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4081. Mixed Methods Analysis of Medical Error Event Reports: A Report from the ASIPS Collaborative (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol2/Harris.pdf
      June 30, 2004 - Mixed Methods Analysis of Medical Error Event Reports: A Report from the ASIPS Collaborative 133 Mixed Methods Analysis of Medical Error Event Reports: A Report from the ASIPS Collaborative Daniel M. Harris, John M. Westfall, Douglas H. Fernald, Christine W. Duclos, David R. West, Linda Niebauer, Linda Ma…

4082. 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…

4083. From Insight to Implementation: Lessons from a Multi-site Trial of a PDA-based Warfarin Dose Calculator (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol3/Kravitz.pdf
      February 09, 2005 - From Insight to Implementation: Lessons from a Multi-site Trial of a PDA-based Warfarin Dose Calculator 395 From Insight to Implementation: Lessons from a Multi-site Trial of a PDA-based Warfarin Dose Calculator Richard L. Kravitz, Jonathan D. Neufeld, Michael A. Hogarth, Debora A. Paterniti, William Dager, …

4084. 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…

4085. Pillars of a Smart, Safe Operating Room (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol3/Advances-Seagull_98.pdf
      April 07, 2008 - Pillars of a Smart, Safe Operating Room Pillars of a Smart, Safe Operating Room F. Jacob Seagull, MD; Gerald R. Moses, PhD; Adrian E. Park, MD Abstract Major gains in patient safety can be achieved through development of innovative approaches to the care of surgical patients. Investigators and clinicians have…

4086. Implementing an Ambulatory e-Prescribing System: Strategies Employed and Lessons Learned to Minimize Unintended Consequences (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol4/Advances-Devine_83.pdf
      April 06, 2008 - Implementing an Ambulatory e-Prescribing System: Strategies Employed and Lessons Learned to Minimize Unintended Consequences Implementing an Ambulatory e-Prescribing System: Strategies Employed and Lessons Learned to Minimize Unintended Consequences Emily B. Devine, PharmD, MBA; Jennifer L. Wilson-Norton, RPh, MBA…

4087. Intravenous Infusion Safety Initiative: Collaboration, Evidence-Based Best Practices, and “Smart” Technology Help Avert High-Risk Adverse Drug Events and Improve Patient Outcomes (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol4/Advances-Maddox_38.pdf
      March 26, 2008 - Intravenous Infusion Safety Initiative: Collaboration, Evidence-Based Best Practices, and “Smart” Technology Help Avert High-Risk Adverse Drug Events and Improve Patient Outcomes Intravenous Infusion Safety Initiative: Collaboration, Evidence-Based Best Practices, and “Smart” Technology Help Avert High-Risk Adverse…

4088. II. Hotline Design and Development | Agency for Healthcare Research and Quality
      www.ahrq.gov/patient-safety/reports/hotline/design2.html
      May 01, 2016 - Developing and Testing the Health Care Safety Hotline: A Prototype Consumer Reporting System for Patient Safety Events II. Hotline Design and Development Previous Page Next Page Table of Contents Developing and Testing the Health Care Safety Hotline: A Prototype Consumer Reporting System for Patient…

4089. Supplemental Resources on Self-Management Support (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/education/continuing-ed/moc_smsresources.pdf
      July 01, 2014 - Supplemental Resources on Self-Management Support External Resources On Self-Management Support For Clinicians and Staff Background, resources, and tools • AHRQ’s Self‐Management Support Resource Library has basic information about self‐management support plus links to a wide range of practical tools, technique…

4090. Info FAQs | Agency for Healthcare Research and Quality
      www.ahrq.gov/faqs/index.html?page=6
      October 01, 2020 - Frequently Asked Questions Check to find the answers to your questions about the Agency for Healthcare Research and Quality (AHRQ) programs and activities. You can search by category or key words. You can also send us your questions or website feedback here. We will respond to your requests based on the bes…

4091. VHA's Journey to High Reliability: Advancing Toward Zero Harm and Becoming a Learning Health System
      www.ahrq.gov/sites/default/files/wysiwyg/action-alliance/high-reliability-journey-slides.pptx
      September 26, 2023 - VHA's Journey to High Reliability: Advancing Toward Zero Harm and Becoming a Learning Health System September 26, 2023 Pre-Decisional Deliberative Document Internal VA Use Only Advancing Toward Zero Harm and Becoming a Learning Health System Gerard R. Cox, MD, MHA  Assistant Under Secretary for Health for Quality & …

4092. Understanding the Role of Health Care Facility Design in the Acquisition and Prevention of HAIs: Summary (pdf file)
      www.ahrq.gov/sites/default/files/publications/files/haidesign-summary.pdf
      September 01, 2013 - Understanding the Role of Health Care Facility Design in the Acquisition and Prevention of HAIs: Summary 1 Contract Final Report Understanding the Role of Health Care Facility Design in the Acquisition and Prevention of HAIs Executive Summary Prepared for: Agency for Healthcare Research…

4093. Executive Summary | Agency for Healthcare Research and Quality
      www.ahrq.gov/professionals/quality-patient-safety/patientsafetyculture/medical-office/2014/mosurv14sum.html
      June 01, 2014 - Medical Office Survey on Patient Safety Culture Executive Summary Previous Page Next Page Table of Contents Medical Office Survey on Patient Safety Culture Executive Summary Chapter 1. Introduction Chapter 2. Survey Administration Statistics Chapter 3. Medical Office Characteristics Chapte…

4094. Executive Summary | Agency for Healthcare Research and Quality
      www.ahrq.gov/research/findings/final-reports/crcscreeningrpt/crcscreensum.html
      April 01, 2018 - Health Care Systems for Tracking Colorectal Cancer Screening Tests Executive Summary Previous Page Next Page Table of Contents Health Care Systems for Tracking Colorectal Cancer Screening Tests Executive Summary 1. Introduction 2. Description of the Intervention 2. Description of the Interve…

4095. Enhancing Care Coordination for CR Resource Guide (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/takeheart/training/care-coordination-resource-guide.pdf
      November 17, 2022 - Enhancing Care Coordination for CR Resource Guide 1 Enhancing Care Coordination for CR Resource Guide Care Coordination 1. International Council of Cardiovascular Prevention and Rehabilitation-CR Utilization This online course is intended to train inpatient CR care coordinators/liaisons on how to encourage…

4096. PowerPoint Presentation (ppt file)
      www.ahrq.gov/sites/default/files/wysiwyg/antibiotic-use/long-term-care/manage-resident-UTI-slides.PPT
      June 01, 2021 - PowerPoint Presentation Management of the Resident With a Suspected Urinary Tract Infection Long-Term Care AHRQ Safety Program for Improving Antibiotic Use AHRQ Pub. No. 17(21)-0029 June 2021 UTI Management 1 Objectives Describe empiric treatment options for urinary tract infections (UTIs). Discuss reasonable dur…

4097. Presentation: Program Overview
      www.ahrq.gov/sites/default/files/wysiwyg/antibiotic-use/long-term-care/assess-resident-RTI-slides.pptx
      June 01, 2021 - Presentation: Program Overview Assessment of the Resident With a Suspected Respiratory Tract Infection Long-Term Care AHRQ Safety Program for Improving Antibiotic Use AHRQ Pub. No. 17(21)-0029 June 2021 Assessment of RTI 1 Objectives Recognize the signs and symptoms of a suspected respiratory tract infection Ident…

4098. 5 Tk2 T2-Concise Antibiogram Toolkit Getting Started (doc file)
      www.ahrq.gov/sites/default/files/wysiwyg/nhguide/5_TK2_T2-Concise_Antibiogram_Toolkit_Getting_Started.doc
      May 01, 2014 - Concise Antibiogram Toolkit Getting Started—Sources of Data 2 Concise Antibiogram Toolkit Getting Started—Sources of Data Once you decide that an antibiogram will be a useful tool for your nursing home, there are a few things to consider. 1. What will you need to create the antibiogram? 2. What data are neede…

4099. New AHRQ SOPS® Diagnostic Safety Supplemental Items for Medical Offices - Yount (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/sops/events/webinar/04-new_sops_diagnostic_safety-yount.pdf
      October 20, 2021 - New AHRQ SOPS® Diagnostic Safety Supplemental Items for Medical Offices - Yount Diagnostic Safety Supplemental Items for the SOPS Medical Office Survey Naomi Yount, PhD Westat 39 Diagnostic Safety Supplemental Items 40 • Designed as a supplemental item set that can be added to the end of the SOPS Medical Off…

4100. Tk2 T4 Common Suspected Infections Tools To Improve Communication And Decisionmaking (doc file)
      www.ahrq.gov/sites/default/files/wysiwyg/nhguide/TK2_T4_Common_Suspected_Infections_Tools_To_Improve_Communication_and_Decisionmaking.docx
      October 01, 2016 - Slide Title and Commentary Slide Number and Slide Title Slide Toolkit 2. Common Suspected Infections: Communication and Decision Making for Four Infections Tool 4. Tools To Improve Communication and Decision Making SAY: Today we are introducing you to new tools to help improve communication and help prescribing clin…