diagnoses: Influenza and RSV – Facilitator Guide
AHRQ Safety Program for Improving Antibiotic Use
1
The “Never Antibiotics” Diagnoses:
Influenza and RSV
Ambulatory Care
Slide Title and Commentary
Slide Number and Slide
The “Never Antibiotics” Diagnoses: Influenza and RSV
Ambulatory
SAY…
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www.ahrq.gov/hai/cusp/toolkit/content-calls/framework-slides/slides.html
October 01, 2014 - CUSP: A Framework for Success (Slide Presentation)
On the CUSP: Stop BSI
This PowerPoint slide presentation was shown on March 7, 2012
Contents
Slide 1. CUSP: A Framework for Success
Slide 2. Today's Speakers
Slide 3. Working Together – The Players
Slide 4. Learning Objectives
Slide 5. The Mic…
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www.ahrq.gov/patient-safety/settings/long-term-care/resource/injuries/fallspx/man4.html
December 01, 2017 - The Falls Management Program: A Quality Improvement Initiative for Nursing Facilities
Chapter 4. Long Term Management
Previous Page Next Page
Table of Contents
The Falls Management Program: A Quality Improvement Initiative for Nursing Facilities
Chapter 1. Introduction and Program Overview
Chapt…
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integrationacademy.ahrq.gov/bhi-directory
November 05, 2025 - An official website of the Department of Health & Human Services
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psnet.ahrq.gov/web-mm/mismanagement-acute-decompensated-heart-failure-hypertensive-emergency
May 01, 2018 - SPOTLIGHT CASE
Mismanagement of Acute Decompensated Heart Failure with Hypertensive Emergency
Citation Text:
Lee J, Fernilius J, Frick W. Mismanagement of Acute Decompensated Heart Failure with Hypertensive Emergency. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, U…